Menopause is the time in a woman’s life when menstruation ends permanently, a time that affects different women in different ways. Some are troubled by symptoms, some are not. Some say they have a new feeling of freedom and energy after the “change of life” while others are hardly aware of a change. We still have a lot to learn about menopause, but one thing is certain if you do have problems with it, there are ways to cope with them.
Menopause is the end of a long and slow process. The primary functions of the ovaries are to produce eggs for the purpose of procreation and female hormones essential for the individual’s well-being. The number of eggs in the ovaries decreases steadily through a woman’s lifetime. About three to five years before menopause, there is a decrease in ovulation (the production and discharge of eggs). During this time, menstrual periods change too. They may become irregular, and for many women lighter. Other women have heavy bleeding. Eventually, oestrogen falls below the level that does not support the thickening of the endometrium and hence menstruation stops. Periods stop altogether around the age of 50 on average, but menopause occurs at different ages anywhere from the thirties to the mid-fifties.
As medical health and welfare improves, female life expectancy increases (in Singapore, to more than 75 years), and many women can expect to spend more than 30% of their lives in the menopausal state.
The symptoms are self-limiting and not life-threatening, but are nonetheless unpleasant and sometimes disabling. Some, not all, women have the following symptoms of menopause.
Mood changes and depression. Is it true that women tend to be more moody, irritable or depressed around the time of their menopause? While some women may feel more emotional and depressed, many do not.
Sex life. Lower oestrogen levels cause the tissues of the vagina to become thinner, drier and less elastic, which can make sexual intercourse uncomfortable. Interest in sex may change at this time, but this varies with different women. Some say they feel liberated by menopause, relieved that pregnancy is no longer a worry. However, it is worth noting that pregnancy is still possible, even when periods are few and far between unless menopause has finally set in.
Will taking hormones reduce the symptoms of menopause?
Taking oestrogen and progesterone, known as hormone replacement therapy or HRT, can relieve the symptoms of menopause. The hormones are usually taken as pills, but may take the form of skin patches, creams, implants or injections. There is still a lot to learn about HRT, but we do know that oestrogen, especially taken alone (so-called unopposed oestrogen therapy) in high doses, increases the risk of endometrial cancer, a cancer of the uterus.
Most doctors now prescribe lower doses of oestrogen, usually along with a form of progesterone to reduce this risk. (Women who have had their uterus removed can, of course, take oestrogen alone). Drawbacks of HRT include side effects: bloating, breast tenderness, cramps, irritability and depression. Risks such as breast and colon cancer are inconclusive. Research in these areas is under way.
The duration of treatment necessary for menopausal symptoms is usually 3-5 years. Menopausal symptoms such as hot flushes and depression are unpleasant and sometimes disabling but not life-threatening.