Menopause

Menopause is a phase in women’s life when the ovaries stop releasing eggs and slowly stop producing hormones, leading to cessation of menstruation (period).
Most of the women stop their periods between the age of 45 and 55 years.
Some women for different reasons can stop their periods earlier, before 40 years of age, which we call premature menopause.

Some women may only experience mild symptoms, but for others, it may be distressing.
Symptoms you may experience are:
- Hot flushes.
- Night sweats.
- Vaginal dryness.
- Mood changes.
- Joint and muscle pain.
- Loss of sexual desire.

Exercise regularly, like walking, running, and swimming.
Decrease intake of coffee.
If symptoms are affecting the day-to-day life, see the gynecologist (women’s health doctor) for hormone replacement therapy (known as HRT).

This treatment is available in the form of tablets, patches, cream, and vaginal pessaries.
There are 2 ways of hormone replacement therapy: sequential and continuous hormone replacement therapy:
- In sequential hormone replacement therapy, only one hormone (called Estrogen) is given for the first 2 weeks, and then 2 hormones (Estrogen and Progesterone) are given for the next 2 weeks.
- Because estrogen can cause thickened uterine lining (endometrium), progesterone is added to prevent it.
- This cycle is repeated.
- When periods stop for more than a year, combined hormone replacement therapy (Estrogen and Progesterone) is used. There will be no regular vaginal bleeding during this time. This regimen is called “continuous hormone replacement therapy”.

Side effects may affect only 10% of women:

Fluid retention, bloating.
Breast tenderness or enlargement.
Nausea, headaches, indigestion, and leg cramps.
Premenstrual syndrome-like symptoms: mood swings, depression, acne, lower abdominal pain, and back pain.
Skin redness, irritation, itching, rash, and Hair loss at the site of hormone patch placement.
Irregular vaginal bleeding or spotting, painful menstruation, and vaginal infection.

Combined hormone replacement therapy (Estrogen and Progesterone) may increase the risk of breast cancer. The longer you stay on it, the higher the risk.
Only estrogen hormone replacement therapy causes a very small or no increase in breast cancer risk.
Unlike patches, oral hormone replacement therapy can increase the risk of blood clots and stroke.

HRT is not used as a method of birth control (contraception).
If you are under the age of 50, continue using birth control for 1 year after your last period.
If you are over the age of 50, continue using birth control for 2 years after your last period.

Premature menopause occurs when a woman's menstrual period stops or becomes less frequent before the age of 40, along with menopausal symptoms (as given above). They must have two hormonal tests 4-6 weeks apart.to confirm premature menopause.
Premature menopause reduces fertility and increases the risk of osteoporosis (weak bones) and heart disease.
Premature menopause is treated with hormone replacement therapy or birth control pills.
Birth control pills have the benefit of preventing pregnancy, whereas hormone replacement therapy is preferable if you have high blood pressure.
The treatment should be continued until the natural age of menopause.

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