Menopause: Stages, Symptoms and Treatments

Menopausal syndrome or menopause affects every woman differently, bringing unexpected changes in your body and mood. This natural phase designates the end of a woman's reproductive years and significantly impacts her overall well-being. Understanding menopause symptoms helps women navigate this transition with confidence and seek appropriate support when needed. This blog explains menopause, exploring signs of menopause at 40 and other ages, causes, and management strategies. 

What is Menopause?

Menopause is a natural biological and physiological process that indicates the end of a woman's reproductive years. It is defined as the point when a woman has gone 12 consecutive months without a menstrual period. On average, menopause occurs between the ages of forty-five and fifty-five, but it can happen earlier or later for some women.

Stages of Menopause

The transition to menopause is gradual and happens in three stages:

1. Perimenopause: During this stage, menstrual periods become irregular but have not stopped completely.
2. Menopause: Menopause is the point when a woman has not had a period for 12 consecutive months. This indicates the end of her reproductive years.
3. Post menopause: This is the stage after menopause when a woman's ovaries have stopped synthesising hormones like estrogen and progesterone.

Types of Menopause

Menopause can happen naturally. Sometimes, it may be induced by certain medical conditions or menopause treatments:

• Natural Menopause: This is the most common type. It occurs between the ages of 45 and 55 as part of the normal ageing process.
• Early Menopause: When menopause occurs before the age of 45, it is considered early menopause.
• Premature Menopause: If menopause occurs at or before the age of 40, it is classified as premature menopause.
• Induced Menopause: Certain medical procedures or treatments can induce menopause. These include oophorectomy (surgery to remove the ovaries ), hysterectomy (surgery to remove the uterus), chemotherapy, or radiation therapy.

Signs and Symptoms of Menopause

The symptoms can vary from person to person, with some experiencing multiple symptoms while others not experiencing any.

• Physical Symptoms: The following are some common physical symptoms of menopause and perimenopause:
  • Sudden feelings of intense heat (hot flashes) in the face, neck, and chest
  • Excessive sweating during the night leads to disrupted sleep and fatigue.
  • Vaginal dryness, which can be a reason for discomfort or pain during sexual intercourse.
  • Increased susceptibility to recurrent UTIs due to hormonal changes.
  • Aches & pains in the muscles and joints, potentially leading to decreased mobility.
  • Hormonal shifts can contribute to changes in body shape and weight distribution.
  • Dryness, itchiness, and thinning of the skin.
• Psychological and Cognitive Symptoms: Menopause can also impact mental health and cognitive function, leading to:
  • Fluctuations in mood, including irritability, anxiety, and depression.
  • Difficulty falling or staying asleep, exacerbated by night sweats.
  • Commonly called "brain fog," women may experience forgetfulness and difficulty concentrating.
  • Physical changes during menopause can affect a woman's self-confidence and self-image.

Causes of Menopause

Menopause is a natural biological process, but various factors influence its onset and timing. Understanding the causes of menopause can help women better prepare for and manage this transition.

• Natural Causes: The primary cause of natural menopause is the gradual depletion of ovarian follicles, leading to a reduction in estrogen and other hormone levels. This process typically happens between the ages of 45 and 55.
• Early or Premature Menopause: In some cases, menopause can occur earlier than expected, known as early or premature menopause. Potential causes include:
  • Cancer treatments
  • Removal of the ovaries (oophorectomy) or uterus (hysterectomy) 
  • Chromosomal anomalies, such as Fragile X or Turner's syndrome
  • Autoimmune conditions like rheumatoid arthritis, Crohn's disease, or thyroid disorders 
  • Smoking and exposure to certain toxins may accelerate the onset of menopause.
  • Conditions like HIV/AIDS or chronic fatigue syndrome can impact ovarian function.
  • Women with a family history of early menopause may be more likely to experience it themselves.
• Late Menopause: While less common, some women may experience a delayed onset of menopause, known as late menopause. Potential causes include:
  • Thyroid Diseases: An overactive or underactive thyroid can disrupt the timing of menopause.
  • High Estrogen Levels: Abnormally high estrogen levels throughout a woman's lifetime can delay menopause.
  • Pregnancy: A pregnancy in a woman's late 40s or early 50s can temporarily delay menopause due to hormonal changes.

