Menopause refers to the end of your menstrual cycle. Not having your period for 12 months is the primary menopause symptom, commonly exhibited around the age of 45.

Menopause

Overview

Menopause has been denoted as the evident end of a regular menstrual cycle. The term can depict any progressions one goes through nearing the end of the period or what one may experience closely after it, indicating the completion of your reproductive years and stages<a href="#accordion">[12]</a>.

&nbsp;

Typically, menopause is marked after 12 months of the previous menses, usually affecting menstruating women between the ages of 45-55, but there have been reports of people reaching menopause before and after that age bracket<a href="#accordion">[8]</a>. It is a normal and natural process but can also be triggered after certain medical procedures such as the removal of ovaries or the uterus, or treatments of chronic illnesses such as chemotherapy, or hereditary dispositions. Perimenopause is the point at which the person has side effects before their periods have halted.&nbsp;

Menopause and perimenopause can cause side effects like nervousness, temperament swings, mind haze, hot flashes, and unpredictable periods. These side effects can begin a long time before the period pause and continue a while later. Menopause and perimenopause side effects can hugely affect the individual&rsquo;s life, including connections and work. There are things one can do to assist with side effects. There are additional drugs that can supplant the missing chemicals and assist with easing the unavoidable signs and symptoms.

&nbsp;

Signs And Symptoms

Types of menopause have been characterized by four classifications: natural menopause, last menstrual period (LMP) over a year prior, and periods concluded without intervention or as a side effect of any medical procedure, chemotherapy, or hormone enhancement; hysterectomy, periods discontinued because of hysterectomy, with the protection and preservation of one of the two ovaries; bilateral oophorectomy, periods halted in light of careful and medically necessary removal of the two ovaries, regardless of hysterectomy; surgical menopause, an amalgamation that joined those in the bilateral oophorectomy and hysterectomy for comparative analysis<a href="#accordion">[4]</a>.

However, the medical fraternity studies menopause along its various stages. The three most common stages are as follows:

&nbsp;

<ul>
	<li>
	<h5>Perimenopause</h5>
	</li>
</ul>

The vague and short time frame leading up to menopause, when estrogen and hormone levels within the body witness a gradual decline, is called perimenopause. It is commonly observed that women enter perimenopause in their late 40s, and can start to encounter unpredictable feminine cycles and side effects. Signs and symptoms may range from hot flashes to vaginal dryness. At this stage, there persists an opportunity that individuals can conceive, but if they choose to not conceive or reduce the slim possibility of it, a type of contraception is suggested until one year after their last period. A type of progestin treatment may likewise be a choice to control the menstrual cycles and address vasomotor side effects. To ease and relieve discomfort from the unpleasant symptoms of perimenopause, most doctors recommend lifestyle changes<a href="#accordion">[9]</a>.

&nbsp;

<ul>
	<li>
	<h5>Menopause</h5>
	</li>
</ul>

Menopause happens when the reproductive system discontinues creating the hormones that initiate the menstrual cycle, as the ovaries have stopped producing estrogen or releasing eggs and have proceeded without a period for a considerable length of time<a href="#accordion">[2]</a>. The transition from perimenopause to menopause varies from woman to woman&nbsp;but can take roughly 1 to 3 years.&nbsp;

&nbsp;

