Embracing menopause – a new phase of your life
In recent times in my practice, I have come to realise that many women are not clear on what menopause is, what the symptoms are, or what to expect. This can be very frustrating and can be a source of anxiety for many women, who are simply confused about the changes that are occurring in their bodies, and the myriad symptoms that they are experiencing.
Hopefully, this will help to quell any anxiety and clear up any confusion being experienced.
Menopause, in simple terms, is the ending of menstruation (monthly periods) for a period of one year. It signals the time in a woman's life when the ovaries stop producing eggs, and as such, is the end of a woman's fertile years. After menopause, a woman can no longer get pregnant. It usually occurs between the ages of 45 and 55 years.
It is very important to note that menopause does not happen suddenly. Most women experience several years of changes to their menstrual periods before they stop completely. This time period is called the perimenopause or the menopause transition, and it signals the time when the ovaries have begun producing less oestrogen. During this time, many women start having menopausal symptoms as a result of declining oestrogen levels in the body. These symptoms may include hot flashes, night sweats, mood changes, sleep problems, and vaginal dryness.
A woman is considered to have completed menopause once she has gone a full year without having a period.
Another important note: after a year of not having a period, there should be no more vaginal bleeding. Any bleeding which occurs after is NOT a return of the menses and is abnormal. If this happens, you should see your gynaecologist.
How do you know if you are going through menopause?
The average age of menopause is 51 years. Before the menopause, as explained earlier, many women begin to experience certain symptoms as well as menstrual cycle changes, in what is called the perimenopausal period.
These symptoms include:
- Hot flashes and night sweats (most common)
- Trouble sleeping
- Mood swings
- Irregular periods
- Lower sex drive
- Vaginal dryness and discomfort during sex
- Breast tenderness
How long does perimenopause last?
The average length of perimenopause is four years, but can vary widely, lasting only a few months for some women, and continuing for up to 10 years in others. Perimenopause lasts up until menopause, and ends when a woman has gone 12 months continuously without seeing her period.
Symptoms of Concern
As previously stated, irregular periods are common and normal during perimenopause. But other conditions can cause changes in menstrual bleeding. Ensure that you see a gynaecologist to rule out other causes if any of the following situations apply to you:
- Your periods are heavy and have clots.
- Your periods last longer than usual.
- You have bleeding or spotting in-between periods.
- You have bleeding or spotting after intercourse
How is perimenopause diagnosed?
The diagnosis of perimenopause is very easily made by your gynaecologist based on your symptoms. A blood test can also be used to check hormone levels that will also help with making the diagnosis; however, your blood hormone levels fluctuate during perimenopause, and so a few blood tests done at different times for comparison may be required in order to make diagnosis.
Can you get pregnant if you are perimenopausal?
The answer is YES! Despite the perimenopaus being a signal of a decline in fertility, you can still become pregnant ... all it takes is one egg and one sperm. So if you do not want to become pregnant, you should be on some form of birth control, until you have reached menopause (12 months without seeing your period).
However, if you are trying to get pregnant, fertility assistance will be required.
Are there treatments to ease the symptoms of perimenopause?
The most common complaint from women in the perimenopause is the hot flashes. Many women get through with no treatment (tough it out) while others get relief after taking low-dose hormone treatment (birth control pills) for a short time. Not all women are candidates for hormonal therapy, so it's best to talk to your gynaecologist to see if this option is suitable for you.
Tips for Easing Hot Flashes
- Avoid getting too warm by dressing in layers and sleeping in a cool room.
- Avoid eating hot and spicy foods.
- Avoid alcohol; it can trigger hot flashes
- Reduce stress
- Incorporate soy into the diet, after first checking with your doctor. There is some evidence that soy may relieve mild hot flashes; these effects may take several weeks to realise.
Vaginal lubricants and moisturisers are available without a prescription if vaginal dryness and painful intercourse is a problem. They will help lubricate the vagina and make sexual intercourse more comfortable during perimenopause, menopause and in postmenopause.
