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Dr. Vijayakumar D.R MBBS, DPM, DNB (NIMHANS), CCST (UK)
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The Menopause

 

THE MENOPAUSE.

 

 ‘What is Menopause?’

          The Menopause is a time of change in your body, and often in your life too.

  You may find this time to enjoy and take control of your life, when you have more time and energy for yourself.                                     Or you may find that the changes taking place in your life make you feel anxious or low. 

 

When will it happen to me?

       It usually happens between the ages of 45 and 52, although it can happen earlier or later.

 

What causes it?

    The monthly cycle is controlled by two natural chemicals called hormones, oestrogen and progesterone. These prepare the body for pregnancy each month. When pregnancy doesn’t occur, you have a period.

  As you grow older, your ovaries are less able to produce eggs each month and the level of oestrogen falls. Your periods will probably become irregular and unpredictable, until they finally stop altogether.

 

What are the symptoms?

Hot flushes, night sweats and felling emotional are all common symptoms of the menopause. They are caused by hormonal changes and vary from women to women. They may start before your periods stop, or develop several years later. They may be mild or they may be unpleasant and distressing. Irregular periods are another common sign that the menopause is approaching.

 

Irregular periods.

Your periods may become erratic and unpredictable some months or years before they actually stop. The flow might start to vary, from heavy one month to light the next. If your periods are very irregular or very heavy, see your doctor.

 

 

 

 

 

Hot flushes and night sweats.

      These can occur any time before or during the menopause. They can be uncomfortable, but they are not harmful. Some women have none at all.

Hot flushes and sweats usually happen in the week of your period in the lead up to the menopause. After your periods have stopped, they may happen more frequently.

      Hot flushes can happen on and off throughout the day, and may affect your sleep at night. They are probably caused by hormonal changes, but the exact cause is not known. You feel a wave of heat passing over your body, sometimes accompanied by redness, sweating or tingling. This can last for a number of seconds or up to several minutes. You may also feel a little faint and dizzy, and you may fell your heart beating faster.

     Sweats can happen with or without a flush, usually at night. After sweating, you can feel very cold. Night sweats can make it very hard to get a good night’s rest.

Dryness in the vagina.

    Your vagina may become drier, which can make sex painful or uncomfortable and increases the risk of vaginal inflection. There may also be an increased risk of cystitis (bladder infection). If you notice any unusual discharge from your vagina, this may be sign of infection ,see your doctor.

 

 

 

 

Feeling emotional.

       At this stage in their lives, many women experience symptoms such as headaches, forgetfulness, irritability and feeling low. For some, it is the worst aspect of menopause. As well as struggling with your own feelings, you may also worry about the effect of your mood swings on the people around you.

     The changes in your body may certainly be responsible for some of these feelings. Mood changes may become worse around the time of your periods, for example due to increased premenstrual tension. But there may be other reasons for feeling emotional or down, particularly due to the changes and stresses in your life.

     

        If you do not feel depressed, find someone sympathetic to talk to. This could help you understand why you are feeling the way you are. You could try talking to friends or relations who have gone through menopause and  your doctor. 

 

 

 

 

When can I stop using contraception?

     It’s best to discuss this with your doctor . Generally, women under 50 are advised to wait until they have had no periods for two years before stopping their method of contraception. Women over 50 should wait one year.

      Remember the ‘natural’ methods of birth control such as safe times or temperature monitoring is not reliable once your periods become irregular. Also, some forms of the pill might not be advisable around the time of the menopause, especially if you smoke. Again, discuss appropriate methods with your  doctor.

 

 

What can I do to help myself?

       Some women have little or no trouble with the menopause. Don’t assume it’s going to be awful- every woman has a different experience. Even if you do have problems, there’s a lot you can do to help yourself.

 

Be prepared. If you experience sweating at night, try lying on a large towel and use cotton night clothes and sheets. Keep a fan and bottle of cold water by your bed. If you get hot flushes throughout the day, wear layers of clothing that you can take off. Deep breathing can help to ‘cool down’ hot flushes.

Eat a healthy, balanced diet. Eating sensibly and well is important for good health and for the prevention of osteoporosis.   

Avoid smoking. If you smoke, try to quit. Smoking may make menopause start about one year earlier. It also increases the risk of osteoporosis and heart diseases.

Stay active. Regular physical activity can also help you feel better. Try to treat this as a time to relax and reduce stress in your life.

Use a vaginal lubricant. If dryness in your vagina makes sex painful or difficult, try using a lubricant such as KY jelly, available from any chemist.

Consider Hormone Replacement Therapy. It can bring significant relief to menopause symptoms, including hot flushes, night sweats .

 

 

 

 

 

 

 

 

Should I talk to my family about what’s happening to me?

     Talking things through with your family, friends and colleagues can be very positive. Partners and families may be worried about the effect the menopause will have.

    If you are in a relationship, it’s important to help your partner understand what is happening and how you feel. If your symptoms seem to be causing difficulties, discuss how you can improve things.

  

   Since men don’t have a physical menopause themselves it’s hard for them to understand what a woman goes through at this time. Men often have emotional problems of their own in middle age, feeling nervous, irritable, tired or experiencing loss of confidence. It’s importance to keep communicating and supporting each through what can be a time of change for both of you.

