What is the Menopause?
First of all you should know that what the “Menopause” is? The word comes from Greek “Men’s” meaning monthly and “pauses” meaning cessation. Menopause is basically the natural cessation of ovarian function and menstruation. You can also say that it is the loss of ovarian activity, loss of menses and loss of estrogen. The life span in menopause is 1/3 to 1/2. It can occur between ages of 42 and 56 but usually around the age of 51 when ovaries start producing eggs and the estrogen level goes on decline. At that age Menstruation becomes less frequent eventually stopping altogether. Mostly it is found that the natural event at the age between 45_55 ears old.
The “Menopause” is not a simple case. It involves many aspects. There are many factors that play role in explaining menopause. These are:
At present, there are 42 million women found over age 50, and 52 million were expected by 2012.The average age at which menopause occurs is 51.4 years.
→How Menopause occurs?
The explanation of menopause includes causes of menopause, how it occurs and its risk factors etc.
Menses or Periodic cycle:The monthly female reproductive cycle that occurs after every 28 days is known as Menses or periodic cycle. The permanent stop of menstruation is known as menopause. The duration between the menstruation and menopause is known as “menarche”.
Once menopause is complete it is known as post menopause. When post menopause occurs then you have not had a period of 1 year, you are no longer at risk of becoming pregnant.
The hormone are very important factors that causing menopause. These hormones are estrogen and progesterone.
Action of Progesterone:
Progesterone is very specific in its functions:
• It interacts with hypothalamus and pituitary to regulate the menstrual cycle.
• It produces secretary changes in the endometrium.
• It increases viscosity of cervical mucus.
• It prepare breast for lactation during pregnancy.
• The loss of progesterone level causes menopause.
Action of Estrogen:
Estrogen is the most important hormone that influences the life of women. It is specific too in its functions.
• It plays role in development of ovaries, uterus, vagina etc.
• It causes HPO axis interaction.
• It causes proliferate changes in the endometrium.
• It increases fat deposition and vascular profusion of skin.
Estrogen in women:
This hormone is important both for male and female. In female estrogen is hormone responsible for female sexual feature such as breast development and menstrual cycle. For young women, puberty starts when the production of estrogen increases in ovules.
The estrogen level remains relatively the same during 25 years, after which it will decease constantly. Since the number of ovules that mature in the ovary decrease as women get older, that formation of estrogen decreases. The body tries to fight this problem by producing 2 other hormones by hypotheses. The ovule stimulating hormone and the Leutinisante Hormone (LH).
The decrease level of estrogen increased production of FSH and LH creates hot flushes or night sweat.
There are 3 forms of estrogen found in human body.
Estradiol is the measured type of estrogen in non-pregnant women. Amount of estradiol varies in blood varies throughout the female menstrual cycle. After menopause, estradiol production drops to very low but constant level. In men FSH and LH are necessary for formation of sperm and stimulation of synthesis of testosterone. Here a question arise that’ Is menopause occurs in men? The answer is that the male also effected by estrogen hormone. They share some symptoms similar to women but this is not a menopause. This is another kind of pause which is known as “andropause” or “adrenal pause”.
So the menopause is caused by changes in estrogen level and progesterone level. Ovaries make less of these hormones over time. The specific symptoms and how it is significant varies from woman to woman. It may be mild or moderate or may be severe.
Gradual decrease of estrogen allows body to slowly adjust hormonal changes. Hot flashes and sweats are at their worst for 1st – 2nd years after last period. The symptoms last at 5 or more years. Estrogen level may drop suddenly after some medical treatment as it is seen when ovaries removed surgically. It is also known as “surgical menopause”. Chemotherapy and anti-estrogen treatment for breast cancer are also other examples. Their symptoms also can be more severe. As a result of fall in hormone level, changes occur in entire female reproductive system. The vaginal wall becomes less elastic and thinner vagina becomes short, lubricating and the secretion become watery. Outside genital tissue becomes thin. This is also called “atrophy of labia”.
