Q&A: Menopause

Have you reached perimenopause? Your body shows signs that you’re going through the big change. Our medical expert advises you on what to expect and how you can cope.

Simply, what is menopause?

Menopause is not a disease, but rather the point in a woman’s life at which she is no longer fertile and menstrual periods have ceased (stopped). In simple words it means not having menses for 12 consecutive months due to the ceasation of ovarian functions.

Average age in Malaysia is 51.7 years (varies between 45 to 55 years). This may or may not be associated with symptoms. It can also be seen as a positive beginning of a new phase of life, with opportunities to take preventive action against major health risks.

Will everyone undergo menopause?

Yes, once the ovarian function ceases then menopause sets in. And all ovaries will have to cease their function at one point or another.

Do men undergo menopause?

Yes. In women we call it menopause (ceasation of menses due to hormonal effect), and in men we call it andropause (ceasation of the male hormones or other words the androgens). It simply means ceasation of hormones as men do not have menses like women but they too undergo hormonal changes and has effect from it.

What is early or premature menopause?

Menopause that occurs before the age of 40 is known as premature menopause. Genetic conditions, illness, and medical procedures are some of the reasons women may go through premature menopause. One major medical cause of premature menopause is premature ovarian failure. Other causes of premature menopause include damage to the ovaries by chemotherapy and/or radiation treatments, or surgical removal of the ovaries

Is there a difference between perimenopausal and premature menopause?

The transition to menopause and the time approaching menopause are referred to as perimenopause. Peri means around, so perimenopausal means around menopausal time. During this time the ovaries are still functioning, but their function has started to decrease. It’s still possible for a woman to become pregnant even if she is showing signs of perimenopause, because she may still ovulate. Meaning, she can still menstruate although irregularly. This is only telling you that menopausal time is around the corner.

What changes will I face as menopause approaches?

The experience of menopause is different for every woman. Some women have few complaints, while others have severe symptoms that affect their quality of life. When menopause occurs suddenly (as a result of chemotherapy or surgery) the transition can be difficult as it is sudden and our body does not have enough time to adapt to the changes.

The most common symptoms are hot flashes, vaginal dryness, skin dryness, mood swings and changes in the menstrual pattern but the extent to which women suffer from all of these varies, including:

Period Changes

With approaching menopause, a woman’s menstrual periods may change. They may get shorter or longer, lighter, or heavier. The interval between periods may increase or decrease. If you have concerns about changes in your periods, talk with your doctor. Sometimes, conditions other than menopause can also cause changes in your period.

Hot Flashes

Hot flashes are a common symptom around the time of menopause. A hot flash is a feeling of warmth that tends to be concentrated around the face and neck. It can cause flushing, or reddening of the skin, in these areas as well as the chest, arms, or back. Hot flashes vary in their intensity and can be followed by sweating and/or chills. They last anywhere from 30 seconds to 10 minutes. Women can help reduce the symptoms of hot flashes by dressing in light layers, exercising regularly, using a fan, managing stress, and avoiding spicy foods.

Sleep Issues

Hot flashes can occur at night and result in night sweats. The following tips can help you sleep well if you are having night sweats:

• Use lightweight bedding
• Use a fan in the bedroom
• Wear lightweight, cotton pajamas or gowns
• Use a damp washcloth to cool off your face and keep one handy at bedside
• Don’t allow pets in the bed or bedroom (they may give off heat)

Sex Problems

Along with menopause, women experience lower levels of the hormone estrogen. One of the effects of lowered estrogen levels is vaginal dryness, which can result in painful or uncomfortable intercourse. Water-soluble lubricants can help overcome this problem. Vaginal creams and suppositories can be prescribed to ease vaginal dryness.

Another effect of hormonal changes is a change in libido or sex drive. This may improve or worsen (most often worsen) but it is important to remember that other factors besides menopause can affect libido. Stress, sleep disturbances, medications, and anxiety can all affect sex drive. Your gynae can help you find ways to manage the changes in your sex drive if they occur.

Finally, although fertility ends at menopause, women of all ages are still susceptible to STDs, so safe sex is still important.

Does menopause cause moodiness and depression?

Unfortunately, these emotional changes are a normal part of menopause. Some of the emotional changes experienced by women undergoing perimenopause or menopause can include:

• Irritability
• Feelings of sadness
• Lack of motivation
• Anxiety
• Aggressiveness
• Difficulty concentrating
• Fatigue
• Mood changes
• Tension

If you are feeling irritable and sad, there is a good chance it could be related to menopause, but the listed symptoms are not linked only to menopause. There are a number of conditions that can cause you to feel downright irritable. Tell your doctor how you are feeling, so he or she can rule out other medical or psychiatric conditions.

I have a hard time concentrating and I’m forgetful. Is this a normal part of menopause?

Unfortunately, difficulty with concentration and minor memory problems can often be a normal part of perimenopause. The good news is that it is likely to be temporary.

Current medical knowledge is limited as to why memory changes occur with perimenopause, and there are currently no treatments available to relieve these symptoms. If you are having memory problems, discuss this with your doctor. He or she can help manage memory problems, or may be able to provide reassurance.

How can I counteract vaginal dryness during menopause?

Hormone changes leave the vagina thinner and dryer, which can make sex painful. Lucky for you, lots of products exist today that can help. Try water-based vaginal lubricants or vaginal moisturizer. You can also ask your gyne about vaginal creams, or prescription pills for vaginal dryness and painful sex. The more sex you’re able to have, the better for blood flow, which helps vaginal health.

Ever since my periods stopped, my desire for sex has decreased. Is that normal?

