Menopause (by Dr Mayen Egbe)

Attention ladies! It’s coming to a house near you. It will eventually come knocking on your door sometime in the future or soon, or, if you are one of the ‘special ones’ it may already have arrived. Yes, the menopause. It’s always good to know what to expect as to be fore warned is to be fore armed.

The word menopause simply means the cessation of menstruation. It is commonly used in a wider sense for events leading up to and following the menopause. Menstruation may gradually decrease, suddenly cease or become irregular.

At birth, every female child has special cells in the ovary called follicles that develop until about the age of about 11 to 12 years when these cells trigger the cyclical activity that results in the menstrual cycle and menstruation. The child bearing years begin at the onset of menstruation and end with the onset of menopause. During this time the ovaries are active and produce oestrogen, the main female sex hormone. At the onset of menopause the ovaries cease to be active. The job would have been done by then, the children born and growing, and the ovary’s services no longer required. They then go into retirement after a lifetime of active service, but not so quietly though.

Oestrogen levels decrease over the five or so years before the ovaries cease to be active. This is sometimes referred to as ovarian failure and occurs usually between 45 and 55 years of age, with an average around 50 years.
What could cause the menopause?Ovarian failure occurs when the ovary only has few special cells (follicles) left - usually insufficient to stimulate the menstrual cycle that would result in menstruation. About a third of a woman’s life could be spent in the menopausal years.

Menopause could occur prematurely if the both ovaries are removed surgically due to any cause. It could also occur following radiotherapy (X-ray treatment) or chemotherapy given for the treatment of cancer. Due to reasons we may not understand some girls are born with an unusually small number of special cells (follicles) and results in the early onset of menopause.
What things could be confused with the menopause?Before the advent of sensitive pregnancy tests and effective contraception, the menopause could be easily confused with pregnancy.

A condition common in overweight ladies called polycystic ovary syndrome may cause menstruation to cease and be mistaken for the menopause. (This condition is often associated with infertility and is due to a hormonal imbalance which prevents the egg-containing follicles (special cells) on the ovaries from maturing and releasing an egg. Instead it forms multiple ovarian cysts which could sometimes be painful). A tiny growth in the brain called prolactinoma could result in irregular menstruation that could easily be mistaken for the onset of menopause.
So, how am I sure it is the menopause?If in doubt, the menopause is confirmed by tests that measure the blood levels of some special hormones in the body.

How does menopause manifest? What are the things to look out for?These are usually related to the falling levels of oestrogen circulating in the body. Symptoms may occur some years before menstruation actually ceases while others occur later. Hot flushes are common and occur at any time of the day or night. There is usually a feeling of warmth working its way up the body in a ‘rising’ manner. This could be accompanied by sweats which are often associated with palpitations. If hot flushes and sweats occur frequently during the night it results in sleep disturbance. Panic attacks could occur.Psychological symptoms occur commonly also. Emotions could be unstable and it would not take much to make the person “fly off the handle”. The dear lady is then said to wear her temper on her sleeve. Mood may be depressed and anxiety may also be a problem. Memory and concentration may be poor and the person could be irritable. Sexual drive (libido) could be decreased.

Changes occur in the urinary and genital (sexual) organs and these shrink and become smaller in size. The sexual areas shrink also. The result of this is that the urge to pass urine could become more frequent. Shrinkage of the vaginal opening and the vagina itself may cause painful sexual intercourse.As time passes the bones become brittle and break easily. This is osteoporosis or brittle bone disease. Osteoporosis causes an increased tendency for the bones in the spine to crumble or break. It also does not take much for the thigh bone (femur) to break. In the longer term hardening of the arteries in the heart and the brain could result in heart disease and brain disease (tendency to strokes and ‘mini-strokes).

So, what is the treatment?The first step is to chat to your doctor about your symptoms. Your doctor will want to know if you or anyone in your family has breast cancer or heart disease among other things. If there are no major concerns with your health or family history you may be offered treatment with Hormone Replacement Therapy (HRT). This replaces the low levels of oestrogen in the body and relieves most of the troublesome symptoms, especially hot flushes, sweats and the increased frequency of passing urine, among others. Your doctor is able to offer effective treatment for brittle bones as well. Calcium supplements are helpful if used in conjunction with recognised treatment for brittle bones (osteoporosis).Homeopathic remedies like evening primrose oil and black cohosh, among others have not been scientifically proven to help. Exercise will help to strengthen the bones while a healthy diet high in fibre (fruit and vegetables) and low in fat and free sugar will help in the fight against heart disease. Sensible light clothing at night instead of warm pyjamas could help to lessen the impact of hot flushes and night sweats. Lubricant gels help to relieve pain during sexual intercourse.

The menopause should be approached positively with the knowledge that there is nothing God Almighty cannot help us through. God, in the bible, encourages us to bring our troubles to Him, and reminds us that He cares for us. Good advice from the doctor coupled with faith in God will give succour and reassurance in a time of change and uncertainty. Even if all the doctor has to offer is advice and reassurance, God is still able to work through the modest measures you put in place to make your life more comfortable.
The take home message today is that God is still the one in control even when the menopause sets in.
Do you have any experience that might help fellow ladies or do you disagree with anything written here?Your contributions to this discussion will be welcomed, thanks