<ul>
	<li>
	<h5>Postmenopause</h5>
	</li>
</ul>

Postmenopause is the stage labeled after menopause has happened. When this occurs, the person is in post-menopause until the end of their life. Individuals in post-menopause are at growing risk for specific medical issues like osteoporosis and coronary illness<a href="#accordion">[12]</a>. There is no defined age bracket that naturally commences an individual&#39;s journey into a postmenopausal life. Once the menstrual bleeding has been depleted for over one year, the person is said to be in post-menopause paying little heed to maturity. By and large, individuals go through menopause close to 51 years old. Several people in post-menopause have expressed residual or similar side effects from menopause. The side effects are less extreme. At times, they nearly vanish. Residual or less hyped symptoms are brought about by low degrees of reproductive hormones<a href="#accordion">[2]</a>. Vaginal bleeding during post-menopause is certainly not an ordinary symptom of diminishing hormone levels. Now and again, the dryness in your vagina can cause some light bleeding or spotting after physical exertion or sexual intercourse. In different cases, it could lead to a condition like endometrial hyperplasia or uterine fibroids, diseases like endometritis, or malignant growth. Contact your medical healthcare professional if you experience any vaginal bleeding, so you can be assessed, monitored, and provided with the necessary medical aid<a href="#accordion">[2]</a>.

&nbsp;

Causes

Research has suggested different causes of menopause, albeit, sometimes the cause may be obscure. Menopause can result from the following:&nbsp;

&nbsp;

<ul>
	<li>
	<h5>Natural Depletion Of Reproductive Hormones</h5>
	</li>
</ul>

When menstruating individuals approach&nbsp;their late 30s, their ovaries begin making less estrogen and progesterone &mdash; the hormones that directly influence and affect the feminine cycle &mdash; and their fertility level decreases gradually. In their 40s, they observe their regular cycles might turn out to be longer or more limited, heavier, or lighter, and more frequent or with much significant dry spells, until in the end &mdash; on average, by age 51 &mdash; their ovaries quit delivering eggs, and they have no more periods<a href="#accordion">[6]</a>.

&nbsp;

<ul>
	<li>
	<h5>Surgical Procedures</h5>
	</li>
</ul>

The ovaries are responsible for producing hormones, including estrogen and progesterone, that control, monitor, and synchronize the monthly menstrual cycle. Thus, medical procedures to eliminate the ovaries cause early and prompt menopause. The monthly periods halt, and the person is likely going to have to go through hot flashes and experience and adjust to other menopausal signs and symptoms. Signs and side effects can be serious, as hormonal changes can occur immediately rather than building a tolerance for low estrogen and progesterone over the years. A medical procedure that calls for the removal of the uterus rather than the ovaries (hysterectomy) generally does not impede the menstrual cycle or bring into effect menopause. Even though the individual may never again have periods, the ovaries continue to discharge eggs&nbsp;and produce estrogen and progesterone<a href="#accordion">[6]</a>.

&nbsp;

<ul>
	<li>
	<h5>Chemotherapy And Prolonged Radiation Therapy</h5>
	</li>
</ul>

These disease treatments can actuate menopause, causing side effects, for example, hot flashes during or not long after the course of treatment. The stop to the monthly cycle (and fertility) is not necessarily irreversible or long-lasting following chemotherapy, so contraceptive measures might in any case be wanted. Radiation treatment possibly influences ovarian capability if radiation is aimed at the ovaries. However, radiation treatment to different parts of the body, for example, breast tissue or the head and neck, generally does not influence menopause<a href="#accordion">[6]</a>.

&nbsp;

<ul>
	<li>
	<h5>Primary Ovarian Insufficiency</h5>
	</li>
</ul>

​​​​​​​Approximately 1% of women undergo menopause before age 40, commonly referred to as premature menopause. Untimely menopause might result from the inadequate creation of normal degrees of reproductive hormones by the ovaries and this condition is known as primary ovarian insufficiency, which can come from hereditary elements or immune system illness. Be that as it may, frequently, no conclusive origin or cause for such untimely and premature menopause has been found. For these individuals, hormone treatment is regularly suggested until the normal period of menopause to safeguard the cerebrum, heart, and bones<a href="#accordion">[14]</a>.

&nbsp;

<ul>
	<li>
	<h5>Autoimmune Diseases And Chromosomal Defects</h5>
	</li>
</ul>

​​​​​​​Studies have shown relationships between certain birth conditions with premature menstruation. Turner Syndrome is when one of the two X chromosomes is absent, it can cause a variety of medical problems such as the ovaries failing to develop properly, heart disease, and short height. Thyroid disease refers to the imbalance of the thyroid to produce normal functioning levels of hormones<a href="#accordion">[10]</a>.

