Thursday, 4 October 2018

CLIMACTERIC, MENOPAUSE & INFERTILITY

Introduction
It is an essential prayer that we live till a ripe old age. Perhaps we should also be quick in adding that such ageing must be with grace and good health. It is also a well, known fact that in some individuals, ageing is inevitably accompanied by increasing variety of ailments ranging from hypertension, diabetics mellitus, arthritis etc. in both sexes.


However, in women a peculiar medical condition, the menopause accompanied by Climacteric constitutes a significant source of worry, sorrow, and agony sometimes-requiring hospital admission

What is menopause?

This condition refers only to cessation of menstruation. It is merely one of the manifestations of the Climacteric.

What is Climacteric?

This condition is a transitional phase lasting 1 to 5 years during which the genital organs involute in response to the cessation of ovarian activities. It is to be noted that, although the period may stop (at menopause) due to reducing hormone from the ovary, some ovarian activity remains after the menopause in addition to some oestrogen being made available from another source (adrenal cortex) and ovarian cortex. Note also that the MENOPAUSE and CLIMACTERIC is PECULIAR only to the human race

At what Age does menopause occur?
Contrary to some beliefs, age at menopause does not depend on the age at a woman’s first menstruation (menarche) or the type of menstrual cycle or number of pregnancies the woman has had. In the absence of general or pelvic diseases, factors that can influence age at menopause are  
(1)              Economic and social status
(2)              Familial tendencies
(3)              Racial Factors

Menopause usually occurs between the ages of 45 and 52. It is however not uncommon to meet a woman of 53 or 54 years who is still menstruating regularly. With affluence, improved health, social and economic status, age of menopausal goes up.

PATTERNS OF MENOPAUSE
Menstrual function may cease suddenly without warning. It is however usually heralded by a gradual decrease in the amount and sometimes by a decrease in the frequency of the period for several months or years. The period stops because the ovaries can no longer react (by producing egg and its hormones) to the stimulus from the brain.

PHYSICAL CHANGES AT MENOPAUSE
At menopause, most women experience significant changes in their GENITAL tract in form of Atrophy (Drying up) and inactivity. The breasts shrivel and become flat. The waist line is lost and slight hair growth may appear on the face. Appetite may increase.

PSYCHOLOGICAL CHANGES
These vary widely and depends on (a) The make-up of an individual (b) The woman’s outlook on the menopause. Other factors which can then influence the above factors are (a) Being single or married (b) Whether childless, grand childless or surrounded by a happy family.

The well-adjusted and well-informed woman copes better psychologically. Many women approach menopause with fear, anxiety. They fear loss of feminity, loss of husband’s affection and some wrongly associate menopause with development of cancer. One important cause of emotional stress is the fact that the menopause represents the end of reproductive era. Married women also entertain worries that the menopause means the end of sexual desire and physical love. The fact is that LIBIDO dose and should not alter.

In Great Britain, research shows that 75% of couple’s age 60 years still practices sex regularly. Some researchers even documented increased sex urge at menopause. Middle age is often a period of stress in the home concerning the children, household duties and the husband.

What are the symptoms associated with the menopause & Climacteric

 Strictly speaking, these symptoms are necessarily those of the climacteric and for this reason they arise some month or years after the period have stopped. Hence many women who in their forties experience various discomforts and are told they are due to change of life would be re-assured by the fact above.

Research statistics suggest that 75% or less women experience some disturbance at the time of the climacteric but only ⅓ of these require seeking medical advice and not more than 1/5 of these latter group require some form of treatment. The rest need only counseling and reassurance.

Also, it is a fact that the incidence, severity and type of symptoms experienced depend largely on the presence of emotional instability before menopause.

TYPES OF MENOPAUSE SYMPTOMS

(A)            Neurotic or Psychotic:. This includes depression, nervousness, irritability and inability to concentrate. Others are headaches, lack of sleep (Insomnia) funny feelings in the hands and feet (par aesthesia) and sometimes dizziness. Occasionally are rarely the depression can worsen and become psychosis. Usually, in this situation, the person may already have a background of mental disorder.
(B)            Gastrointestinal :. Appetite may be increased or decreased. Indigestion, and constipation are common.
(C)             Cardiovascular:. This include (a) palpitation (when you feel your heartbeats) (b) Hot flushes usually associated with profuse sweating. These occur both day and night and may disturb ones sleep.
(D)            Genital and Sexual
Intercourse may become painful due to dryness and thinness of vagina and its secretions.
(E)             Others
These include: - painful and tender breasts, joint pains, some skin pigmentation and osteoporosis (bone thinness). Some heart condition may worsen (coronary thrombosis)

MANAGEMENT OF MENOPAUSE AND CLIMACTERIC SYMPTOMS

The first thing to consider is that whatever complaint the patient has is not due to other reasons apart from the climacteric. Also it is important for the woman to appreciate that this period in life represents just a change of life and not its end.

