There is a great deal of rubbish written and believed about the menopause. The “change” is feared by many women who see it as a sign that they are “over the hill” while some husbands going through their own “male menopause” blame their problems on their wife.
Like it or not the menopause is a natural part of a woman’s life and she has to accept it. What she doesn’t have to accept are the symptoms that sometimes go with it.
Menopause now comes usually sometime between 45 and 50. It marks the end of a woman’s reproductive life – it doesn’t mean she has lost her femininity.
When the ovaries begin to fail and the hormone production falls, periods finally cease. This is what we call the menopause.
For many women this event passes with a minimum of discomfort. Unfortunately, for others it may bring many unpleasant side effects.
Most of the symptoms of the change of life are due to a lack of estrogen or an excess production of the stimulating hormones of the pituitary, gonadotrophins.
The first sign of the menopause is a reduction in the frequency and the amount of bleeding with the periods. Should the reverse happen and the periods come more often or the loss is heavier, this indicates something is wrong, but not necessarily cancer.
The commonest symptom at this time is the development of hot flushes.
They are caused by surges of the gonadotrophins from the pituitary, dilating the superficial blood vessels of the skin. The other symptoms are usually due to a lack of circulating estrogens.
The vagina may lose its softness and become dry. This can cause pain or difficulty with intercourse or the dry thickened skin may become itchy. Similar changes may occur in the lining of the urethra, the tube that passes urine from the bladder to the outside. This inflammation may lead to frequency and discomfort or burning in passing urine.
The tissues on the pelvic floor may become weak and sag and this may allow the womb and the vaginal walls to drop down and produce a prolapse.
The bones may lose their protein matrix on which the calcium is laid down. The calcium also is lost and the bones become thin and brittle. This condition, osteoporosis, can be prevented by estrogens but not reversed.
However, most of the other symptoms and signs are quickly cleared by replacing this hormone.
The altered chemistry of the body leads some women to gain weight and this is usually on the thighs or abdomen.
Depression is common at this time and maybe due to different things. Some mild depression may be due to the altered hormonal state, just as some women experience a lowering of mood at the time of the period. This depression rapidly clears when estrogens are given.
Other depression comes from an altered lifestyle or from loss, or fear of loss, of the things or values associated with reproductive life. It may require anti-depressant drugs and psychotherapy.
For many women the menopause presents no problems and indeed they may welcome it. It means they are free from worrying about pregnancy and can abandon contraception.
Women who have been inhibited in their sex life because of a fear of pregnancy, may suddenly “discover” sex and find full enjoyment for the first time. This can produce some marital discord as their husbands are losing the ardor of youth.
Other women who see sex only in terms of reproduction may lose all interest as now there is no “reason” for it.
Menopause is a normal phenomenon and most women sail through it with only minor discomforts. For those who don’t, what can be done?
Should women receive hormone replacement treatment at this time of their lives? This question has raised arguments among both lay and medical groups.
Most doctors in this country would accept that where the symptoms of the menopause are severe then they require treatment, but few women should be given these hormones routinely.
One of the problems of giving estrogens is that it may cause some vaginal bleeding. Any bleeding in postmenopausal women should be investigated to exclude cancer of the uterus. The usual investigation is to do a curette.
In a woman taking estrogen over a long time there may be several episodes of bleeding. It is not always safe for the doctor to assume that the hormones are the cause. For this reason and to prevent repeated curettes, some doctors have suggested that women having estrogen treatment should also have a hysterectomy.
This is a major operation and should not be undertaken lightly.
The danger of estrogen is that it does increase the risk of developing cancer of the body of the uterus by some four or five times, but this is a rare disease.
The younger woman who has had her ovaries removed and has had her menopause thrust on to her will usually require estrogen supplements at least until she reaches the normal menopausal age of the late 40s. The older woman requiring estrogen may only need it for a few weeks.
One problem that does seem to worry most women at this time of life is whether they can become pregnant or not. The answer is yes, but requires qualification.
Those women who have not had a pregnancy for 10 or 20 years despite a casual attitude to contraception are not likely to conceive as readily as women who have demonstrated their fertility right up to or past their 40s.
If a woman’s periods have stopped for a full year it can be assumed that she has passed the menopause and can abandon contraception.
What we think important is for every woman to be treated as an individual and receive advice that applies to her and her special needs.
The doctor regrets that he is unable to enter into correspondence with readers.