Demystifying the pause5 min read . Updated: 15 Aug 2011, 09:57 PM IST
Demystifying the pause
In 2000, when Radhika* turned 42, she found herself feeling uneasy and more fatigued than usual. There were sudden spells when she would feel so hot that regardless of the temperature outside, she would be drenched in her own sweat. Apart from the physical symptoms, she found that she was also feeling less positive than usual.
The period of change
Menopause is a transitory phase in a woman’s life. She undergoes physical and emotional changes—a consequence of the slowing of her reproductive capacity. Her reproductive capacity or fertility is tied to the monthly release of eggs and the regular cycle of the sex hormones, progesterone and oestrogen. During menopause, the egg and hormone release, and the consequent monthly menses, slowly come to an end. When a woman’s monthly periods have stopped for at least a year, she is said to have undergone menopause. The word menopause has Greek origins and translates into “the end of the month".
Worldwide, the average age for women to have their last monthly period is 51. Studies suggest that Indian women undergo menopause much earlier. A survey conducted in 2007 by the Institute for Social and Economic Change, Bangalore, found that Indian women are at higher risk of early and premature menopause, before the age of 45. The data for the study was obtained from the National Family Health Survey and examined samples from 100,000 women between 15-50 years across 26 states. The study found that on average, 4% of Indian women experience premature menopause between 29-34 years. Premature menopause is a perplexing medical condition for researchers—it may be triggered by various causes, including genetic abnormalities and autoimmune ovarian damage.
“Many women feel a sense of relief that they no longer have to worry about their monthly period," says Duru Shah, chairman, Gynaecworld, Mumbai, and a consultant at the Breach Candy Hospital and Jaslok Hospital, Mumbai.
But early menopause not only reduces the amount of time on a woman’s biological clock, it also increases the risk of osteoporosis and heart disease. This is because oestrogen plays a protective role in bone and cardiac health. As menopause is an oestrogen-deficient state, early onset can put bone and heart health at risk at a younger age.
The HRT myth
One-third of the women going through menopause have mild to moderate symptoms, like Radhika’s. For another third, the symptoms can be quite severe, while for the remaining third, there may be no symptoms at all. Symptoms that typify menopause include period changes, hot flashes, vaginal dryness, urinary problems, sleep disturbances, and volatile emotions.
Gayathri Karthik, obstetrics and gynaecology consultant at Manipal Hospital, who runs the Mother and Child Clinic, Bangalore, says that treatment of menopause has to be customized depending on the symptoms experienced and the age of the patient. She recommends oestrogen supplements in a pill or patch form as an effective treatment for hot flashes. For menopausal symptoms such as vaginal dryness, recurrent urinary infections or pain during intercourse, oestrogen therapy administered vaginally has been found to be effective. Hormone replacement therapy, or HRT, is also effective in treating osteoporosis and reducing bone loss after menopause.
Dr Shah advocates the use of HRT for the treatment of menopausal symptoms. She says that to determine whether a woman is eligible for HRT, she is made to first undergo a series of tests—including a pap smear, an ultrasound of the ovaries/uterus, a mammography and blood tests for liver function and clotting factors. Once the test results are cleared by her doctor, HRT may be prescribed. Dr Shah says that while she counsels her prescreened healthy menopausal women to try HRT, only 5% actually take it—she attributes this to the negative coverage of HRT.
In 2002, when the US National Institutes of Health’s Women’s Health Initiative trial designed to study the effects of HRT first published its findings based on data gathered from 160,000 post-menopausal women, it seemed that HRT was not cardio-protective and seemed to increase the incidence of certain types of cancers. However, when the data was reanalysed by an international panel of experts affiliated with The Endocrine Society in the US, it was found that the risks of HRT may have been overstated and that it should be considered as an option.
If a woman cannot take HRT because of a history of breast or uterine cancer, active liver disease or if she is wary of HRT, there are other alternatives available. Hot flashes can be treated with oestrogen-like plant compounds called isoflavones, says Dr Karthik. Relief from vaginal dryness may be achieved by using vaginal lubricants, frequent intercourse and Kegel exercises. Women can also learn to avoid certain triggers of hot flashes—stress, caffeine, alcohol and very hot environments. Since women tend to put on weight around their mid-section post-menopause, managing weight with regular exercise and a healthy diet can go a long way in maintaining self-image and self-esteem.
Nirmala Vaze and Sulabha Joshi from the Nagpur chapter of the Indian Menopause Society published a review on the uses of yoga in combating menopausal symptoms in the Journal of Mid-Life Health in July 2010. In this they cited half-a-dozen studies that showed yogic asanas (stretching exercise) and Pranayam (breathing exercise) are useful in the treatment of menopause-related symptoms.
How to cross the bridge
What to expect when menopause is setting in, and how to ease the transition
Problem: Hot flashes
Symptoms: A sudden feeling of heat in the upper part of the body, or all over the body, followed by heavy sweating and cold shivering
Treatment: Oestrogen pills or patches, Paroxetine, Venlafaxine,Clonidine, avoiding hotflash triggers such as caffeine
Symptoms: Thinning of the vagina and a corresponding increase in vaginal infections
Treatment: Oestrogen administered vaginally, vaginal lubricants,frequent intercourse, Kegel exercises
Problem: Urinary problems
Symptoms: Increased frequency of urinary infections,leakage of urine-or urinary incontinence-during exercise or while coughing
Treatment: Hormone replacement therapy (HRT), antibiotics, urological surgery, Kegel exercises, yogic stretches
Problem: Sleep disturbances
Symptoms: Interrupted sleep and night sweats
Treatment: HRT, Pranayam
Problem: Volatile emotions
Symptoms: Increased irritability and darker moods
Treatment: HRT, antidepressant medication, cognitive behavioural therapy, Pranayam, regular exercise
* Name changed on request
Sujata Kelkar Shetty, PhD, writes on public health issues and is a research scientist trained at the National Institutes of Health in Bethesda, US.
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