Nurture that lost desire. Make more time for sex. Try massage and other acts short of intercourse. Use erotica and new-for-you sex routines as ways to build desire too. Other causes besides hormone changes can strike at the same time. Ask a doctor about poor sleep, bladder trouble, or feeling depressed or stressed.

What are health risks that are associated with menopause?

Health risks associated with menopause include an increased risk for heart disease (the #1 cause of death for U.S. women) and bone density loss (osteoporosis).

Estrogen offers some protection against both of these conditions, so when estrogen levels fall at menopause, the risk increases.

Is there any way to prevent the health risks? What can I do in my daily life to reduce symptoms of perimenopausae?

Staying healthy

It’s never too late to start living a healthy lifestyle. Regular checkups should include a measurement of cholesterol, blood sugar, and blood pressure. And don’t skip routine preventive screenings such as mammograms. You can work with your doctor to establish a plan for a healthy lifestyle including a nutritious diet, physical activity, and stress management skills.

Active menopause is a must

Regular physical activity is important. Aerobic exercise strengthens the heart, and weight-bearing exercises to maintain bone strength are two important components of an exercise programme. Regular exercise can also help keep weight off and elevate your mood. Even if you weren’t active before, you can start to increase your physical activity at any age.

What are proven alternative therapies for menopause symptoms?

There are no proven alternative remedies for menopause symptoms, although some small studies have suggested a benefit for certain preparations.

Black cohosh – is an herbal supplement that is believed to help reduce hot flashes. This needs to be discussed with the doctor before consumption.

Plant estrogens (phytoestrogens) – such as soy protein are another popular remedy for hot flashes – data to show their effectiveness are limited. Inconclusive and conflicting studies indicate that other herbal preparations and supplements including, such as dong quai, red clover (Promensil), chasteberry (Vitex), yam cream, Chinese medicinal herbs, and evening primrose oil. It is advisable to take them with care under the supervision of a health care professional.

Can postmenopausal women still bear children?

When menopause occurs, the function of the ovaries ceases. The ovaries release the mature eggs that are available for fertilisation during the normal menstrual cycle. When ovarian function stops, a woman does not have menstrual cycles and can no longer become pregnant.

Can we predict the exact age of menopause for a women?

No. Women tend to undergo menopause at an age similar to that of their mothers. The age at which a woman began menstruating is not related to the age at which she will reach menopause. Hormone levels cannot precisely predict when menopause will occur, and these levels can vary greatly in an individual woman. No blood or urine test is able to confirm the onset of menopause. Blood tests may be ordered to exclude other medical causes of irregular periods. The only definitive way to diagnose menopause is to observe a lack of menstrual periods for 12 consecutive months in the typical age range.

Besides Hormone Replacement Therapy, how can I treat hot flashes?

You probably can’t avoid hot flashes during menopause, but there are things that may bring them on more often or cause them to be more severe. To prevent hot flashes, avoid these triggers:

• Stress
• Caffeine
• Alcohol
• Spicy foods
• Tight clothing
• Heat
• Cigarette smoke

Other things you can do to keep hot flashes at bay include:

• Stay cool. Keep your bedroom cool at night. Use fans during the day. Wear light layers of clothes with natural fibers such as cotton.
• Try deep, slow abdominal breathing (six to eight breaths per minute). Practice deep breathing for 15 minutes in the morning, 15 minutes in the evening and at the onset of hot flashes.
• Exercise daily. Walking, swimming, dancing, and bicycling are all good choices.
• Try chill pillows. Cooler pillows to lay your head on at night might be helpful.

Can eating and drinking soy milk (Tau fu) help?

Data’s are limited. Effectiveness is not known regarding the benefits but it is a good source of protein which is needed in peri/post menopausal period. So conclusion, no harm trying and there are benefits.

Soy is high in isoflavones. Isoflavones are a type of phytoestrogen. Phytoestrogens are chemicals found in plants that work like estrogens.

Are soy isoflavones effective?

Menopause symptoms

Soy products may improve menopausal symptoms, such as hot flashes. This is based on mixed evidence. So far, studies have used many different soy sources and different measures of success, which are hard for experts to compare. Soy isoflavone (rather than soy protein) studies have shown the most promise for hot flash treatment.

Are soy isoflavones safe?

Eating and drinking soy on a daily basis has no known risks. For some people, it upsets the digestive system. The long-term effects of a diet high in soy have not been well-studied. High soy intake can’t be considered safe until more research is done. Some experts think that soy phytoestrogen does not lead to cancer like estrogen can. But this has not been proven. Experts do not yet know if a high-soy diet is a risk for women who have had breastcancer.

Making soy a part of your daily diet

Isoflavones are short-acting. If you use soy for health reasons, try to eat it throughout the day, rather than all at once. Try to eat 40 mg to 80 mg of isoflavones each day. Remember that soy protein is different than soy isoflavone. A high-protein soy food may or may not have a large amount of isoflavones in it. Soy comes in many forms, so you have a lot of choices for adding soy isoflavones to your diet.

When to call a doctor?

Call your doctor if you have:

• Menstrual periods that are unusually heavy, irregular, or prolonged (1 to 2 times longer than normal).
• Bleeding between menstrual periods, when periods have been regular.
• Renewed bleeding after having no periods for 6 months or more.
• Unexplained bleeding while you are taking hormones.
• Symptoms, such as insomnia, hot flashes, or mood swings, that aren’t responding to home treatment and are interfering with your sleep or daily life.
• Vaginal pain or dryness that doesn’t improve with home treatment, or you have signs of a urinary tract infection, such as pain or burning during urination or cloudy urine.