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
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