Definition

Menopause is a natural biological process that marks the end of the menstrual cycle, where menstruation has stopped for 12 months. All women will experience menopause as they age, typically occurring between the ages of 45 and 55, though it can sometimes happen earlier. Menopause indicates changes in hormone production (primarily estrogen).

Many women will experience symptoms such as hot flashes and emotional complaints that can disrupt sleep and affect their emotional health. There are many effective treatments available to manage the complaints arising from menopause. Meanwhile, perimenopause is a transitional period leading to menopause when someone has symptoms due to hormonal changes before menstruation completely stops.

Causes

Menopause occurs due to changes in hormone levels such as estrogen and progesterone as women age. The ovaries gradually produce fewer eggs. Eventually, the ovaries will stop producing eggs entirely. When your last period was 12 months ago, you are considered to have entered menopause.

However, menopause can also occur earlier due to several factors, such as:

• Genetic factors
• Surgery to remove the ovaries or uterus
• Cancer treatments such as chemotherapy or radiation therapy
• Primary ovarian insufficiency, or a condition where the ovaries fail to produce reproductive hormones at normal levels
• Sometimes the cause of early menopause is unknown

Risk Factor

A family history of early menopause is thought to play a role in your menopause transition. The age you start experiencing menopause-related complaints may be related to the menopause age of your mother, grandmother, or sisters.

Certain lifestyle habits can affect the age at which menopause begins. Smoking can accelerate menopause by up to 2 years earlier than non-smokers, thereby increasing the risk of early menopause in women. Additionally, alcohol consumption, caffeine, and a high-fat diet can also influence the age of menopause onset.

Symptoms

Menopause symptoms can vary for each woman. During the transition to menopause (perimenopause), many women will experience irregular menstrual cycles. Additionally, physical symptoms and emotional complaints can arise. All these symptoms can start a few months or a few years before menstruation completely stops. These symptoms include:

• Mood changes or mood swings, anxiety, or low self-confidence
• Brain fog, characterized by difficulty concentrating or forgetfulness
• Hot flashes or warm sensations in the face, neck, and chest
• Sleep disturbances and night sweats
• Headaches like migraines
• Weight gain
• Dry vagina, causing pain, itching, or discomfort during sex
• Palpitations that feel more pronounced than usual
• Decreased breast size

Diagnosis

Information related to menopause signs and symptoms, the patient's current age, and the absence of other illnesses is usually sufficient to confirm if the patient is in perimenopause or menopause. Generally, additional examinations are not needed to diagnose menopause. However, in some situations, the doctor may recommend blood tests to measure Follicle-Stimulating Hormone (FSH) and estrogen (estradiol) levels, as FSH levels will increase and estrogen levels will decrease when menopause occurs.

Management

The treatment generally aims to minimize complaints caused by menopause and to prevent complications due to the decrease in hormone levels during menopause, such as osteoporosis.

Hormonal Therapy

Hormone therapy can address symptoms caused by hormonal changes. This type of treatment can be administered in several ways and is available as systemic estrogen, estrogen-progestin, progestin only, or combination oral contraceptives. This treatment can help reduce the severity and frequency of hot flashes, improve sleep disturbances, and prevent osteoporosis and fractures that can occur due to bone loss.

Treatment must be under a doctor's supervision, as hormone therapy is also associated with an increased risk of breast cancer and ovarian cancer if given for a long time. Hormone therapy should not be given to women with a history of the following diseases:

• Breast cancer
• Uterine (endometrial) cancer
• Deep vein thrombosis
• Pulmonary embolism
• Liver disorders
• Unexplained vaginal bleeding
• Coronary heart disease

Non-Hormonal Therapy

Doctors can prescribe medications to address complaints arising from menopause. Doctors can prescribe antidepressants or anti-anxiety medications if you have symptoms of depression or anxiety. In menopausal women experiencing osteoporosis, doctors can also prescribe medications and calcium and vitamin D supplements.

Complications

After menopause, the risk of developing certain medical conditions increases. Examples include:

• Cardiovascular disease During menopause, the decrease in estrogen levels can cause changes in a woman's lipid profile and narrowing of blood vessels, so menopausal women have a greater risk of cardiovascular disease. There is a 2-3 times increased risk of coronary heart disease in menopausal women compared to individuals of the same age who have not yet experienced menopause.
• Osteoporosis Menopause can cause women to experience a decrease in bone density due to reduced estrogen levels. More than 250,000 menopausal and postmenopausal women experience osteoporosis. During menopause, the rate of bone density loss increases from 3% to 5% over 5-7 years. Postmenopausal women with osteoporosis are particularly more vulnerable to fractures in the spine, hips, and wrists.
• Urinary incontinence As the tissues in the vagina and urethra (urinary tract) begin to lose elasticity, sudden, frequent, and strong urges to urinate can occur, followed by unintentional urine leakage. Urine leakage can also happen when coughing, laughing, or lifting objects. Urinary tract infections are also more common.
• Sexual function Vaginal dryness due to decreased moisture production and loss of elasticity can cause discomfort and slight bleeding during sexual intercourse. Additionally, sexual desire or libido can also decrease.

Prevention

Since menopause is a natural occurrence that happens to every woman as part of the aging process, there is no way to prevent menopause. However, you can manage symptoms to be controlled and prevent complications. Avoid a high-fat diet and increase your consumption of fruits and vegetables. A healthy diet can slow down the onset of menopause. Regular exercise helps maintain bone strength.

When to See a Doctor?

You can consult a doctor if you think you are experiencing perimenopause or menopause symptoms to get advice on therapy and what you can do to manage them.

Early treatment will help you reduce the effects of perimenopause and menopause on your health, relationships, and work.

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