Understanding the process of Menopause

In contrast to the myths that foster the misconception that menopause is a tumultuous time, if embraced and dealt with in the right manner, it can certainly be a positive time of life too. Although menopause can cause some noticeable and uncomfortable changes, these can be effectively managed too. After all, this is nothing but a normal process of aging and no woman is the first one going through it all alone.

Eleanor Roosevelt once said, "A woman is like a teabag; you can't tell how strong she is unless you put her into hot water." Just like this quote goes, from bleeding every month to giving birth to new life — a woman goes through it all in her lifetime. And in all these phases of her life as she grows and ages, her body evolves dramatically too.

The menarche, or the very first period cycle of an average woman's life tends to take place between the age of 10 and 16. Henceforth as she grows older, she continues to have her regular periods on a monthly basis. However, between her early 40s and 50, she usually goes through three critical stages of biological changes in her life, each of which affects her physical and mental health significantly. This cluster of changes is known as climacteric, (commonly known as menopause) which occurs over a period of time in three phases and it is the period when a woman experiences decline in her fertility and sexual activity.

Dr Syeda Husna Akhter, Senior Consultant, Department of Gynecology and Obstetrics, Bangladesh Medical College and Hospital, highlighted each phase in detail.

"A woman goes through a plethora of hormonal and metabolic changes in her lifetime; in fact, the last one-third of a woman's life is spent almost completely without any ovarian functions," she explained.

Dr Akhter added that this timeline specifically, is a very critical one in every woman's life as this is when she tends to become the most self-conscious and needs the most amount of physical and mental care from the people around her.

Menopause in Stages and Symptoms 

Perimenopause

The first phase, known as perimenopause or menopausal transition, begins as early as few years (late 30s or 40s) before the actual menopausal period. This is the stage when a woman's ovaries start to gradually produce lesser and lesser estrogen — the key hormone that aids a woman's reproductive and sexual developments. Usually, this phase may last 3-4 years and ends when a woman has gone about a year without having regular periods.

One of the most common symptoms of perimenopause is hot flashes; this gives the incumbent a sudden feeling of heat, causing sweating and redness of the skin and face. Sometimes, it happens at night and are known as "night sweats" and may even leave you with rapid heart rate and chills as well.

Dr Akhter further added that while hot flashes are a key symptom, other symptoms include scanty or delayed periods, fatigue, vaginal dryness, irritability and mood swings.

Menopause

In this stage, a woman proceeds from a reproductive to a non-reproductive stage in her life where she can no longer get pregnant naturally.

"At this point, she has been through months (almost a year) without having periods and she is going through a serious physical and emotional change simultaneously," Dr Akhter pointed out.

Similar to perimenopause, hot flashes continue to occur during menopause as well. Indigestion, following by bloating and/or constipation are also common symptoms according to Dr Akhter. Adding to that, an average woman may also experience a variety of indications relating to mental health and some common symptoms include depression, lethargy, irritability vertigo, headache, insomnia, anxiety, mood swings and even forgetfulness.

Post menopause

This occurs in the period after a woman has not bled for an entire year or longer, and is basically the rest of her life after going through menopause. Hot flashes are usually quite reduced in this phase.  However, according to Dr Akhter, post-menopausal health is equally important and it is crucial to look out for any peculiar or severe symptoms or after-effects.

For certain women, developing osteoporosis — health issues relating to the bones and muscles — is quite common. The symptoms of osteoporosis include backache, fractures on minimal trauma, decreased height, and mobility. Moreover, after menopause, women may also become prone to having cardiovascular diseases as they experience hypertension and generally fat deposition also increases in this stage. In fact, in some cases relating to mental health, depression also heightens in an alarming manner.

Dr Akhter further discussed more serious cases when due to the mucus linings thinning out and drying up (dry vagina), atrophic changes occur along the female genitalia when the elastic tissues start to get replaced by fibrous ones. This may lead to painful consequences such as vaginal bleedings, irritation, inflammation, and even urinary tract infections (UTIs) and urinary incontinence. 

Finding relief in distress

Even though so much happens while a woman is going through her menopausal transition, there are of course several ways in which she can make her journey easier.

On this note, Dr Akhter strongly recommended that mental support and comfort is the most important remedy and reassurance for every woman going through these phases.

"It is the duty of her family, friends and loved ones around her to make her feel safe, loved and protected in this time of turmoil when she might be feeling the most vulnerable," she stated.

Being a part of support groups/communities where she can speak with others going through similar journeys can also make her feel a like she's in a safe space.

Having a balanced diet, filled with fresh fruits, vegetables, vitamin supplements, and the appropriate amount of fluids/water is another core component of coping with menopause. Especially, to prevent the occurrence of osteoporosis, Dr Akhter advises to increase the intake of calcium and Vitamin D-rich food, go for early morning sunbathing, and form an active lifestyle.In fact, regular exercise, yoga, meditation and walking — an overall active lifestyle also helps significantly to reduce the downsides of menopausal stages. 

In some cases, specialist help may be sought for artificial treatments. Usually the specialist will tend to prescribe few hormone tests, and after successful results they may move on to prescribing estrogen supplements coupled with calcium; this is a kind of a short-term hormone replacement therapy and helps the body to produce estrogen artificially.

However, Dr Akhter cautions that in case the patient has any previous history of breast cancer, jaundice, etc. then aggressive estrogen therapy may lead to undesirable and severe health conditions such as cancer.

As life goes on  

After all that has happened, it is crucial to remember that menopause is a very natural biological process of life and every woman has to go through it when it is time.

"Just like menarche happens in its time, so does menopause," said Dr Akhter comfortingly. The focus should lie primarily on how to live on normally after menopause has occurred. 

Photo: Collected

Essentials

Dr Syeda Husna Akhter, Senior Consultant Bangladesh Medical College and Hospital (Gynae and Obs)

Contact Number: 01819252304