Menopause is a natural biological state marking the end of a woman’s fertile years and menstruation, around age 45 to 55. It is said to have happened after 12 consecutive months without a period. This period of transition, known as perimenopause, can bring hormonal ups and downs, causing symptoms. Let us understand and manage the transition from perimenopause to post menopause, specifically addressing common concerns such as hot flashes, vaginal dryness, sleep disturbances and mood changes, exploring hormone therapy and its alternatives and focusing on maintaining bone and heart health during this life stage.
Written By: Dr. Devika Gupta ( MBOBG)
Reviewed By: Dr. Sarita Dhawan
- Perimenopause (Pre Menopause)- This begin before menopause, often starting in your 40s. During this phase, the ovaries gradually start producing less oestrogen and progesterone, causing physical and emotional changes, and you experience irregular periods, hot flashes, night sweats, mood swings, and sleep disturbances. Perimenopause can last from 4 to 10 years.
- Menopause- When you have not had a period for 12 consecutive months. Menopause is a natural process, not a disease, but it can bring physical and emotional challenges.
- Post menopause- Once you have reached menopause, you enter the post menopausal phase. During this time, many of the symptoms of menopause subside, but the long term effects of hormonal changes like bone density loss and increased heart health related risk, become more important to monitor.
Symptoms of menopause
- Changes in menstrual cycle: Your monthly periods may become less regular- they might come late, early, or skip months before they stop completely.
- Hot flashes: You suddenly feel very hot, especially on your face, neck, or chest, like a heatwave inside your body. You may sweat a lot for few minutes, especially at night, sometimes your clothes or bed feel wet. This may also disturb your sleep.
- Vaginal dryness: There may be feeling of dryness or itching. It can make sex uncomfortable or even painful.
- Changes in libido: You might not feel like having sex as often. This can be due to vaginal dryness, tiredness, or just not feeling in the mood.
- Mood changes: You may feel more irritated, sad or anxious than usual- like you’re on an emotional rollercoaster for no clear reason.
- Changes in skin and hair: Hair may become thinner, and skin can feel drier or less firm.
- Sleep disturbances: It may be hard to fall sleep or stay asleep. You may wake up feeling tired even after a full night in bed.
- Memory and concentration issues: You may have a hard time remembering things or focussing, this is sometimes called as brain fogging.
- Bone health: There may be decreased strength in bones, making it more likely to break once if you fall.
- Cardiovascular health: With menopause, you may watch out for unusual tiredness, shortness of breath, chest discomfort, heart beating fast, swelling in legs or feet.
Managing Menopausal Symptoms
- Hormone replacement therapy (HRT): HRT helps to replace the hormone in your body, which decreases around your menopause.
- Non hormonal medications: There are certain medicines like antidepressants, clonidine, gabapentin that may reduce the symptoms like hot flushes, mood swings, or sleep issues but are usually prescribed only after consultation and examination by the treating doctor.
- Lifestyle modifications: Regular aerobic exercise, such as running and swimming, may help, as may low intensity exercise, such as yoga. Reduced intake of caffeine and alcohol may also help to reduce hot flushes and night sweats.
- Vaginal and urinary care: Many women find using vaginal moisturisers, lubricants, vaginal estrogen creams may help for vaginal dryness but should be taken only after gynecologist consultation.
- Hormonal therapies can also reduce bladder infections and help urinary symptoms. If you experience any unexpected vaginal bleeding, you should see your doctor at the earliest.
- Mental & sexual well being: Therapies and counselling, mindfulness and stress reduction along with the exercises help with the mood swings, brain fogging, anxiety and decreased confidence or body image concerns.
- Vaginal lubricants, moisturisers or local oestrogen may help with the lower sex drive, discomfort while having sex.
- Bone Health: Eating calcium rich foods like milk, paneer, curd, Ragi, almonds. Sunlight exposure for 15-20 minutes a day for Vitamin D which helps in absorbing calcium along with exercises like yoga, stair climbing, walking helps to maintain bone strength.
- Cardiovascular health: You can protect your heart by eating more of fruits, vegetables, less of processed foods. By staying active, yoga or light exercise most of days of the week. Avoiding smoking and alcohol as much as possible.
- Regular health checkups: Visiting your Gynaecologist once a year during or after menopause helps you stay on top of your health.
- Herbal supplements: Plants or plant extracts are widely used to reduce hot flushes and night sweats. Their safety is not known and they can react with other medications you may be taking for breast cancer, epilepsy, heart disease or asthma. These must not be consumed regularly or for long term.
- Alternative therapies such as acupressure, acupuncture or homeopathy may help some women. More evidence is required on the benefits and if they are used, this should be done with advice from qualified professionals.
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Hormone Replacement Therapy (HRT):
- Hormonal therapy helps to replace the hormone in your body, which decreases around your menopause.
- Hormonal therapies can be given in the form of tablets, skin patch, gels, sprays and implants.
- Benefits: Helps in alleviating the symptoms of menopause like hot flushes, low mood, improving sexual desire, reducing vaginal dryness and keeping your bone strong.
- Risks: There may be slight increase in the risk of breast cancer. However, it varies with other underlying risk factors such as body weight, your drinking and smoking habits. Slight increase risk of forming blood clots with oral tablets, which is not the case if taken as patch or gel.
- If you are interested in taking HRT, your healthcare professional should cover both the shortterm (over the next 5 years) and the longer term (beyond the next 5 years) benefits and risks for you.
- How long to be taken: There are no time limits for how long it can be taken. The benefits and risks associated depends on your individual situation and your doctor.
- Follow up: Once started with the hormonal therapies, you should visit your gynaecologist at 3 months to assess your symptom response, also to look for any side effects and reinforcing the lifestyle strategies.
- Further visits can be done at – 12 months interval to keep track on progress or any new concerns and evaluating bone health, heart health.
When to see a gynaecologist:
- If you are having irregular or heavy bleeding after having menopause
- If you are experiencing menopausal symptoms before the age of 45
- If your menopausal symptoms are disrupting your life.
Latest guidelines regarding menopause:
The menopause Society: www.rcog.org.uk/en/patients/menopause