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Your menopause and you

Feb 22. 2016
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Menopause, sometimes known as the “Golden Years”, is the phase of a woman’s life when her ovaries stop working and menstruation ends.
Menopause can occur as a natural part of the ageing process or as a result of the uterus being surgically removed. However, it always results in a decrease in levels of the female hormone, oestrogen. 
Menopause has a variety of symptoms, the occurrence and severity of which can vary greatly. In more severe cases, these symptoms can have such an impact on the ability to carry on with normal routines that they adversely affect the quality of life. 
In most cases, women will typically experience hot flashes, night sweats and insomnia, which leads to increased fatigue and irritability. Other possible symptoms include palpitations, headaches, an aching body, anxiety, decreased self-confidence, depression, and loss of libido. The urinary tract and vagina may also develop problems, such as vaginal dryness, vaginal inflammation, frequent urination and urinary incontinence. Not surprisingly, menopause can place a strain on a woman’s relationship with her spouse. 
The loss of oestrogen is a major cause of problems faced during menopause. As the oestrogen levels fall, the hair becomes dry and some women experience hair loss. The skin becomes thin and dry, causing wrinkles, while the fingernails also become brittle. 
In addition to the symptoms mentioned above, menopausal women are at increased risk of the following conditions:
l Osteoporosis 
Because oestrogen helps to maintain appropriate levels of calcium in the bones, the shortage of oestrogen caused by menopause leads to the bones thinning and becoming more brittle over time. This heightens the risk of hip fractures, broken arms, and broken legs. As there are no obvious symptoms, menopausal women are advised to undergo a bone density test every two years.
l Cardiovascular diseases 
Because oestrogen also protects a woman from the time she begins menstruation until menopause by reducing her cholesterol levels, the risk of heart disease and strokes increases during menopause. Even women with previously strong and healthy hearts are exposed to a greater risk of cardiovascular disease during menopause. Some of the early warning signs to watch out for include fatigue, insomnia, difficulty breathing, pain in the neck and shoulder area, stomach indigestion, and nausea. However, it should also be noted that women with heart disease often do not experience any chest pain during atherosclerosis (blocked arteries). 
l Stroke 
Low oestrogen levels also adversely affect the LDL level, and this is another risk factor for menopausal women as it can lead to a stroke. One of the main early warning signs to watch out for is a numbness or weakness in one part of the body, which then disappears in 30 minutes. Other indicators of an imminent stroke include feeling disoriented and having difficulty seeing, speaking or walking. When any of these symptoms occur, medical advice should be sought immediately to minimise the risk of a stroke and subsequent paralysis.
Because of the potential dangers, all women are recommended to visit their doctor for a full health examination as they enter menopause. While screening for cervical cancer, ovarian cancer and breast cancer are the most common tests performed on menopausal women, it is also advised that they undergo a more thorough examination.
Hormone Replacement Therapy (HRT) can be administered to replace the lost oestrogen with substances that have a similar molecular structure. While this can significantly improve the quality of life for menopausal women experiencing extreme symptoms, it is not necessary in all cases. Whether HRT is prescribed should be decided by the doctor after taking into consideration each woman’s particular situations and condition. For example, HRT should not be prescribed if a woman has breast cancer, endometrial cancer, deep vein thrombosis, or liver disease. Also, HRT should be used with caution if the patient has gallbladder stones, diabetes, high blood pressure, tumour in the uterus, asthma, SLE or migraine. In addition to deciding whether a woman is suitable for HRT, the doctor will also determine which type of HRT to recommend in order to improve the woman’s quality of life.
In addition to HRT, there are some steps that all women can take to maintain good health during menopause. A nutritious diet, regular exercise, sufficient rest, and a stress-free lifestyle can all play an important role in minimising the negative impacts of menopause. Menopausal women should try to eat a varied diet from all five major food groups. Foods which are high in calcium and naturally occurring oestrogen, such as soybeans, are strongly recommended, while fatty foods, alcohol, caffeine and smoking should all be avoided. Women should also aim to exercise least three times a week.
Understanding menopause and managing its risks can go a long way to helping women carry on as normal a life as possible during their “golden years”. While eating nutritious food, exercising regularly, and getting plenty of rest can minimise the risks and effects of menopause, even more important is an annual health check-up that includes a mammogram, a Pap smear test, a bone density test, and a blood test so that any potential complications can be identified and treated before they develop.
DR YAOWALUK RAPEEPATTANA is a specialist in obstetrics and gynaecology with the Women’s Health Centre at Samitivej Sukhumvit Hospital. Call (02) 711 8555-6.

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