If these over-the-counter treatments do not work, there are topical vaginal oestrogen creams which are also recommended. This type of oestrogen preparation will not affect other menopausal symptoms such as hot flashes.
Other treatments available are dependent on the patient's other perimenopausal symptoms, for example, antidepressants may be prescribed for mood swings.
Discuss your specific symptoms with your Gynaecologist so a suitable treatment plan can be made.
This is when you have your final menstrual period. Remember, you won't know for sure that is has happened until one year has passed without one. Perimenopausal symptoms continue in this stage.
This begins when you have gone the one year from your final period. Once this happens, you are now referred to as postmenopausal. Again I remind you that after more than one year of no menstrual periods due to menopause, vaginal bleeding is NOT normal.
Pap Smear After Menopause
A lot of women think that now that they are postmenopausal they no longer need to visit their gynaecologist ... Wrong! You will still need to see your gynaecologist regularly for your pap smear and regular health checks.
Yes. Even if you are menopausal or postmenopausal, you should continue to have Pap smear. Women who have had a total hysterectomy (removal of womb and cervix) for a non-cancerous condition (e.g. fibroids) and have not had an abnormal Pap smear before surgery, may be able to stop Pap smear screening. Screening may also be discontinued at ages 65 or 70 if women have had at least three normal Pap tests in a row and no abnormal Pap tests in the previous 10 years.
If you do not fall into either of those categories, you should get a Pap smear done every two to three years if both of these are true for you:
1. You have had normal Pap smear results for three years in a row.
2. You have no history of a precancerous Pap smear result, you do not have HIV infection, or a weakened immune system.
Women who have a higher risk of cancer may need a Pap test more often. Your gynaecologist will recommend what is best for you.
Other Medical Considerations for Postmenopause
The risk for heart disease goes up as we age, and even more so after menopause. Ensure that you are also taking care of your heart health by:
- Getting your cholesterol and blood pressure checked regularly at your gynaecologist visits.
- Taking steps to reduce your cholesterol and lower blood pressure, such as regular exercise and a healthy diet.
- If lifestyle changes are not enough to keep your cholesterol at a healthy level and your blood pressure normal, your doctor will start prescription medication.
- If you are diabetic, control your blood sugar.
There are many tips postmenopausal woman can take to stay healthy and feel better. I found this an easy way ... by remembering your ABCs, and D, E, and F.
- Avoid: Smoking, caffeine, alcohol, excess salt, and excess sugar.
- Balanced diet: Nutritionists recommend whole grains, leafy vegetables, and nuts to help keep your body healthy and potentially help relieve hot flashes. Soy is also believed to also ease mild hot flashes.
- Calcium: To help keep bones strong.
- Vitamin D: Also helps the calcium to keep bones strong.
- Exercise: Weight-bearing exercises daily, at least 30 minutes.
- Fat: Choose foods that are low in saturated fats and cholesterol.
I usually end my articles with an anecdote, and this time, I found it difficult to select just one. Then a patient came in for follow-up and so I selected her. She was more than five years postmenopausal when I met her. She had an episode of bleeding a year prior to seeing me, which stopped on its own, so she ignored it, but in delving more into her history, I found out she also had episodes of spotting. I explained to her my concerns and ordered for her an ultrasound, which showed thickening to the lining of her womb. After a short office procedure to biopsy this thickened lining it revealed she had endometrial cancer. We quickly did further scans and did surgery to remove her uterus (womb) and ovaries. Results came back that we got it just in the nick of time before it spread. We both are very happy with the results, and she remains on follow-up management.
Hopefully, this article has helped to clarify any questions, concerns, or misconceptions about menopause and the menopausal transition, so you are now better equipped to embrace this new phase of your life.
- Dr Rhonda Reeves is a consultant obstetrician/ gynaecologist at Southdale Medical & Gynae
Centre; email: firstname.lastname@example.org