What is menopause?
Menopause is the pause of the monthly menstrual flow. It can happen all of a sudden, but it is more usual for menopause to happen gradually. That is to say, the amount of bleeding starts diminishing and the interval between bleeding episodes keeps on rising over the months, till it finally comes to an end.
The average age at which women experience menopause ranges from 45-52 years. There is actually a wide deviation in the age at which menopause occurs, depending on the weather, degree of nutrition, obesity and socio-economic status. Family history also has to be taken into account Women who have menopause in their early or mid-forties find that their mothers had an early menopause too. Obese women often have a late menopause, around the age of 55 years. If menopause occurs before the age of 40, it is diagnosed as premature menopause.
Climacteric is the period just prior to menopause, when symptoms first start to emerge, and it continues till the postmenopausal period, i.e. when one has completed a full year without having another period. It is just the reverse of puberty changes, just as menopause is the reverse of menarche changes. Basically, climacteric is the intermediary phase of 1-5 years during which the genital organs involute as a result of stoppage of ovarian activity. Menopause is only a expression of climacteric, and precedes complete stoppage of ovarian functions by a few months to a few years.
In 50 per cent of all women, the changes of climacteric are for the time being deferred by a slight amount of oestrogen from the adrenal gland.
Ultimately the following changes are seen:
Changes of climacteric, which can be seen outside (Physical Changes)
Changes seen in the skin during climacteric / menopause:
Slowly the skin becomes drier than earlier. There is also a loss of tissue from below the skin ensuing in a loss of elasticity and leading to the emergence of wrinkles. Greater than before facial hair is another indication of menopause.
Urge for sex or, libido diminishes after menopause:
The urge for sex declines as vaginal dryness causes painful penetration. Psychological alterations caused by menopause also influence the sex drive. Women may feel unloved, unattractive and surplus, and may pull out into themselves rather than face rejection. Menopause is the time when it is of utmost importance for both partners to be truthful and unrestrained with each other.
From the medical point of view, the decrease in sex drive is due to a decline in the circulating testosterone levels. Testosterone is the male hormone, and though readers will find it amazing, all women have testosterones circulating in their blood stream! This testosterone is responsible for the sex drive. Menopause with its associated decline in ovarian activity results in a fall in the testosterone level as well. This to a great extent affects the sex urge.
The sex organs atrophy with the menopause:
The vulval skin becomes slender and shiny, and prone to trauma. Subcutaneous fat of the vulva diminishes in amount. Both the labia minora reduce in size and be inclined to disappear. The opening of the vagina gets smaller and loses its elasticity. Later on, pubic hair becomes meager and scarce.
The vagina becomes 'tent shaped' and undergoes contracture in length and width. But those continue sexual activities these chane may not appear. The uterus and cervix become small. The ovaries become atrophied and dried-up in appearance. Breasts get shriveled and tend to become flat, with the exception of in obese women, where they remain large and pendulous. This is because shrinkage is due to the glandular tissue only; fats in the breast and obese women have them in abundance.
Getting overweight after menopause:
Gaining weight is frequent at climacteric but not always, as is generally supposed. When occurs, it is associated to excessive eating to combat emotional stress, and also to change in metabolism. BMR falls significantly after the menopause, while the lady continues to eat the same amount and starts putting on weight.
Changes in heart and blood vessels after menopause:
Women at menopause may have symptoms like palpitation and occasional chest pain related to heart. But the most important symptom of menopause is 'hot flushes'. Flushing of the face and neck may be accompanied by profuse sweating particularly in the night when she reclines leading to night sweats. The basic reason of hot flushes is a increase in the pituitary hormone levels due to lowered circulating estrogen. The duration of a hot flush may vary from half a minute to several minutes. Too much drinking of alcohol, stress, anxiety, heat, or emotional outbursts may all set off a hot flush, but usually hot flushes take place without any precipitating factor.
The level of uneasiness experienced during hot flushes is variable. In some it may be so severe that pillows and bed linens are soaked due to sweat, others may just feel that they have had a disturbed night, and may vaguely remember feeling uncomfortably hot. Most women fall in between these extreme ranges. Insomnia is a natural result of hot flushes. Even if there is no sleep disturbance, there is a feeling of being neglected, dismay, downhearted and depressed. This fact is due to vasodilatation - dilatation of the peripheral blood vessels as a result of hormonal imbalance.
The frequency of coronary arterial disease is more after menopause. Estrogens have a shielding effect on the heart. At menopause, this protection is lost. Blood pressure also tends to rise.
Bones weaken and joint starts paining after menopause:
At menopause, pain in the joints and weakness of bones is also frequent. Bones become frail with the loss of calcium deposits. Increased intake of calcium containing foods such as milk and some green vegetables, along with regular exercise, can help to avert osteoporosis. It has been undoubtedly proved that bone density diminishes after menopause.
Women who have had an early menopause, whose ovaries are surgically removed during hysterectomy, or who suffers from anorexia are at elevated risk of acquiring osteoporosis. Most women have maximum bone density when they are in their thirties, after which bone mass starts declining. Minor traumas result in fractures. Hip, spine and wrist are the most susceptible. At least 1000 mg of calcium supplement along with Vitamin D is recommended daily.
Digestion problem and menopause:
Dyspepsia, indigestion, constipation and abdominal distension of varying degree may also occur during and after menopause.
Psychological Changes following menopause:
Being a major change from all aspects, menopause is viewed with uneasiness by most women. The fright of losing one's womanliness, appearing unpleasant to one's partner or acquiring cancer are very real at this stage. At menopause, women comprehend that their reproductive capacity is lost. Some wrongly regards this is an end of sexual activity and the herald of old age.
For these facts, variety if neurotic and psychotic changes occurs. Depression, irritability, mood swings, irrational behavior, nervousness, tingling or burning in the hands and feet are all common symptoms. Though some of these symptoms are related to the withdrawal of estrogen too as they sometimes disappear after giving HRT or, hormone replacement therapy. Melancholia, leading to suicidal attempts, though rare but may occur in women who have a background of mental instability.
Menopause is just the reverse of menarche. It can be turbulent and annoying for some women. Others seem to sail through menopause smoothly and gracefully. Mood swings usually last for a year or two, and then taper away gradually.
Depression is seen quite commonly in postmenopausal women, and the reasons are multifarious. A sudden drop in estrogens is probably the major cause of depression. It may also be aided by disturbed sleep, gaining weight, or feeling of chronic fatigue. This phase of life is associated with changes in the family dynamics also. Children grow up and leave home and there may be deaths in the family or extra burdens in the form of ageing parents who need care. All these can cause energy loss and thereby depression.
It is essential for the spouse to understand that menopause itself is not a disease, and the menopausal woman is not a neurotic annoyance. An thoughtful spouse can make this complex phase of changeover very simple and smooth.
This article is also published in India Study Channel
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