Menopause: Symptoms, Causes, Complications, and Treatments

Menopause marks the time in a woman's life when menstruation stops. With the end of periods, a woman may experience a range of issues due to fluctuating hormone levels, including stress, aging, infertility, and emotional discomfort.

Understanding the signs and symptoms of menopause can help navigate this transition more smoothly.

What is Menopause?

Menopause is a natural part of aging in women, characterized by the complete cessation of menstruation as the ovaries stop functioning due to a decline in reproductive hormones. The diagnosis of menopause is made after a woman has had no menstrual periods for 12 consecutive months.

It is a gradual process, beginning with perimenopause, where menstruation becomes irregular before stopping altogether. In India, the average age for menopause is between 47 and 51 years, although about 1% of women experience early menopause before age 40, known as Premature Ovarian Failure.

What are the Symptoms of Menopause?

Hormonal changes don't happen overnight. Perimenopause precedes menopause, during which hormone levels of estrogen and progesterone start to decline. Symptoms usually vary and can include:

• Irregular Periods: Periods may become frequent, lighter, heavier, or irregular periods.
• Hot Flushes: Sudden feelings of heat, sweating, and redness in the upper body.
• Night Sweats: Hot flushes occurring during sleep, disrupting the sleep cycle.
• Vaginal Dryness: Thinning, drying, and swelling of the vaginal walls, leading to painful intercourse and possible incontinence.
• Decreased Libido: Reduced interest in sex due to lower estrogen levels.
• Decreased Fertility: Lower chances of pregnancy due to declining reproductive hormones.
• Insomnia: Difficulty sleeping caused by anxiety and night sweats.
• Urinary Incontinence: Difficulty holding urine due to weakened pelvic muscles and tissues.
• Urinary Tract Infections: Increased susceptibility to infections due to low estrogen levels.
• Depression: Mood swings, irritability, and in severe cases, depression caused by hormonal fluctuations.

Complications After Menopause

The post-menopausal period can bring several complications:

• Osteoporosis: Loss of bone density due to decreased estrogen.
• Heart Diseases: Increased risk due to the decline in estrogen, which helps maintain arterial health.
• Urinary Tract Infections: Higher risk due to estrogen deficiency.
• Breast Cancer: Increased risk as age advances and estrogen exposure increases.
• Endometrial & Ovarian Cancer: Risk increases with the length of estrogen exposure and age.

Note: Hormone Replacement Therapy (HRT) may also raise the risk of certain cancers.

Causes of Menopause

• Natural: Decline of reproductive hormones with age.
• Induced: Menstrual periods stopped as part of medical treatments.
• Hysterectomy: Immediate onset of menopause if ovaries are removed.
• Chemotherapy & Radiotherapy: Can induce menopause and related symptoms.
• Premature Ovarian Failure: Occurs due to genetic factors or autoimmune diseases before age 40.

Menopause Diagnosis

Diagnosis generally involves observing the absence of periods for 12 months. Blood tests to check Follicle-stimulating Hormone (FSH) and estrogen levels may be recommended, and a pregnancy test might be conducted to rule out pregnancy.

Menopause Treatment

While menopause itself doesn't require treatment, managing symptoms can improve quality of life:

• Hormone Replacement Therapy (HRT): Supplements estrogen and progestin to alleviate symptoms but may increase cancer risks.
• Healthy Lifestyle: A balanced diet and regular exercise can help manage symptoms.
• Medications: Antidepressants for mood swings, supplements for osteoporosis, lubricants for vaginal dryness, and clonidine for hot flushes.

Is Pregnancy Possible After Menopause?

During perimenopause, pregnancy is possible despite irregular periods, as ovulation can still occur. Once menopause is reached, natural pregnancy is not possible. However, if a woman has her uterus intact and desires a baby, options like IVF with a donor egg are available.