HEALTH ALPHABET
Turbulent phase
UMA KRISHNASWAMY
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A natural event in a woman's life, menopause tends to be highly variable in timing and pattern.
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PARTH SANYAL
There are a number of symptoms associated with menopause.
MENOPAUSE is a natural phase in a woman's life, indicating a cessation of reproductive ability and signalled visibly by the stoppage of the menstrual periods. The ovaries cease to respond to certain hormones thus bringing ovulation to a halt. There is a concomitant reduction in the levels of the female sex hormones. The reasons for this event are complex and perhaps genetically pre-determined.
The menopause is an event that tends to be highly variable in timing and pattern. It occurs relatively early in women from the developing countries and later in women in the developed countries of the world. The age at which menopause occurs may also have a familial pattern. In some women there may be a very early menopause and conversely, in some, it may be quite delayed.
When a woman has her ovaries removed surgically, usually as part of an operation called hysterectomy (removal of the uterus), an artificial menopause occurs abruptly.
The pattern of menopause tends to be highly variable. There may be a gradual lightening in the flow of blood and a lengthening of the menstrual cycle. In some, the occasional cycle may be missed. While some irregularity may be termed normal, it must be understood that frequent periods, heavy bleeding are not due to menopause. The changes in menstrual pattern may occur over the course of a few years and a woman is said to be through her menopause if she has had no bleeding for a year.
Bleeding occurring after this is termed post menopausal bleeding and may signify disease. Post menopausal bleeding requires evaluation by a gynaecologist. In many women, menopause is a silent event and this is particularly true in women from traditional cultures. A woman who perceives the menopause as a natural event is likely to have little by way of symptoms.
This is particularly true of women from cultures that see the menopause as a sign of ageing and hence an enhanced social status. It is also true that in such traditional cultures, the consumption of phyto oestrogens (plant based oestrogens) tends to be higher than in a "westernised" or urbanised culture. Whether this dietary pattern has an ameliorating effect on potential symptoms of menopause is debatable.
In some women, however, there may be a constellation of symptoms associated with the menopause: hot flushes and night sweats, fatigue, emotional changes, sleep disturbances, dry skin and hair, aches and pains in the joints, headaches, palpitations, vaginal dryness, urinary symptoms etc. The intensity of these symptoms tends to vary.
Some have minor symptoms that can be easily ignored while others may have crippling symptoms interfering with lifestyle.
The important point to make in this regard is that these symptoms usually get better with time and disappear. The menopause is also associated with certain health risks such as: loss of bone density (osteoporosis), an increased risk of heart attacks and strokes, increased blood pressure, weight gain, increased cholesterol levels, weakness of the pelvic floor muscles and so on These require evaluation by one's physician and are often treated by non hormonal options.
The concept that the menopause requires medication is a fallacy. Women with minor symptoms usually require little else other than reassurance. Lifestyle changes to enhance calcium and vitamin D consumption, along with an active lifestyle are very helpful at this stage of life. Increasing the consumption of foods rich in phyto oestrogens (plant based oestrogens) such as: soya, beetroot, parsley, root fennel and wild yam may help. But there is little definite scientific evidence for the effectiveness of phyto oestrogens.
Women with severe symptoms particularly for relief from hot flushes, night sweats, vaginal dryness etc. may benefit from short term Hormone Replacement Therapy (HRT). Women who have had a hysterectomy can take oestrogen alone.
Those with an intact uterus need a combination of oestrogen and progesterone, because taking oestrogen alone increases the risk of cancer in the lining of the womb. Such combined HRT causes bleeding every month.
Combined HRT is available as tablets and patches. Oestrogen only preparations are available as tablets, patches, implants and skin gels.
Contrary to popular belief, taking HRT in non-tablet form does not protect one against either side effects or potential harm.
HRT may have side-effects such as: tender breasts, heavier periods, enlarging fibroids, weight gain, depression and irritability, an increased risk of developing blood clots which can be life-threatening. Taking HRT increases the risk of breast cancer slightly in the long run. The increased risk disappears within five years of stopping HRT. Hence, prescribing HRT is not undertaken lightly and it is a treatment that requires close monitoring by one's doctor. All this adds to the cost of treatment.
Complementary approaches include the use of herbal remedies such as black cohosh, angelica, evening primrose and valerian. There is limited scientific evidence that these are effective and certainly, herbal remedies may have side-effects. Other therapies such as yoga are very helpful in some.
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