 

 

 

 

 

 

 

 

 

Osteoporosis.

 

     Osteoporosis, or thinning of the bones, affects both men and women. But it can be a problem for women because of the hormonal changes that occur at the menopause.

When bones become weaker and less dense, wrists, spines and hips are more likely to break. The spine starts to curve and there might be discomfort and pain.

    Thinning of the bones is natural, but there is a lot you can do to avoid osteoporosis by staying healthy and strengthening your bones. Even if you do develop it, treatment can prevent further thinning of the bones.

 

 

 

What are the symptoms?

    Osteoporosis develops gradually over many years, usually without any symptoms at all. Someone affected will probably not notice any problems until they are in 70’s. The first sign of it may be when the spine starts to curve, or when a slight fall or awkward movement causes a painful fracture.

 

 

 

 

 

 

Who gets it?

Osteoporosis can occur in both men and women at any time, but is more common from about 40 onwards. In women, thinning of the bones is more rapid around the time of- and just after- the menopause. This is because some women lose calcium more quickly as the level of oestrogen in their body drops.

 

  You are more likely to develop osteoporosis if you:

Have had an early menopause.

Have been treated with long- term corticosteroids.

Have a history of missed periods.

Have already broken a bone after a minor bump or fall.

Have a family history of osteoporosis.

Have a history of heavy smoking or drinking, low calcium intake or immobility.

 

Can it be treated?

Hormone Replacement Therapy (HRT) can halt and prevent further bones loss.

 

 

How can I help myself?

Since osteoporosis actually starts long before you notice any symptoms, it makes sense to take action now to prevent or reduce the effects.

Eat a healthy, balanced diet. Eating a varied and well- balanced diet is important for good health. This can be done by choosing a variety of foods from each of the five food groups: milk and dairy foods; meat, fish and alternatives; bread, other cereals and potatoes; fruit and vegetables; foods containing fat, foods containing sugar. For healthy bones, make sure your diet includes calcium- rich foods such as milk and dairy foods (cheese, yoghurt and so on), nuts, canned fish, and dark, leafy vegetables. Fat- reduced varieties are healthier.

Make sure you get enough vitamin D. This is particularly important in winter. Vitamin D helps to activate the production of calcium and is found in fortified margarines, oily fish, eggs and milk. It is also made by your skin when you go out into sunlight.

Stay physically active. This is extremely important in maintaining bone density, muscle strength and balance throughout life. It reduces the risk of fracture and osteoporosis in later life. Try walking, dancing, cycling, tennis, swimming or something similar that you enjoy.

Avoid smoking and heavy drinking. They can make the condition worse.

     

 

Hormone replacement therapy (HRT).

   Hormone replacement therapy (HRT) can help ease or prevent some of the uncomfortable symptoms of the menopause. It can also protect against osteoporosis and heart disease. Some women believe HRT has completely changed their lives for the better. Others feel that they do not need it, or that it’s ‘unnatural’.

         You need accurate information about the nature of the treatment and its benefits and its drawbacks in order to decide if HRT is right for you.

 

What is hormone replacement therapy?

      Before, during and after the menopause, your body produces less and less of the hormone oestrogen. HRT is designed to ‘top up’ the body’s natural supply of oestrogen. Progestogen is usually added to protect the lining of the womb.

     Oestrogen is usually taken by mouth in tablet form, as a skin patch or skin gel, as a vaginal cream or ring to ease vaginal discomfort. Your doctor would be able to explain the different options.

 

 

 

 

 

What are the benefits?

HRT is prescribed to ease or prevent many of the uncomfortable symptoms associated with the menopause.

It can:

Stop hot flushes and sweats.

Restore the vagina’s elasticity and natural lubricant.

Help you feel better in yourself. 

    HRT also protects against osteoporosis. It helps to prevent thinning of the bones in women after the menopause, especially when it is taken within a few years of the menopause when bone loss is most rapid. 

    HRT is particularly valuable for women who have had their ovaries removed before the menopause, as they are at an even higher risk of osteoporosis.

 

How long would I have to take it?

     A course of treatment can last from around six months to two years, sometimes a little longer under supervision. Symptoms such as hot flushes and vaginal dryness should not return after the treatment stops.

 

 

 

 

What are the risks?

    There may be a slightly risk of breast cancer when HRT is taken for 5-10 years or more. 

 

Are there any side effects?

     There might be some side effects, including the return of periods (withdrawal bleeds). If you are taking HRT and notice side effects, don’t stop taking the treatment- tell your doctor. There a many different doses and types of treatment, and if one kind of treatment does not work well for you, there should be other options.  

Possible side effects include:

Oestrogen 

Breast tenderness and enlargement.

Leg cramps.

Bloating.

Nausea.

Headaches.

Progestogen

Pain in the lower abdomen.

Fluid retention, back pain.

Depressed mood.

 

How do I know if HRT is right for me?

    This is something you should consider carefully and discuss with your doctor. Find out all the information you can about HRT. You will need to weigh the benefits to yourself against the possible risks. Much will depend on your medical history, symptoms and state of health.