Menopause: Get informed

Menopause affects women generally between the ages of 45-55. Menopause is caused by the gradual reduction of estrogen and progesterone production.

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Menopause

What is Menopause?

Menopause is a natural process that marks the permanent end of a woman’s ovulation and menstrual cycles. Every woman is born with a set number of ovarian follicles. During the period known as “reproductive activity”, the ovarian follicles mature and are released cyclically. If the ovarian follicle remains unfertilized, it is flushed out of the woman’s body during the next menstrual period. These cycles continue until the stock of ovarian follicles has been depleted. Once there are no more ovarian follicles and ovulation has ceased, production of progesterone and oestrogen hormones slows down and eventually stops. The slowing down of hormone production marks the beginning of menopause

At what age does menopause start?

Menopause usually starts between the ages of 45 and 55. Menopause is defined as the absence of a menstraul period for 12 consecutive months; therefore, a woman is said to enter menopause after 12 consecutive months without experiencing a menstrual period.

There is a time period, generally between 2 to 4 years, known as perimenopause, which refers to the time in which the body transitions into menopause. Perimenopause usually manifests with irregular periods, premenstrual syndrome or PMS (breasts tenderness just prior to the start of a period, irritability, fatigue), hot flashes, and night sweats. Perimenopause symptoms usually appear around the age of 47 and are due to a deficiency in progesterone, while estrogen production continues.

Diagnosis

The principal diagnostic criteria is the absence of a menstrual period for at least 12 consecutive months in women, near or over the age of 50. In such cases, further tests are usually deemed unnecessary. If in doubt, a physician could prescribe a test of progesterone levels. The patient takes progesterone 10 days per month during 3 consecutive months. If she is menopausal, her periods will not return.

Symptoms of Menopause

Menopause symptoms are “climacteric” which means they are closely linked to diminishing hormone levels as ovular production shuts down. It’s important to note that both the number and intensity of symptoms vary from woman to woman. No two women’s symptoms are exactly alike and some women report no symptoms at all.

Symptoms

  • Hot flashes or nausea may appear from time to time or up to several times in a single hour. They are often experienced at night, disturbing sleep patterns. These symptoms may also appear during the day and are often provoked by ambient heat, eating a meal, alcohol, exercise, or strong emotions. Hot flashes are the most common symptom and are noted by 8 out of 10 menopausal women;
  • Night sweats;
  • Headaches, fatigue, insomnia, irritability and anxiety;
  • Joint pain, fleeting and changing from joint to joint, often more intense in the morning hours;
  • Genital symptoms including vaginal dryness, pain during sexual intercourse (“dyspareunia”), vaginal inflammation (“vaginitis”) and reduced libido;
  • Unitary tract infections, irritations, urine leaks or more frequent bouts of acute cystitis;
  • Weight gain (especially around the belly) due to reduced estrogen levels and a lower
    metabolic rate.

Increased risk of certain diseases

Menopause raises the risk of developing certain diseases like osteoporosis (heightened risk of fractures and vertebral compression) and cardiovascular diseases. The risk is even higher for smokers and the overweight.

What is Premature Menopause?

Premature menopause is when the symptoms of menopause appear before age 40. It may manifest naturally or be provoked by treatment for another condition (Removal of the ovaries, chemotherapy or radiation therapy for example).

Treating Menopause

During Perimenopause

Perimenopausal women should take steps to avoid unwanted pregnancies during this time. A low-dose oral contraceptive like Desogestrel or use of an intrauterine contraceptive device will not only prevent pregnancy but could also reduce symptoms. A progestin-based treatment like Prometrium may also be prescribed.

Living with Menopause

As the intensity of symptoms varies considerably, there are many women who need no treatment at all. However, if symptoms begin to affect quality of life, there are treatments physicians can prescribe to reduce the severity of the symptoms:

  • Hormone Replacement Therapy (HRT) is a hormonal replacement therapy that locally administers estrogen and progesterone, for example the combination of Estrogel (topical estradiol gel) and Prometrium (pill). HRT should be re-evaluated monthly to make adjustments depending on patient health. 
  • Other treatments like beta-alanine for hot flashes, and vaginal lubricants or hydration.

Any treatment should be complemented with living a healthier lifestyle, such as quitting smoking, reducing alcohol consumption, regular physical activity, and a balanced diet.

North American Menopause Association, US Office on Women's Health

Article written by Camille Dauvergne, 4th-year Pharmacy student.

Last updated: 11/12/18

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