Menopause is defined as the state of an absence of menstrual periods for at least 12 months. The menopausal transition starts with varying menstrual cycle lengths and ends with the final menstrual period. Perimenopause is a term sometimes used and means “the time around menopause.” It is often used to refer to the menopausal transitional period. It is not officially a medical term but is sometimes used to explain certain aspects of the menopause transition in lay terms. “Postmenopausal” is a term used as an adjective to refer to the time after menopause has occurred.
Thank you for reading this post, don't forget to subscribe!Menopause is the time in a woman’s life when the function of the ovaries ceases. As a result, she can no longer become pregnant. The ovary (female gonad), is one of a pair of reproductive glands in women. They are situated in the pelvis, one on each side of the uterus. Each ovary is about the size and shape of an almond. The ovaries produce eggs (ova) and female hormones such as estrogen. During each monthly menstrual cycle, an egg is released from one ovary. The egg travels from the ovary through a Fallopian tube to the uterus.
The ovaries are the main source of female hormones, which control the development of female body characteristics such as the breasts, body shape, and body hair. The hormones also regulate the menstrual cycle and pregnancy. Estrogens also protect the bone. Therefore, a woman can develop osteoporosis (thinning of bone) later in life when her ovaries do not produce adequate estrogen.
At what age does a woman typically reach menopause?
The average age of menopause is 45 years old. However, there is no way to predict when an individual woman will have menopause or begin having symptoms suggestive of menopause. The age at which a woman starts having menstrual periods is also not related to the age of menopause onset. Most women reach menopause between the ages of 45 and 55, but menopause may occur as earlier as ages 30s or 40s, or may not occur until a woman reaches her 60s. As a rough “rule of thumb,” women tend to undergo menopause at an age similar to that of their mothers.
Symptoms and signs related to the menopausal transition such as irregularities in the menstrual cycle, can begin up to 10 years prior to the last menstrual period.
How long does menopause last?
Menopause is a single point in time and not a process; it is the time point in at which a woman’s last period ends. Of course, a woman will not know when that time point has occurred until she has been 12 consecutive months without a period. The symptoms of menopause, on the other hand, may begin years before the actual menopause occurs and may persist for some years afterward as well.
Symptoms and signs
It is important to remember that each woman’s experience is highly individual. Some women may experience few or no symptoms of menopause, while others experience multiple physical and psychological symptoms. The extent and severity of symptoms varies significantly among women. It is also important to remember that symptoms may come and go over an extended period for some women. This, too, is highly individual.
1. Irregular vaginal bleeding
Irregular vaginal bleeding may occur as a woman reaches menopause. Some women have minimal problems with abnormal bleeding during the prior time to menopause whereas others have unpredictable, excessive bleeding. Menstrual periods (menses) may occur more frequently (meaning the cycle shortens in duration), or they may get farther and farther apart (meaning the cycle lengthens in duration) before stopping. There is no “normal” pattern of bleeding during the perimenopause, and patterns vary from woman to woman. It is common for women in perimenopause to have a period after going for several months without one. There is also no set length of time it takes for a woman to complete the menopausal transition. A woman can have irregular periods for years prior to reaching menopause. It is important to remember that all women who develop irregular menses should be evaluated by their doctor to confirm that the irregular menses are due to perimenopause and not as a sign of another medical condition.
The menstrual abnormalities that begin in perimenopause are also associated with a decrease in fertility since ovulation has become irregular. However, women who are perimenopausal may still become pregnant until they have reached true menopause (the absence of periods for 1 year) and should still use contraception if they do not wish to become pregnant.
2. Hot flashes
Hot flashes are common among women undergoing menopause. A hot flash is a feeling of warmth that spreads over the body and is often most pronounced in the head and chest. A hot flash is sometimes associated with flushing and is sometimes followed by perspiration. Hot flashes usually last from 30 seconds to several minutes. Although the exact cause of hot flashes is not fully understood, hot flashes are likely due to a combination of hormonal and biochemical fluctuations brought on by declining estrogen levels.
There is currently no method to predict when hot flashes will begin and how long they will last. Hot flashes occur in up to 40% of regularly menstruating women in their forties, so they may begin before the menstrual irregularities characteristic of menopause even begin. About 80% of women will be finished having hot flashes after five years. Sometimes (in about 10% of women), hot flashes can last as long as 10 years. There is no way to predict when hot flashes will cease, though they tend to decrease in frequency over time. They may also wax and wane in their severity. The average woman who has hot flashes will have them for about five years.