Diagnosis

Signs and symptoms of menopause are usually enough to indicate that a woman has started the menopausal transition. However, if concerns arise about irregular periods or hot flashes, it is advisable to consult a doctor. In some instances, doctors may recommend further evaluation, such as:

• Blood Picture: Doctors may recommend blood tests to check the following levels:
  • Follicle-stimulating hormone (FSH) and Estrogen (Estradiol) levels 
  • Thyroid-stimulating hormone (TSH

Managing Menopause Symptoms: Treatment Options

There are various treatment options available to help manage menopause symptoms effectively, such as:

• Hormone Replacement Therapy (HRT): HRT is the most effective menopause treatment for relieving menopausal symptoms. It replaces the hormones, primarily estrogen and progesterone, that are at low levels during menopause. HRT is available in different forms, including tablets, skin patches, gels, sprays, and implants.
• Vaginal Estrogen Therapy: If you experience vaginal dryness, itching, or discomfort during intercourse, your doctor may recommend vaginal estrogen therapy. 
• Non-hormonal Treatments: For women who cannot or choose not to take HRT, there are non-hormonal treatment options available:
  • Low-dose antidepressants 
  • Gabapentin: To help reduce hot flashes
  • Clonidine: To provide relief from hot flashes.
  • Fezolinetant: Targets the regulation of body temperature to reduce hot flashes.
• Medications for Osteoporosis Prevention: Depending on individual needs, doctors may recommend medications to prevent or treat osteoporosis, which can occur with ageing. Doctors may prescribe several medications to help reduce bone loss and the risk of fractures and vitamin D supplements to strengthen bones.

Complications

Menopause is a natural transition, but if not managed properly, it can enhance the risk of certain health conditions. It's essential to be aware of these potential complications and take proactive steps to maintain overall well-being.

• Cardiovascular Disease: Estrogen protects against various cardiovascular diseases, and its decreased levels during menopause can contribute to factors like high cholesterol and high blood pressure. 
• Osteoporosis: Bone loss accelerates after menopause due to decreased estrogen levels. Women may lose up to 25% of their bone density after menopause.
• Vaginal Dryness: The thinning and deterioration of vaginal tissues caused by decreased estrogen levels can lead to persistent vaginal dryness. 
• Urinary Incontinence: Menopause can cause the tissues of the vagina and urethra to lose elasticity, leading to sudden, strong urges to urinate and involuntary loss of urine incontinence.
• Mood Disorders: Some women may experience moodiness, anxiety, and depression during and after menopause. 

When to See a Doctor

Seeking medical advice can be beneficial when experiencing menopausal symptoms. Here are some instances when consulting a doctor is recommended:

• Irregular periods or hot flashes
• If you're experiencing menopausal symptoms before the age of 45
• If your menopausal symptoms are severe or disruptive to your daily life

Conclusion

Navigating through menopause can be challenging, but understanding its symptoms and available treatment options empowers women to take control of their health. From hot flashes and mood swings to physical changes, menopause has a significant impact on a woman's overall well-being. By recognising these signs early and seeking appropriate medical advice, women can better manage this transition and maintain their quality of life.

FAQs

1. How long do symptoms of menopause last?

Menopausal symptoms can last for months or even years, and their duration can vary significantly among individuals. For instance, hot flashes and night sweats may improve, while mood changes and anxiety may persist. Some symptoms, such as vaginal dryness or joint pain, can continue even after menopause.

2. What are the side effects of menopause?

Menopause can cause various physical and emotional side effects. Common physical symptoms include hot flashes, night sweats, irregular periods, vaginal dryness, urinary tract infections, joint and muscle aches, weight gain, and skin changes. Emotional and cognitive symptoms may include mood changes, anxiety, depression, sleep disturbances, memory and concentration problems, and low self-esteem.

3. How to avoid menopause?

Menopause is a natural biological activity that marks the end of a woman's reproductive years and cannot be avoided. While some lifestyle factors may potentially delay the onset of menopause or reduce the severity of symptoms, they cannot prevent menopause altogether.

4. How does a woman feel during menopause?

Women can experience a range of physical and emotional changes during menopause. Physical symptoms like night sweats,  hot flashes, vaginal dryness, and insomnia can contribute to emotional distress and impact a woman's overall well-being during this transition. Common emotional symptoms include crankiness, feelings of sadness, anger, loss of confidence or self-esteem, anxiety, forgetfulness, trouble concentrating, fatigue, and mood swings.