Why menopause occurs?
Yes, menopause occurs as a result of cessation of estrogen activity, but why estrogen activity comes to a halt?
The answer for this is, there are a limited number of ova, which produce estrogens in the female body. A 20-week-old female fetus has as many as 6-7 million ova in their body but at the time of delivery of the female, there are only about 1-2 million remains. This is because of normal physiological ageing. By ageing it does not mean that the baby has aged, but that age-related changes starts even in them. At the time of menarche only 200,000-400,000 ova remain in the ovaries. The others die a natural death during these years. Out of remaining these, only about 400-500 ova will grow to maturity and be released at the time of ovulation. By the time menopause occurs, most of these usually exhaust. The ovary itself develops a shrunken appearance and ovaries cease to produce further estrogen and climacteric followed by menopause sets in. Meager amounts of estrogen continue to be released from other organs like adrenals but these compensate to a limited extent only.
Treatment of menopause and Climacteric symptoms:
It is essential to move toward menopause with a positive attitude. Menopause does not mean the end of life, on the contrary, here starts a new and dynamic phase of a woman's life. It is that stage in a woman's life when she is liberated from the stresses and anxieties of middle age. Her children are adult and settled. She finds more time and space for herself and can take pleasure in both work and leisure. This is the time when she can make use of her talent to the maximum. Many women find sex more enjoyable after menopause as they are no longer concerned about unwanted pregnancies. At times, if sex is painful due to dryness, lubricating jelly ( KY jelly) solves the problem. Sometimes, escape ovulation occur after menopause, though rare, sometimes pregnancy occurs.
Itching of the vulva as sometimes thought, is not a symptom of menopause but dryness is. If there is Itching or heavy discharge, gynaecological checkup is needed to rule out underlying infection-of the lower genital tract.
Regular exercise is required at all stages of life, especially after menopause. Exercise keeps body weight under control, increases basal metabolic rate, which leads to faster burning up of calories, enhances deposition of calcium in the bones and guards the heart from coronary arterial disease. It also offers a feel of wellbeing because of release of certain hormones known as endorphins in the body.
Diet has to be given due attention. A well balanced diet, with plenty of fruits and vegetables will give the body with vitamins, fiber, minerals, and antioxidants, all of which are essential to the body. It is very easy to get obese after menopause, so one should keep the total calorie intake under control and reduce the intake of fats. Vitamins and calcium supplements is essential particularly at this time.
Hormonal Replacement Therapy (HRT)
HRT, as hormonal replacement is popularly known, is the low dose estrogen either synthetic or in natural form is used in the management of climacteric and menopausal symptoms. As most of the symptoms of climacteric can be attributed to estrogen deficiency and compensatory over activity of certain pituitary hormones, administration of estrogen as supplement relieves most of the symptoms in a majority of women.
Arguments and studies are still going on regarding the safety of HRT, but this greatly improves the quality of life. Any deleterious effect like increased incidence of breast carcinoma, heat attacks or endometrial carcinoma is not yet proved convincingly. However, HRT should be started with proper baseline investigations.
There are so many routes and methods one can have estrogen replacement or HRT. It can be given orally as pill, patch in the skin, vaginally as gel. The consulting gynecologist is the best judge to chose which form the woman needs. Those women are having their uterus intact has to take progesterone sequentially to protect the endometrium from cancer.
Most of the irritating symptoms revert following HRT. Bone density improves. Libido increases with elevated mood and disappearance of vaginal dryness. Slightest chance of being pregnant is eliminated.
My personal view is, when HRT improves the quality to a great extant and nothing is proved beyond doubt about its side effects and even if it is there, percentage is so little, the woman should live life with joy by taking HRT, if she agrees after informed counseling.
Tibolone, another drug claims to give all the good effects without the deleterious effects on heart, blood vessels, breast tissue, and endometrium works fine in some but not all women.
Natural food extract capsules like soya extracts with the helpful isoflavones, vitamin E are absolutely safe and help some but not all the women with menopausal syndrome.
This article is also published at India study Channel
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