3. Night sweats
Night sweats (episodes of drenching sweats at night-time) sometimes accompany hot flashes. This may lead to awakening and difficulty falling asleep again, resulting in unrefreshing sleep and daytime tiredness.
4. Vaginal symptoms
Vaginal symptoms occur because the tissues lining the vagina become thinner, drier, and less elastic as estrogen levels fall. Symptoms may include vaginal dryness, itching, irritation, and/or pain with sexual intercourse (dyspareunia). The vaginal changes also lead to an increased risk of vaginal infections.
5. Urinary symptoms
The lining of the urethra (the transport tube leading from the bladder to discharge urine outside the body) also undergoes changes similar to the tissues of the vagina and becomes drier, thinner, and less elastic with declining estrogen levels. This can lead to an increased risk of urinary tract infection, feeling the need to urinate more frequently, or leakage of urine (urinary incontinence). The incontinence can result from a strong, sudden urge to urinate or may occur during straining when coughing, laughing, or lifting heavy objects.
6. Emotional and cognitive symptoms
Women in perimenopause often report a variety of thinking (cognitive) and/or emotional symptoms, including fatigue, memory problems, irritability, and rapid changes in mood. It is difficult to determine exactly which behavioral symptoms are due directly to the hormonal changes of menopause. Research in this area has been difficult for many reasons.
Emotional and cognitive symptoms are so common that it is sometimes difficult for a woman to know if they are due to menopause. The night sweats that may occur during perimenopause can also contribute to feelings of tiredness and fatigue, which can have an effect on mood and cognitive performance. Finally, many women may be experiencing other life changes during the time of perimenopause or after menopause, such as stressful life events, that may also cause emotional symptoms.
7. Other physical changes
Many women report some degree of weight gain along with menopause. The distribution of body fat may change, with body fat being deposited more in the waist and abdominal area than in the hips and thighs. Changes in skin texture, including wrinkles, may develop along with worsening of adult acne in those affected by this condition. Since the body continues to produce small levels of the male hormone testosterone, some women may experience hair growth on the chin, upper lip, chest, or abdomen.
What conditions can cause early menopause?
Certain medical and surgical conditions can influence the timing of menopause.
Surgical removal of the ovaries
The surgical removal of the ovaries (oophorectomy) in an ovulating woman will result in an immediate menopause, sometimes termed a surgical menopause, or induced menopause. In this case, there is no perimenopause, and after surgery, a woman will generally experience the signs and symptoms of menopause. In cases of surgical menopause, women often report that the abrupt onset of menopausal symptoms results in particularly severe symptoms, but this is not always the case.
The ovaries are often removed together with the removal of the uterus (hysterectomy). If a hysterectomy is performed without removal of both ovaries in a woman who has not yet reached menopause, the remaining ovary or ovaries are still capable of normal hormone production. While a woman cannot menstruate after the uterus is removed by a hysterectomy, the ovaries themselves can continue to produce hormones up until the normal time when menopause would naturally occur. At this time, a woman could experience other symptoms of menopause such as hot flashes and mood swings. These symptoms would then not be associated with the cessation of menstruation. Another possibility is that premature ovarian failure will occur earlier than the expected time of menopause, as early as one to two years following the hysterectomy. If this happens, a woman may or may not experience symptoms of menopause.
Cancer chemotherapy and radiation therapy
Depending upon the type and location of the cancer and its treatment, these types of cancer therapy (chemotherapy and/or radiation therapy) can result in menopause if given to an ovulating woman. In this case, the symptoms of menopause may begin during the cancer treatment or may develop months following the treatment.
Premature ovarian failure
Premature ovarian failure is defined as the occurrence of menopause before the age of 40. This condition occurs in about 1% of all women. The cause of premature ovarian failure is not fully understood, but it may be related to autoimmune diseases or inherited (genetic) factors.
Diagnosis
Because hormone levels may fluctuate greatly in an individual woman, even from one day to the next, hormone levels are not a reliable method for diagnosing menopause. There is no single blood test that reliably predicts when a woman is going through the menopausal transition, so there is currently no proven role for blood testing to diagnose menopause. The only way to diagnose menopause is to observe the lack of menstrual periods for 12 months in a woman in the expected age range.
