Menopause (Cessation of Fertility in Women)

Definition

Menopause is not a disease but rather a physiological phenomenon characterized by cessation of monthly menstrual bleeding. Women usually experiences menopause in midlife between the late 40s to early 50s. When it occurs in younger women in may be premature menopause or ovarian failure. With menopause the ovaries also stop producing egg cells thus ending the fertile period in a woman’s life.

The absence of menstruation for one year after the age of 40 years is considered as menopause provided the woman is not pregnant or breast feeding. In the preceding months before menopause, women experience irregular bleeding, vaginal dryness, mood swings and hot flashes. After menopause women become prone to certain diseases like heart disease, increased fracture risk due to weak bones, and weight gain. Menopause does not require any treatment but in some women the symptoms may interfere with daily life thereby requiring treatment.

Symptoms

The principal symptom is cessation of menstrual bleeding for at least 12 months in a non pregnant and non lactating woman. Certain symptoms, which tend to arise in the preceding months before the menses ceases, includes  :

  • Irregular bleeding
  • Dryness of the vagina
  • Hot flushes/flashes
  • Disturbed sleep
  • Frequent episodes of mood swings
  • Depression
  • Hair loss
  • Weight gain

Long term effects of menopause may lead to :

  • Heart disease. Estrogen usually protects women against heart diseases therefore women are may develop heart disease before and during menopause. After menopause the risk of heart disease in women becomes similar to those in men of the same ago.
  • Raised blood cholesterol levels.
  • Weakening of bones known as osteoporosis leading to increased tendency to fracture.
  • Urinary incontinence where there is involuntary passage of urine during laughing, coughing and sneezing. This type of urinary incontinence known as stress incontinence. When there is  inability to hold urine after the urge is felt then it is known as urge incontinence. This situation arises because both the vagina and urethra lose elasticity and and there is weakening of the pelvic floor muscles.

Causes

The menstrual cycle in women is approximately of 28 days which is counted from the first day of menstruation. It is preceded by ovulation where the ovary releases an egg cell. If fertilization occurs the fertilized ovum travels down the fallopian tube and gets implanted in the endometrium. This is known as pregnancy. The entire process occurs approximately every month in a woman’s life, starting in the teens (menarche) and continuing till the 30s to 40s. It is the fertile period in a woman’s life.

In menopause, this cycle is disrupted and eventually ceases. Menopause occurs due to following factors :

  • Reduced production of estrogen and progesterone by ovaries and also ovulation becomes unpredictable.
  • Surgical removal of uterus does not cause menopause if the ovaries are intact, however monthly bleeding will not occur.
  • Chemotherapy or radiation therapy may induce menopause.

About 1% female experience menopause before 40 years due to failure of hormone production by the ovaries.

Risk factors

Every female will experience menopause after the age of 40 years. It is a normal physiological process that marks a stage in a woman’s life where fertility ceases. In some women, menopause will occur earlier. Age is therefore considered a risk factor for the development of menopause.

Treatment

Menopause does not require any treatment but symptoms are can be managed with medication. Women are encouraged to manage the symptoms conservatively where possible but hormonal replacement therapy (HRT) should be instituted if the symptoms are unbearable of there is risk of complications.

  • Hormone replacement therapy with estrogen and progesterone.
  • Antidepressants.
  • Bisphosphonate to prevent osteoporosis.
  • Vaginal estrogen to relieve vaginal dryness.

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