Menopause is not a disease or disorder though some people call it a menopausal disorder. It is a natural phenomenon in a woman’s life but still needs to be diagnosed and treated because of the symptoms it causes and the risk it carries.
The North American Menopause Society (NAMS) certified menopause practitioners (NCMP) to help women deal with the process of menopause, including perimenopause and postmenopause symptoms and risks.
Natural menopause is defined as the permanent ending of menstrual periods after a woman has experienced 12 months of amenorrhea (no menstrual cycle) in the absence of any obvious pathologic or physiologic cause.
The average age of menopause in a woman is 51 years and is accompanied by complete, ovarian follicular depletion. This results in low concentrations of estrogen hormones and high levels of follicle-stimulating hormone (FSH).
Menopause signals the end of the reproductive years of a woman’s life. The premenopausal period is typically characterized by irregular menstrual cycles, endocrine changes, and symptoms such as hot flashes.
“Early menopause” is the period between the ages of 40 and 45 years or <40 years and is also referred to as “primary ovarian insufficiency”. This period is associated with an increased risk of cardiovascular disease, and loss of bone density and cognitive function.
There are several ways by which your healthcare provider will proceed to diagnose menopause.
He will first discuss your menstruation history over the last year. If you’ve gone a full year (12 straight months) without a period, you’ve entered menopause and may be postmenopausal.
Blood and urine tests
Although blood and urine tests are not required, your health provider may ask for these tests to determine the levels of the hormones estrogen, follicle-stimulating hormone (FSH), and luteinizing hormone (LH).
At menopause, the ovaries do not respond to FSH and LH hormones due to ovarian follicular depletion.
The body, therefore, produces more of these hormones to compensate, and therefore, their levels are high.
The production of estrogen and progesterone decreases and their levels in the body fall. It is the big drop in estrogen levels that causes most of the symptoms of menopause and increases the risk of health conditions.
Diagnostic findings that confirm menopause
Therefore, from the following findings, your health provider will confirm the diagnosis of menopause:
• Age more than 45 years
• History of irregular menstruation
• Absence of menstrual period for than 12 months
• Symptoms such as hot flashes
• Falling levels of estrogen
• Elevated levels of FSH and LH hormones
During and after menopause, a woman should get regular physical examination tests to monitor for any menopause complications such as cardiovascular disease and osteoporosis.
Menopause is a natural process in a woman’s life. You may not need any treatment most of the time.
Treatment is about treating the symptoms of the menopause disorder or syndrome that make you uncomfortable and minimizing the health risks of menopause such as cardiovascular disease and osteoporosis.
The main types of treatment for menopause are:
• Hormone replacement therapy (HRT).
• Nonhormonal treatments
Hormone therapy for menopause
As explained above, during menopause, your body goes through major hormonal changes. Your ovaries produce estrogen and progesterone.
During menopause, due to ovarian follicular depletion, your ovaries no longer make enough estrogen and progesterone. Hormone therapy can make up for lost hormones and increase your hormone levels and can help minimize symptoms like hot flashes and vaginal dryness. It can also help prevent osteoporosis.
There is a correlation between the symptoms of severe hot flashes and night sweats and your risk for cardiovascular disease. Your healthcare provider will recommend hormone therapy if you have these severe symptoms because these severe symptoms increase your risk of cardiovascular disease.
There are two main types of hormone therapy:
- Estrogen therapy (ET). In this treatment, you take only estrogen in a low dose. This hormone comes in many forms, such as a patch, pill, cream, vaginal ring, gel, or spray. Estrogen therapy is contraindicated if you still have a uterus because of the increased risk of endometrial hyperplasia.
Endometrial hyperplasia is a precancerous condition in which there is an irregular thickening of the inner uterine lining. This may cause heavy postmenopausal bleeding, and anemia due to the excess bleeding.
- Estrogen Progesterone/Progestin Hormone Therapy (EPT). EPT is a combination therapy because it comprises giving doses of both estrogen and progesterone. Progesterone is given in its natural form, or also as a progestin (a synthetic form of progesterone). This type of hormone therapy is indicated in women who still have their uterus.
Health risks of hormone therapy
The health risks of hormone therapy include:
• Endometrial cancer in women who have the uterus and receive only estrogen therapy
• Gallstones and gallbladder problems
• Blood clots from the use of oral tablets
• Deep vein thrombosis
• Pulmonary embolism
• Increased risk of breast cancer with long-term use of combination HRT and not from the use of estrogen therapy alone
The risks reduce if you have started hormone therapy within 10 years of the onset of menopause. However, your risk for cardiovascular diseases is increased.
Prescription medications are used to relieve menopausal symptoms. They include:
• Estrogen therapy in the form of cream, gel, or pill,
• Birth control pills, and
• Antidepressants (SSRIs and SNRIs). Antidepressants can help manage symptoms of menopause like mood swings and hot flashes.
• Prescription vaginal creams can help relieve vaginal dryness.
• A seizure medication, gabapentin, has been shown to relieve hot flashes.
Self-care lifestyle tips
Tips for managing the problems of menopause include:
• Exercise regularly and do deep breathing exercises
• Practicing stress management techniques
• Incorporate nutritious foods in your diet like plenty of fresh fruits, vegetables, and whole grains
• Do not smoke
• Limit the intake of alcohol
• Seek counseling for anxiety
• Get good sleep
• Do Kegel exercises to strengthen the pelvic floor to avoid incontinence problems
• Do not use strong soaps around the vagina, as it can worsen irritation.
• Socialize with good company
• Keep an active sex life. This will increase vaginal blood flow and help keep the tissues healthy.
• Use protection if having sex with a new partner to protect against sexually transmitted infections.