Allopathic treatment options for menopause
Menopause itself is a normal part of life and not a disease that requires treatment. However, treatment of associated symptoms is possible if these become substantial or severe.
Hormonal therapy
Estrogen and progesterone therapy
Hormone therapy (HT), or menopausal hormone therapy (MHT), consists of estrogens or a combination of estrogens and progesterone (progestin). This was formerly referred to as hormone replacement therapy (HRT). Hormone therapy controls the symptoms of menopause-related to declining estrogen levels (such as hot flashes and vaginal dryness), and HT is still the most effective way to treat these symptoms. But long-term studies (the NIH-sponsored Women’s Health Initiative, or WHI) of women receiving combined hormone therapy with both estrogen and progesterone were halted when it was discovered that these women had an increased risk for heart attack, stroke, and breast cancer when compared with women who did not receive HT. These risks were most pronounced in women over 60 taking hormone therapy. Later studies of women taking estrogen therapy alone showed that estrogen was associated with an increased risk for stroke, but not for heart attack or breast cancer. Estrogen therapy alone, however, is associated with an increased risk of developing endometrial cancer (cancer of the lining of the uterus) in postmenopausal women who have not had their uterus surgically removed.
Hormone therapy is available in oral, transdermal forms (for example, patches and spray). Transdermal hormone products are already in their active form without the need for “first pass” metabolism in the liver to be converted to an active form. Since transdermal hormone products do not have effects on the liver, this route of administration has become the preferred form for most women.
There has been interest in recent years in the use of so-called “bioidentical” hormone therapy (herbal/Homeopathic) for perimenopausal women. The hormones are created in a laboratory by altering compounds derived from naturally occurring plant products. Bioidentical hormone therapy products are typically applied as creams or gels.
In summary, the decision about hormone therapy is a very individual decision in which the patient and doctor must take into account the inherent risks and benefits of the treatment along with each woman’s own medical history. It is currently recommended that if hormone therapy is used, it should be used at the smallest effective dose for the shortest possible time. It is currently recommended that hormone therapy be used if the balance of risks and benefits is favorable for the individual woman.
Oral contraceptives and vaginal treatments
Oral contraceptive pills
Oral contraceptive pills are another form of hormone therapy often prescribed for women in perimenopause to treat irregular vaginal bleeding. Women in the menopausal transition tend to have considerable breakthrough bleeding when given estrogen therapy. Therefore, oral contraceptives are often given to women in the menopause transition to regulate menstrual periods, relieve hot flashes, as well as to provide contraception. They are not recommended for women who have already reached menopause, because the dose of estrogen is higher than that needed to control hot flashes and other symptoms. The contraindications for oral contraceptives in women going through the menopause transition are the same as those for premenopausal women.
Local (vaginal) hormone and non-hormone treatments
There are also local (applied directly to the vagina) hormonal treatments for the symptoms of vaginal
estrogen deficiency. Local treatments include the vaginal estrogen ring (Estring), vaginal estrogen cream, or vaginal estrogen tablets. Local and oral estrogen treatments are sometimes combined for this purpose.
Vaginal moisturizing agents such as creams or lotions (for example, K-Y Silk-E Vaginal Moisturizer or KY Liquibeads Vaginal Moisturizer), as well as the use of lubricants during intercourse, are non-hormonal options for managing the discomfort of vaginal dryness.
Antidepressants and other allopathic medications
Antidepressant medications: The class of drugs known as selective serotonin reuptake inhibitors (SSRIs) and related medications has been shown to be effective in controlling the symptoms of hot flashes in up to 60% of women. Specifically, venlafaxine, a drug-related to the SSRIs, and the paroxetine, desvenlafaxine, citalopram, and escitalopram have all been shown to decrease the severity of hot flashes in some women. However, allopathic antidepressant medications may be associated with severe side effects, including decreased libido or sexual dysfunction.
Other medications: Other prescription medications have been shown to provide some relief for hot flashes, although their specific purpose is not the treatment of hot flashes. All of these may have side effects, and their use should be discussed with and monitored by a doctor. Some of these medications that have been shown to help relieve hot flashes include the antiseizure drug gabapentin and clonidine, a drug used to treat high blood pressure.
