Menopause
Menopause, often referred to as “the change of life,” occurs when a woman stops having monthly periods. It is officially defined as the absence of menstruation for an entire year. After menopause, a woman is no longer able to conceive naturally. In Ghana, the average age of menopause is around 48, although it can occur anywhere from the late 40s to the early 50s.
Why does menopause occur?
Menopause is a natural biological process marked by the ageing of the ovaries, leading to a decline in the production of reproductive hormones. Consequently, the body undergoes several changes due to reduced estrogen levels, progesterone, testosterone, follicle-stimulating hormone (FSH), and luteinising hormone (LH). One significant change during menopause is the gradual depletion of active ovarian follicles. These follicles produce and release eggs from the ovary wall, which is essential for menstruation and fertility.
What’s early menopause?
Menopause occurring before the age of 40 is termed premature menopause, while menopause between ages 40 and 45 is referred to as early menopause. Roughly 5% of women naturally experience early menopause. Various factors can heighten the chances of early menopause:
- Never had children: Women who have never been pregnant may experience menopause at an earlier age. Pregnancy history can delay the onset of menopause.
- Smoking: Smoking is associated with earlier onset of menopause, potentially advancing it by up to two years compared to non-smokers.
- Family history: If women in your family have experienced early menopause, you are more likely to as well, suggesting a genetic predisposition.
- Chemotherapy or pelvic radiation: Cancer treatments such as chemotherapy or pelvic radiation can damage the ovaries, leading to premature menopause.
- Oophorectomy or hysterectomy: Surgical removal of the ovaries (oophorectomy) results in immediate menopause. Removing the uterus (hysterectomy) without removing the ovaries may also bring on menopause a year or two earlier than expected.
- Certain health conditions: Conditions like rheumatoid arthritis, thyroid disease, HIV, chronic fatigue syndrome, and certain chromosomal disorders can contribute to early menopause.
When does menopause begin, and how long does it last?
Most women start experiencing menopause symptoms approximately four years before their final menstrual period. These symptoms typically persist for about four years after menopause begins. Various factors, including genetics and the health of the ovaries, influence the timing of menopause onset. Perimenopause precedes menopause and is characterised by hormonal changes preparing the body for menopause.
This transitional phase can last from a few months to several years. Many women begin perimenopause sometime after their mid-40s. However, some women may bypass perimenopause altogether and transition abruptly into menopause.
Perimenopause vs. menopause vs. postmenopause
During perimenopause, menstrual cycles become irregular, characterised by periods that may be late, skipped entirely, or with varying degrees of flow intensity. This phase marks the transition towards menopause, typically occurring in a woman’s late 40s or early 50s. Postmenopause refers to the stage following menopause, which is defined as a year without menstruation.
During postmenopause, women no longer experience menstrual periods and are considered to have completed their transition through menopause. This phase spans the years after menopause has occurred, during which menopausal symptoms may continue to be present but typically diminish over time.
What are the symptoms of menopause?
Every woman’s experience of menopause is unique, and the severity and duration of symptoms can vary widely. Conditions that affect ovarian health, such as cancer or hysterectomy, as well as lifestyle factors like smoking, tend to influence the intensity of symptoms. Aside from changes in menstruation, the symptoms of perimenopause, menopause, and postmenopause are generally similar. Early signs of perimenopause include irregular menstrual cycles, either less frequent or with heavier or lighter periods than usual.
Vasomotor symptoms (VMS) such as hot flashes, night sweats, and flushing are also common, affecting approximately 75 per cent of women during menopause. Other common symptoms of menopause include:
- Difficulty sleeping
- Dryness in the vaginal area
- Gaining weight
- Depression
- Anxiety
- Trouble focusing
- memory issues
- Reduced libido, or sex drive
- Dryness of skin, mouth, and eyes
- Needing to urinate more frequently
- Sore or tender breasts
- Headaches
- Racing heart or palpitations
- Infections in the urinary tract
- Reduced muscle mass
- Joint pain or stiffness
- Reduced bone mass
- Less full breasts
- Thinning or loss of hair
- Excess hair growth
The changes of menopause can lead to some complications, such as:
- Urinary incontinence
- Vulvovaginal atrophy
- Dyspareunia (painful intercourse)
- Osteoporosis (weaker bones with reduced mass and strength)
- Mood or sudden emotional changes
- Slower metabolic function
- Cataracts
- Periodontal disease
- Heart or blood vessel disease
What is the treatment of menopause?
Hormone therapy may effectively treat symptoms in women under 60 or within ten years of menopause onset, including:
- Hot flashes
- Night sweats
- Flushing
- Vaginal atrophy
- Osteoporosis
Other medications can address specific symptoms such as hair loss and vaginal dryness. Lifestyle modifications, such as quitting smoking and drinking, reducing weight, and supplementing diet with calcium and vitamin D, help manage some symptoms.