&nbsp;

Diagnosis

The most common indicator of menopause is its symptoms such as hot flashes. Other symptoms may include:

<ul>
	<li>Irregular periods</li>
	<li>Vaginal dryness</li>
	<li>Tender to touch breasts</li>
	<li>Frequent urination</li>
	<li>Insomnia</li>
	<li>Unpredictable mood swings</li>
	<li>Dry skin</li>
	<li>Fatigue</li>
	<li><a href="https://www.merisehat.pk/disease/depression" target="_blank">Depression</a></li>
	<li>Headaches</li>
	<li>Joint pain</li>
</ul>

An individual may experience one or more symptoms and should seek out a medical healthcare provider to confirm the suspicion of menopause. They will monitor and examine your symptoms to guide you toward an efficient treatment.

&nbsp;

Menopause, in most cases, is not easy to be self-diagnosed, and missing a period for more than three months is a concerning state which is why professionals should be involved. They may test the prognosis through various methods:

&nbsp;

<ul>
	<li>
	<h5>Physical Exam</h5>
	</li>
</ul>

Before scheduling an appointment with the doctor, monitor all signs and symptoms one is encountering, how frequently they happen, and how serious they are. Important to note when the last period occurred and ultimately report any anomalies in timing that could have happened. Make a rundown of medications and enhancements that might be included in the daily routine and might be affecting the menstrual cycle.

The doctor will pursue to acquire more information about the date of your last period along with how frequently you experience side effects. Go ahead and talk about your side effects, which might incorporate hot flashes, spotting, emotional breakdowns, inconvenience while resting, or sexual issues. It is crucial to not shy away while discussing the current state with your doctor, any issue that you might shrug off as insignificant may be pivotal to formulating a personal and proper treatment.

Menopause is a characteristically feminine cycle, and doctors can offer their patients sound guidance and medically safe advice. Normally, the side effects exhibited are sufficient to reach a hypothesis, but the relevant proof to assist with diagnosing menopause can only corroborate the existing symptoms.

Most likely the medical services supplier will take a swab sample of the vagina to test its pH levels, which can likewise assist with affirming menopause. Vaginal pH is around 4.5 during healthy reproductive years. However, the initiation of menopause ascends the vaginal pH to an equilibrium of 6.

If a woman is having menopausal side effects, the primary care physician might arrange tests to preclude different circumstances, like primary ovarian insufficiency or a thyroid condition, a lipid profile, or an array of tests for liver and kidney function<a href="#accordion">[3]</a>.

&nbsp;

<ul>
	<li>
	<h5>Hormone Test</h5>
	</li>
</ul>

The doctor might arrange a blood test to check the degrees of follicle-stimulating chemicals (FSH) and estrogen. During menopause, the FSH levels are invigorated, while the estrogen levels decline. During the primary stages of the menstrual cycle, FSH, a hormone delivered by the front pituitary organ, activates the development of eggs as well as the creation of a hormone called estradiol.

Estradiol is a type of estrogen that is in charge and liable for (in addition to other things) managing the menstrual cycle and supporting properties and functionality of the reproductive system. As well as affirming the transition to menopause from perimenopause, this blood test can distinguish indications of specific pituitary disorders which may be disguised or hidden.

The primary care physician might arrange an extra blood test to gauge the condition and levels of the thyroid-stimulating hormone (TSH), as <a href="https://www.merisehat.pk/disease/hypothyroidism" target="_blank">hypothyroidism </a>can cause side effects that may resemble those of menopause.