Homeopathic treatment for Menopause
Some of the most effective homeopathic remedies for menopause symptoms include the following:
Graphites
Menses too late, with constipation; pale and scanty, with tearing pain in epigastrium, and itching before. Hoarseness, coryza, cough, sweats and morning sickness during menstruation. Leucorrhoea, pale, thin, profuse, white, excoriating, with great weakness in back. Breasts swollen and hard. Induration of ovaries and uterus and breasts. Nipples sore, cracked, and blistered. Decided aversion to coitus.
Lachesis Mutus
Climacteric troubles, palpitation, flashes of heat, haemorrhages, vertex headache, fainting spells; worse, pressure of clothes. Menses too short, too feeble; pains all relieved by the flow. Left ovary very painful and swollen, indurated. Mammae inflamed, bluish. Coccyx and sacrum pain, especially on rising from sitting posture. Acts especially well at beginning and close of menstruation.
Sepia
Sepia is a very beneficial medicine for treating dyspareunia. Pelvic organs relaxed. Bearing down sensation, Leucorrhoea yellow, greenish; with much itching. Menses Too late and scanty, irregular; early and profuse; sharp clutching pains. Violent stitches upward in the vagina, from uterus to umbilicus. Prolapse of uterus and vagina. Morning sickness. Vagina painful, especially on coition.
Intense pain during intercourse, vaginal dryness, vaginal extremely tender.
There may be some associated pelvic disease like ovarian cysts, uterine fibroids pelvic inflammatory disease (PID) and endometriosis.
In such conditions, other symptoms like abnormal vaginal discharge, menstrual irregularities, painful periods may be present along with dyspareunia.
Sepia is also a leading medicine for managing the complaint of painful intercourse in women during menopause. Inmenopausall patients there may be other attending symptoms like hot flushes, excessive vaginal bleeding, low libido, irritability, sadness, indifference, and mood swings during menopause.
It is also well-indicated for dyspareunia arising with some skin infection or eruptions of the female genitalia.
Valeriana
Valeriana is best for woman during the menopausal stage with sleep disturbances. There is sleepless with nocturnal itching and muscular spasms.
Natrium Carbonicum
Induration of cervix. Pudenda sore. Bearing-down sensation. Heaviness; worse, sitting; better by moving. Menses late, scanty like meat-washings. Leucorrhoeal discharge, offensive, irritating preceded by colic.
Pulsatilla Pratensis
Amenorrhoea. Suppressed menses from wet feet, nervous debility, or chlorosis. Tardy menses. Too late, scanty, thick, dark, clotted, changeable, intermittent. Chilliness, nausea, downward pressure, painful, flow intermits. Leucorrhoea acrid, burning, creamy. Pain in back; tired feeling. Diarrhoea during or after menses.
Cimicifuga Racemosa
Amenorrhoea. Pain in ovarian region; shoots upward and down anterior surface of thighs. Pain immediately before menses. Menses profuse, dark, coagulated, offensive with backache, nervousness; always irregular. Ovarian neuralgia. Pain across pelvis, from hip to hip. After-pains, with great sensitiveness and intolerance to pain. Infra-mammary pains worse, left side. Facial blemishes in young women.
Helonia Dioica
Dragging in sacral region, with prolapse, especially after a miscarriage. Pruritus vulvae. Backache after miscarriage. Weight and soreness in womb; conscious of womb. Menses too frequent, too profuse. Leucorrhoea. Breasts swollen, nipples painful and tender. Parts hot, red, swollen; burn and itch terribly. Albuminuria during pregnancy. Debility attending the menopause.
Glonoinum
Menses delayed, or sudden cessation with congestion to head. Climacteric flushing.
Oophorinum
Oophorinum is effective for the hormone changes during menopause. It is prescribed for acne rosacea and other skin disorder during menopause.
Staphysagria
Nymphomania, with extreme sensitiveness to mental and physical impressions; mind dwells too much on sexual subjects. Painful sensitiveness of genital organs (especially when sitting). Prurigo senilis; or from pediculi. Smarting and lancinating itching in vulva. Sufferings after coitus in newly married women.
Inflammation of the ovaries with burning, stinging, and pressing-drawing, very sharp shooting pains in ovary – exceedingly sensitive to pressure; pains extending into crural region and thighs.Flow of blood from genitals a long time after critical age.
Menses which had ceased for a year, reappeared with cutting colic and violent rumbling, at the new moon. Spasmodic pains in vulva and vagina. Menses: irregular, late, and profuse; sometimes wanting; first of pale blood, then dark and clotted; occasionally spasmodic uterine contractions. Amenorrhoea from chagrin with indignation. Granular vegetations of vagina.