The woman so affected should see it as a normal body process, which requires the body systems to readjust themselves to new conditions. During these adaptations any slight disturbance will correct themselves. She would need to occupy her mind with interesting pursuits of life. Her partner should also be carried along in order for him to show understanding and tolerance. Both should appreciate that it is both normal and advisable for sexual intercourse to continue regularly. If intercourse is painful, they should use lubricants such as K-Y jelly to overcome vaginal dryness. If she is afraid of getting pregnant at this time, oral conceptive may be indicated. When hot flushes are troublesome, alcohol, coffee, hot bath should all be avoided.

 

Medical

Various medications have been in vogue over the years. However, reassurance with some sedation is helpful. We advise that you see your Gynecologist if your symptoms are getting significantly uncomfortable.

Hormone therapy

Since it is a well-known fact that these symptoms are direct result of oestrogen lack, the administration of this hormones in one form or the other bring near complete relief and provide her with a sense of well-being. In fact, we often use it to test if a woman’s symptom is due to Climacteric or not.

Oestrogen

When such oestrogens are given, it is suggested that they are given in increasing measured dose just enough to suppress symptoms significantly but not necessary completely and maintained for say 1 to 3 months before being reviewed. If adequate this can be maintained and then reviewed downwards slowly over a course of 3 or 4 months. Gradual meaning is the secret of treatment because sudden dosage reduction is usually accompanied by return of symptoms with renewed intensity. Tropically, your Gynecologist will prescribe this hormone giving it as mouth tablets or as implant (slow release) or as a skin patch.

Mixed oestrogen/progesterone preparation.
In order to avoid the risk of cancer of the womb such oestrogen preparation is usually given in combination with another hormone called progesterone which prevents this problem. This can be given in form of tablets or injection too. Women who do no longer have a womb, due to any reason can have oestrogen alone for treatment.

Overall, these treatments are to be administered under the strict supervision of a Gynecologist who has the responsibility to offer treatments to patients based on careful selection to avoid complications such as osteoporosis, thrombosis and breast cancer where there is significant lack of oestrogen or inadequate or other forms of complications including other types of thrombosis when the dosages are too high.

It is the Gynecologist who should determine appropriately who needs additional progestogen and when in order to prevent endometrial cancer due to unopposed, continuous use of oestrogen.

ABNORMAL MENOPAUSE

Premature menopause
This occurs when the period stops before the age of 40 years as a result of inactivity of ovaries. This means that other causes of amenorrhoea have been ruled out. There is usually a history of similar problem in the family. No treatment is of value as it means that there are no more eggs in the ovaries.

 

Radiation Menopause

This occurs when the ovaries are exposed to heavy gamma radiation. Thereafter climacteric symptoms appear. However in this case there could be a resumption of menstruation after 1½ -2 years. She may even conceive and have children.

OVULATION AND MENOPAUSE

It is generally believed that menstruations are not frequently accompanied (preceded) by ovulation during the last 5 – 10 years before menopause. This is why fertility is much lower than at younger age groups. However, ovulation occurs and pregnancies have been recorded in women aged 52 years.

My dear reader, you need not worry so much about the effects of Climacteric/ menopause; it is only a natural phase that every living woman must experience. Always be assured and motivated that life continues after menopause. Please, enjoy your life positively with your spouse. I look forward to getting your questions and comments via 08033069466.

Dr. Michael Ogunkoya
Managing Director, The Hope Valley Fertility Clinic
08033069466

The Hope Valley Fertility Clinic
Plot 31, Block 113, Gbemileke Akinsonwon Street, Opposite Treasure Garden, By Ikate Roundabout, Lekki Phase 1, Lagos-Epe Express Way, Lagos.
08033069466