A relatively recent discovery led to the support of a diagnostic and demonstrative test called the PicoAMH Elisa test which estimates how much of the anti-Mullerian hormone (AMH) is present within the blood system. Its results can assist the doctor with predicting when the individual will enter menopause on the off chance that their perimenopausal stage has not concluded yet<a href="#accordion">[3]</a>.&nbsp;

Whenever menopause has been affirmed, the primary care physician will walk the patient through treatment choices. They may not require any treatment if the side effects are not serious. Although the primary care physician might prescribe specific medications and hormone treatments to manage side effects that can influence personal satisfaction.

&nbsp;

Treatment

Menopause cannot be reversed, but due to scientific breakthroughs, its symptoms can be managed to ease the patient. The following course of action might be taken:

&nbsp;

<ul>
	<li>
	<h5>Hormone Replacement Therapy (HRT)</h5>
	</li>
</ul>

This is additionally called menopausal hormone treatment. The patient is required to take meds to supplant the hormones that the body now fails to produce naturally. Certain medications or combinations can assist with hot flashes and vaginal side effects, as well as strengthen the bones. However, they can likewise put the individual at a more probable prospect of succumbing to other medical issues like coronary illness or breast cancer. Therefore, one ought to take the most minimal portion that works for the briefest time conceivable<a href="#accordion">[12]</a>.

Estrogen comes in various forms and dosages, such as skin patches, sprays, gels, implants, and oral tablets. For it to work properly, individuals with a uterus need to protect their lining from the side effects of estrogen by taking progesterone. The latter hormone is accessible as patches, intrauterine devices, and tablets<a href="#accordion">[8]</a>.

&nbsp;

<ul>
	<li>
	<h5>Topical Estrogen</h5>
	</li>
</ul>

The vagina might become dry, difficult, or irritated because of menopause and perimenopause. A GP can endorse estrogen medicines that can be embedded into the vagina, such as a tablet, cream, or ring. This proves to be a multifaceted treatment option as it may positively develop any urinary side effects brought about by menopause and perimenopause like the inconvenience one feels during urination.&nbsp;These vaginal estrogen medicines are not provided with a path to enter the circulation system and just work on the focused areas of the body where you put them. They do not have a rigid time frame and can be utilized for ease throughout the post-menopause stage. Discontinuing the use of the product might welcome back unpleasant symptoms. There have not been any recorded repercussions. Therefore, vaginal estrogen is safe to be used with HRT<a href="#accordion">[8]</a>.

&nbsp;

<ul>
	<li>
	<h5>Non-Hormone Therapy</h5>
	</li>
</ul>

If preferred, one can opt for non-hormonal treatment to abate the severity of menopausal symptoms such as hot flashes. Non-hormonal pharmacological therapy includes alpha adrenoceptors agonists (methyldopa, clonidine, and lofexidine), antidepressants and anticonvulsants, and GABA analog (Gabapentin)<a href="#accordion">[5]</a>.&nbsp;

&nbsp;

<ul>
	<li>
	<h5>Lifestyle Changes</h5>
	</li>
</ul>

For hot flashes, hydrate regularly with cold water, situate yourself in a cool environment, and dress lightly. Participate in yoga to decrease blood pressure and increase bone flexibility. Avoid smoking tobacco as it deteriorates symptoms. To monitor low serotonin and energy levels, occupy with social obligations and gatherings. Decrease alcohol and caffeine consumption to reduce the risk of breast cancer, and avoid disturbing sleep patterns<a href="#accordion">[12]</a>.

&nbsp;

Postmenopause may weaken an individual&rsquo;s immunity, making them more susceptible to specific medical conditions and ailments. Such as:

&nbsp;

<ul>
	<li>
	<h5>Cardiovascular Disease</h5>
	</li>
</ul>

The growing and impending risk of cardiovascular disease is contingent on the stage when estrogen levels decline. <a href="https://www.merisehat.pk/disease/coronary-artery-disease" target="_blank">Coronary </a>illness has a strikingly high mortality rate in women as well as in men. Therefore, it is essential to change the routine by engaging in physical activity, consuming a sound and moderate eating regimen, and monitoring weight within the average and age-appropriate weight bracket. Initiate detailed discussions with the primary care physician for suggestions and recommendations on the most proficient method to safeguard the heart, for example, how to prevent an imbalance in cholesterol or blood pressure if it is excessively high<a href="#accordion">[6]</a>.

