Life after menopause can truly be golden
View(s):World Menopause Day falls on October 18
By Dr. Piyusha M. Atapattu
A bent old woman is slowly walking to the temple with her granddaughter. A lady bank manager looks sadly in the mirror at her graying hair and expanding waistline. A middle-aged teacher gets irritated with her students, finding it difficult to endure the spells of heat and sweating. A husband nearing retirement finds his wife no longer interested in him, but engrossed in religious activities.
These familiar scenarios paint a bleak picture of ageing and menopause. But is menopause a condition to be deplored, ignored and feared? No, it is not.
Here are the facts and myths of menopause and some frequently asked questions.
What is menopause?
Menopause is the time when the monthly menstruation, or period, stops permanently. This occurs in the late forties and early fifties. If it sometimes happens earlier, in the thirties, it is called premature menopause. Menopause is a normal milestone in a woman’s life. Premature menopause however, is a problem and has to be treated.
Why does menopause occur?
A woman has two ovaries (egg sacs) which usually releases one ovum (or egg) every month, from the time she attains menarche till she reaches menopause. A little girl is born with 6-7 million germ cells, but they rapidly get depleted, with only 300–400 maturing into ova, to be released monthly in her lifetime.
The functioning ovaries that produce ova are the key to making of a ‘real’ woman! They release the female sex hormones estrogen and progesterone, which are responsible for the ‘hourglass’ female body, glowing skin and hair, ‘feminine’ brain and many other feminine attributes. A baby is conceived when an ovum is fertilized by a sperm. If there is no fertilization, the ovum is wasted, and the inner lining of the uterus (womb) is shed as the monthly period or menstruation.
After the mid-30s, the quality of the ova becomes poor, and finally all the ova are exhausted by the late 40s to early 50s. This is the time marked by menopause, after which there is no estrogen formed in the ovary, no ova released, no possibility of pregnancy and the best news of all- no periods!
Does this mean that there is no chance of pregnancy after menopause?
Absolutely! The ovaries can no longer produce ova, so there cannot be a natural pregnancy, and as there are no wasted ova, there is no shedding of the lining of the uterus as menstrual ‘periods’. However, menopause cannot be confimed until one year has passed without menstruation. It is also necessary to ensure that the woman is not pregnant, has not had the womb removed, is not on any birth control methods or has any other diseases which interfere with menstruation. Women are advised to use a suitable family planning method during this time to avoid unplanned pregnancies, until menopause is confirmed.
Why is there irregular bleeding around this time?
Periods occur when a wasted ovum is shed with the inner lining of the uterus as menstrual blood. Close to menopause the ovaries do not release ova regularly, and the blood levels of female sex hormones fluctuate. Some may have frequent heavy bleeding whereas others may have periods few months apart with little bleeding. If you have problems with menstrual periods around this time, see a doctor to find the underlying cause. Longstanding blood loss may lead to anaemia, which should also be treated. After menopause there should be no bleeding, and if even a single episode of bleeding occurs, see a doctor to exclude the possibility of a cancer.
What are hot flushes?
A common complaint in women nearing menopause is the sudden feeling of a wave of heat or a hot flush lasting a few minutes, spreading from the face to the upper part of the body. If fair complexioned, the hot flush may be visible. There may be sweating, palpitations and sometimes a feeling of faintness.
Hot flushes are harmless and gradually disappear after menopause; rarely persisting for a few years. Reassurance with explanation, wearing cotton clothing, drinking plenty of fluid, using a fan and frequent bathing are usually successful in managing them, while regular exercise, good nutrition and avoiding caffeine may help. Treatment with hormone replacement therapy (HRT) is effective when simple measures are inadequate.
Why do women become irritable and depressed?
Fluctuating hormone levels affect the brain, and women may feel out of sorts, irritable, anxious or sad for no reason. Close family and friends may have to bear the brunt of unreasonable outbursts. Other factors like hot flushes, ageing changes in the body, feeling unwanted and unattractive, children leaving home, work stress, retirement and midlife crises may all play a part. Support of family and friends, getting involved in new activities, regular exercise and personal care usually help in dealing with this transient period of ‘menopausal blues’. If the symptoms are more serious, medical help will have to be sought.
Why do you get ‘fat in the middle’?
Low estrogen levels and ageing changes in the body are the main reasons for the increasing waistline. It is recommended that a woman’s waistline be less than 80cm (30 inches) but at menopause, most women exceed this. The slowing body metabolism and reducing physical activity lead to fewer calories burnt, so eating the same amount of calories as in the past make excess calories remain in the body. These get deposited as fat, and redistributed from under the skin to the abdominal cavity, around blood vessels and in the organs. This is not only unsightly, but causes major harm as the fat in the abdomen produces harmful chemicals which contribute to high blood pressure, diabetes, high blood cholesterol levels, increasing the risk of heart attacks and strokes.
Cutting down on carbohydrates (especially rice, short eats and sweets) and fats, doing regular exercise (walking, jogging, swimming) for at least 30 minutes daily and maintaining a healthy weight are the cornerstones of maintaining your waistline. Remember you can’t ‘out-exercise’ a bad diet – to burn the calories gained by a piece of cake will need 30-60 minutes of walking!
What about osteoporosis?
Osteoporosis meaning ‘porous bone’ is caused by the reduction of the bone mass. From the mid-thirties the bone mass gradually declines and the loss of bone is accelerated when the ovaries stop secreting estrogen after menopause. This causes bones to fracture easily. Older women commonly fracture their wrist or leg bone in the hip joint after a fall. Further, tiny bits of bones in the spine break without the woman being aware, which leads to bone pain, gradual bending forward of the spine and loss of height, seen in so many grandmothers.
Osteoporosis can be prevented by slowing the bone loss; by increasing weight-bearing exercise like walking and jogging, having a diet rich in calcium, vitamin D and protein while avoiding smoking, alcohol and salty or fatty foods. Don’t wait until menopause to prevent osteoporosis, but adopt a healthy lifestyle from early life. Medicines are available to prevent and treat osteoporosis (eg. Calcium, vitamin D, bisphosphonates, HRT) and so if osteoporosis is suspected, you should see your doctor.
Should HRT be used by all women after menopause?
No. HRT is recommended for women who have premature menopause or when they have severe hot flushes. HRT should be started early and can be continued till the mid-fifties. There is a very slight risk of breast cancer and blood clots in the legs, but the doctors are able to identify these risks before starting HRT. If prescribed according to recommendations HRT is of great benefit.
Is menopause a blessing in disguise?
Menopause marks the end of the reproductive life for women, but it can be a blessing in disguise. There will be no more menstrual periods and no more pregnancies, which could markedly improve sexual relationships. Moreover, this is the time when a woman has achieved much: brought up her children and reached the peak of her career. She is experienced, knowledgeable, respected and valued and has become financially stable. She is free from much of her responsibilities and is able to do many things she had been planning all her life. She is in her late forties or early fifties, her appearance is mature but pleasing, her body still healthy and strong and her mind sharp and clear.
No wonder that many women after menopause become leading professionals, artists, community leaders and even politicians. We see many who become presidents, prime ministers- even a current US presidential candidate! Life after menopause can truly be golden, if women are determined to make it so.
(The writer is a Specialist Physician and Senior lecturer in Physiology, Faculty of Medicine, University of Colombo and Secretary, Menopause Society of Sri Lanka)