Symptoms of Menopause:
There are several symptoms that show severe or mild menopause. The most common menopause symptoms are
• Heart pounding
• Hot flashes
• Night sweats
• Skin flushing
• Sleeping problems (insomnia)
The menopause symptoms also classified in 2 categories:
1. Primary symptoms
2. secondary symptoms
Primary symptoms: The primary symptoms that indicate the menopause are:
• There occurs a change in cycle.
• Oligoamenorrhea – amenorrhea is another symptom.
• Vaginal Dryness also occurs in menopause.
Secondary symptoms: The secondary symptoms appears after the primary symptoms and it is severe than primary symptoms. These are:
• Musculoskeletal pains occurs
• Urinary stress/urge incontinence
• Decreased libido
• There is Psycho physiologic changes
• Frequency-burning (cystitis)
The other symptoms are:
• Decrease interest in sex, possibly decreased response to sexual stimulation.
• Forgetfulness, Headaches, Joint aches and Pains Palpitations (irregular heart beat) indicates the menopause in female.
• An irregular menstrual period also occurs.
• Mood swings including irritability, depression and anxiety.
• Vaginal infections, Urine leakage, vaginal dryness and Painful sexual intercourse.
• Loss of estrogen results in Aging, skin dryness, Osteoporosis, hot flashes, Urinogenital Atrophy.
At the present line, the Menopause is controlled or cured by the main 2 therapy:
i. Hormone replacement therapy
ii. Alternative therapy
Usually in 40s you will begin transition from your reproductive years to menopause. The length of the reproductive cycle will start to vary and you will begin to skip periods. You may experience hot flashes due to decreased estrogen production by your ovaries and may you found difficulty in sleeping as well. Pregnancy is rare but not impossible. So contraception is still needed to avoid the pregnancy. Well in controlling the menopause the hormone replacement theory plays an important role.
Hormone Replacement Theory:
When estrogen level decreases, the menopause starts. The main risk becomes osteoporosis and arteriosclerosis. This is the reason why doctors prescribed the hormone based products as therapy. HRT supposed to be the wonder drug that would improve the quality of life during menopause. However, active hormones have other important functions in the body; it is possible to have unwanted effects. Estradiol (an estrogen) influences in various cancers. High level of estrogen will increase the risk of breast cancer. Women who do not wish to take hormones may use to flavorless supplement for managing their menopause symptoms and risk.
Tests and symptoms:
The most important tests that carry out for testing the menopause are the
i. blood test
ii. urine test
These tests are used for testing the Estradiol, FSH and LH level in the female body. A pelvic exam may indicate changes in the vaginal lining caused by declining estrogen level. Doctors perform bone density test to screen for low bone density levels that occurs with Osteoporosis. The rate of bone loss increases during the first few years after last period.
Menopause is not an uncontrollable disease. It can be controlled and prevented. Some prevention are given below:
• First of all, you must eat a low fat diet.
• You must get regular exercise i.e. Resistance exercise, if you want to prevent from menopause, specially the young females. Resistance exercise helps strengthen your bone and improve your balance.
• If you feel the early symptoms of menopause then must take calcium and vitamin D.
• In the early menopause do not smoke or drink.
• You must control your blood pressure, cholesterol and other risk factors because can easily cause heart diseases with the start of menopause.
In short, Menopause is a disease that is caused by hormonal imbalance. In this article we have put light on what the menopause basically is? It s demographics….. how it occurs? What is pre-menopause and what is post menopause? The treatment and tests are also covered in this article.
The references are also given below:
• American college of Obstetrician and Gynecologists Committee on Gynecologic Practice. ACOG Committee Opinion No.420, November 2008; Hormone therapy and heart disease.
• Col NF, Fair field KM, Ewan-Whyte C Mille H. In the clinic Menopause. Ann Inter Med.2009, April 7:150(7): ITC 4-1-15
SYEDA LAILA HASSAN