Lycopodium Clavatum
Nymphomaniac with terrible teasing desire in external organs. Itching, burning, and gnawing in vulva. Pressure towards the outside, above the vulva, and extending as far as the vagina, when stooping.
Expulsion of wind from the vagina. Chronic dryness of vagina. Shooting pains in labia, when lying down. Excoriation between the thighs, and at the vulva. Burning pain in the vagina, during and after coition.
Catamenia (too early) too profuse, and of too long duration. Catamenia suppressed readily, and for a long time, by fright. Before menses: shivering, sadness, melancholy; bloatedness of the abdomen.
During menses: delirium, with tears; headache; sourness in the mouth; pain in loins; swelling of feet; fainting; vomiting of sour matter; cuttings, colic; and pains in the back. Menstruation too late; lasts too long; sometimes suppression of; profuse, protracted; flow partly black, clotted, partly bright red or partly serum; with labour-like pains followed by swooning; with sadness; suppressed by fright.
May find females at change of life with one side of the body greatly hypertrophied. Foetus appears to be turning summersaults. Metrorrhagia; at menopause; dark blood with large clots pour from her. A rumbling begins in upper abdomen and descends to lower, when a flow of blood follows, and so on successively.
Leucorrhoea: milky, yellowish, reddish, and corrosive; sometimes preceded by cuttings in abdomen. Varices on the genitals. Disposition to miscarriages. Swelling of the breasts with nodosities. Excoriation and moist scabs on nipples. Stinging in nipples. Milk in breasts without being pregnant, vaginl dryness.
Capsicum Annum
Climacteric disturbances with burning of tip of tongue. Uterine haemorrhage near the menopause, with nausea. Sticking sensation in left ovarian region.
Sanguinaria Can
Sanguinaria can is prescribed for menopause with severe burning sensation as from hot water. Burning in various parts of the body like face, palms, soles stomach etc. Another feature is severe headache along with menopausal complaints. The woman experiences a bearing down sensation with leucorrhoea smelling like fish or old cheese.
Coffea Cruda
Menses too early and long lasting. Dysmenorrhoea, large clots of black blood. Hypersensitive vulva and vagina. Voluptuous itching.
Amylenum Nitrosum
Amylenum Nitrosum is also recommended for managing hot flashes in women in menopausal stage. Its use is mainly considered when heat flashes are accompanied by anxiety and palpitations of heart. After heat flashes, excessive sweating follows. There is a desire for fresh open air. The bed coverings are always unbearable from excessive heat. Next Amylenum Nitrosum can also relieve headache during menopause with marked congestion in head. In cases needing it, there is a sensation that the head would burst due to pain and congestion.
Sabina
Sabina can be given for controlling excessive bleeding or flooding during menopause.
Ashoka Joanesia
Delayed and irregular menses; menstrual colic; amenorrhoea, pain in ovaries before flow; menorrhagia, irritable bladder; leucorrhoea.
Kalibi Chromicum
Climacteric flushes. Menopause. Great debility, with desire to lie down. Great prostration.
Complications
Osteoporosis is the deterioration of the quantity and quality of bone that causes an increased risk of fracture. The density of the bone (bone mineral density) normally begins to decrease in women during the fourth decade of life. However, that normal decline in bone density is accelerated during the menopausal transition. Consequently, both age and the hormonal changes due to the menopause transition act together to cause osteoporosis.
Cardiovascular disease
Prior to menopause, women have a decreased risk of heart disease and stroke when compared with men. Around the time of menopause, however, a woman’s risk of cardiovascular disease increases.
Coronary heart disease rates in postmenopausal women are two to three times higher than in women of the same age who have not reached menopause. This increased risk for cardiovascular disease may be related to declining estrogen levels, but in light of other factors, medical professionals do not advise postmenopausal women to take hormone therapy simply as a preventive measure to decrease their risk of heart attack or stroke.
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Dr. Sayyad Qaisar Ahmed (MD {Ukraine}, DHMS) ; senior research officer Dnepropetrovsk state medical academy Ukraine; is a leading Homeopathic physician practicing in Al-Haytham clinic, Umer Farooq Chowk Risalpur Sadder (0923631023, 03119884588), K.P.K, Pakistan.
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