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Imagine if around half of the world’s population were to go through the same life-changing transition, which, if ignored, could significantly affect their vitality and health. This is the current situation for millions of women across the globe who silently struggle with longstanding neglect of menopause due to a lack of awareness. [1]
Described as a late-stage event that marks the end of a woman’s years-long ongoing menstrual cycle, menopause is a critical period of transition with variable experiences. While some women have a smooth transition, others struggle with extreme menopause symptoms and their massive negative impact on everyday life.
With the annual addition of 47 million entrants, the global population of menopausal and postmenopausal women is expected to rise to 1.2 billion by 2030. [2] Understanding menopause and filling the gaps in knowledge regarding its management is crucial to helping women tackle this life-changing period with ease and comfort.
Menopause describes the end of a woman’s menstrual period. It is typically confirmed when a woman misses her period for 12 consecutive months without any other cause. It is a natural life event that all women are expected to experience at some point.
Hormones are the primary determinants of female health and menstruation. Any changes to menstruation, including menopause, are typically brought on by the fluctuating levels of hormones in the ovaries. The following are the essential hormones primarily affected during menopause:
The average age for the onset of menopause is 51 years; however, the phenomenon can hit women at any time between the 30s and the late 50s. Multiple factors come into play in determining the individual menopause age, such as smoking history, body weight, etc. Some experts also believe women have menopause at about the same age as their biological mothers.
While menopause is natural for most women, some can also experience it due to other reasons, such as the following:
Menopause is a normal life transition that can begin between 35 and 55 years and typically occurs in three stages. During these stages, the ovarian size shrinks, the hormonal synthesis fluctuates, and fertility starts declining. The menopause symptomatology can also vary depending on which stage you are in.
Understanding menopause stages and relevant symptoms can help you anticipate and manage the situation well.
Perimenopause or pre-menopause occurs three to five years before the real menopause. Most women enter perimenopause in their mid to late 40s as their estrogen and progesterone levels begin to decline.
Following are some common signs of menopause at 40:
The absence of menstruation for 12 consecutive months without another medical explanation, such as pregnancy, ongoing medication use, or illness, marks the beginning of the second stage, i.e., menopause. [5] Once menopause kicks in, you can no longer get pregnant due to the critically low levels of sex hormones. While most women achieve full menopause at 52, the age bracket can vary significantly, with some achieving it in their mid-40s and others going up to mid-50s.
Hot flashes are one of the most common menopause symptoms during stage two, along with increased heart rate. Other issues you may experience at this point include the following:
Post-menopause is the final stage of the menopausal cycle and officially marks the end of your reproductive years. With critically low levels of progesterone and estrogen, your ovaries are no longer able to produce or fertilize eggs. Post-menopause is an irreversible stage, and many women entering it continue to a mixture of perimenopausal and menopausal symptoms, such as:
Fortunately, most of these symptoms dissipate over time. However, the halted production of estrogen and other hormones can put you at an increased risk of osteoporosis and heart disease.
Menopause can be a challenging time for women and requires a combination of physical, psychological, and social support during and following the transition. Following are some key components of menopause treatment and care to keep in mind:
Hormone replacement therapy, or HRT, is the most effective menopause treatment to date for improving quality of life and symptom control. It has also been shown to significantly cut down the risk of some of the most commonly reported menopause side effects, including osteoporosis and cardiovascular disease. [6]
HRT involves the use of female hormones, estrogen and progesterone. The therapy typically begins in the perimenopausal and menopausal stages and aims to replenish the depleted hormones through the following:
HRT may involve trial and error as the doses of estrogen and progesterone need individual adjustment until the optimal replacement dose can be achieved. Despite the high success rate, HRT may predispose you to certain risks, such as stroke, breast cancer, and clots in veins. Having a detailed conversation regarding risks and benefits is the most sensible way of going forward prior to commencing treatment.
A healthy diet plays a crucial role in the management of your menopause symptoms while protecting you against long-term health issues due to declining estrogen levels. Following some dietary tips to keep in mind to maximize quality of life and improve symptom control:
In addition to medical and dietary interventions, complementary therapies are also advised by professionals as an adjuvant to menopause cure. These interventions do not fall within the mainstream healthcare system but can be used alongside traditional medical treatment for better management.
Following are some examples of complementary therapies to consider for menopause management:
In addition to HRT with adjuvant dietary modifications and complementary therapies, specific lifestyle tweaks can significantly contribute to symptomatic relief. Some of these tips to practice in day-to-day life include the following:
Despite being an expected physical and holistic transition in half of the population, menopause remains a taboo in many circles. The complexity of this transition goes beyond the stereotypical mood swings and hot flashes to encompass a blend of variable hormonal, emotional, and physical changes. Understanding what menopause is and how it can impact the coming years can help you prepare for what’s about to come and make smarter choices.
[1] Lancet T. Attitudes towards menopause: Time for change. Lancet (London, England). 2022 Jun 18;399(10343):2243.https://pubmed.ncbi.nlm.nih.gov/35717972/
[2] Hill K. The demography of menopause. Maturitas. 1996 Mar 1;23(2):113-27.
[3] Harper JC, Phillips S, Biswakarma R, Yasmin E, Saridogan E, Radhakrishnan S, C Davies M, Talaulikar V. An online survey of perimenopausal women to determine their attitudes and knowledge of the menopause. Women’s Health. 2022 Jun;18:17455057221106890.
[4] Grindler NM, Allsworth JE, Macones GA, Kannan K, Roehl KA, Cooper AR. Persistent organic pollutants and early menopause in US women. PloS one. 2015 Jan 28;10(1):e0116057.
[5] Grant MD, Marbella A, Wang AT, Pines E, Hoag J, Bonnell C, Ziegler KM, Aronson N. Menopausal symptoms: comparative effectiveness of therapies.
[6] Hodis HN, Mack WJ. Menopausal hormone replacement therapy and reduction of all-cause mortality and cardiovascular disease: it is about time and timing. The Cancer Journal. 2022 May 1;28(3):208-23.
[7] Ahmadieh H, Jradi N. Prevalence of menopausal hot flashes in Lebanon: A cross-sectional study. International Journal of Reproductive BioMedicine. 2021 Sep;19(9):789.
While menopause symptomatology greatly varies from one woman to another, the earliest sign I notice is period irregularity, which gradually decreases in frequency over the next few months. Some women also report increased facial hair growth, low mood, headaches, hot flashes, night sweats, and palpitations as the earliest menopause symptoms at age 47 or more.
I have noted most women start their menopause transition between the age of 45 and 55. This transition can continue for 7 to 14 years depending on various factors, such as the age of onset, ethnicity, race, smoking history, etc.
There is a small possibility of conceiving during the perimenopausal period as the hormonal levels are still on the decline. Once full menopause has been achieved following a 12-month absence of menstrual periods, the chances of getting pregnant are significantly lowered. However, because of the underlying variability in how menopause progresses in women, I still advise using contraception for up to a year since the last period if you are 50 and above and two years if you are below 50.
I recommend regular workouts and a good sleeping routine to help prevent mood swings significantly. Learning new ways of stress management, such as journaling and mindful meditation, can also improve mood and general well-being. If lifestyle management does not work, I would also recommend seeking help from a therapist or joining a support group.
Most women with symptoms after 50 do not require a confirmatory test. The diagnosis is typically based on clinical symptoms and judgment. However, if you are below 40 and start showing perimenopausal symptoms, I may suggest having two sets of blood tests one month apart to measure the levels of certain hormones. The purpose of these tests is to rule out premature ovarian insufficiency or premature menopause.
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