&nbsp;

<ul>
	<li>
	<h5>Loss Of Bladder Control</h5>
	</li>
</ul>

As the tissues surrounding the vagina and urethra lose flexibility, an individual might encounter successive, abrupt, compelling impulses to urinate, trailed by an involuntary loss of urine (urinary incontinence). Or the deficiency of urine with coughing, giggling, or lifting (stress incontinence). They might become more vulnerable to urinary tract diseases, contracting them more regularly. Fortifying pelvic floor muscles with Kegel activities and utilizing an effective topically administered vaginal estrogen might assist to alleviate the side effects of incontinence. Hormone treatment may likewise be a powerful treatment choice for menopausal urinary tract and vaginal changes that can bring about urinary incontinence<a href="#accordion">[6]</a>.

&nbsp;

<ul>
	<li>
	<h5><a href="https://www.merisehat.pk/disease/osteoporosis-80" target="_blank">Osteoporosis</a></h5>
	</li>
</ul>

This condition makes bones fragile and frail, prompting an exceeding and stressing concern about&nbsp;fractures. During the initial years after menopause, one might lose bone thickness at a quick rate, increasing the complications of osteoporosis. Postmenopausal women with osteoporosis are particularly prone to fractures of their spine, hips, and wrists<a href="#accordion">[6]</a>.

&nbsp;

<ul>
	<li>
	<h5><a href="https://www.merisehat.pk/disease/obesity" target="_blank">Obesity</a></h5>
	</li>
</ul>

Numerous individuals have pointed out a similar and unprecedented outcome of menopause, noting how they put on weight during the menopausal change and after menopause, since it hinders the digestive tract and forces the metabolism to slow down. This might be possible due to the immediate hormonal fluctuations; low and unregulated levels of estrogen may lead to excessive fat storage. Moreover, due to perpetual fatigue and weaning of the bones, the post-menopause lifestyle is most commonly sedentary. Therefore, allowing loss of muscle mass. Menopausal individuals may also develop insulin resistance, which may decrease their chances of losing weight, making them more at risk of diabetes<a href="#accordion">[7]</a>.

&nbsp;

<ul>
	<li>
	<h5>Sexual Function</h5>
	</li>
</ul>

Vaginal dryness occurs from the loss of moisture as there is a decreased production of it. Such a loss of versatility can cause inconvenience and slight bleeding during intercourse. Additionally, the diminished sensation might lessen the longing for sexual activity and affect the individual&rsquo;s natural libido. Water-based vaginal creams and ointments might help. On the off chance that a vaginal lubricant does not provide comfort and ease, numerous individuals benefit from the utilization of regional and easily accessible vaginal estrogen treatment, available as a vaginal cream, tablet, or ring<a href="#accordion">[6]</a>.

&nbsp;

The primary elements adding to additional serious menopausal side effects were age, BMI, smoking, social class, and lack of inclusion of dairy items within the diet. Overall, postmenopausal women experienced, and were ranked notably higher in statistics of menopausal side effects when contrasted with perimenopausal women<a href="#accordion">[15]</a>.

&nbsp;

While certain lifestyle changes and drugs may forestall the menopause stage, it is a natural, inevitable, and unavoidable process every menstruating adult must go through. However, certain preventive measures may delay the arrival of menopause, or changes in lifestyle, diet, and sleep can help alleviate the symptoms.&nbsp;

&nbsp;

<ul>
	<li>
	<h5>Calcium And Vitamin D</h5>
	</li>
</ul>

Hormonal changes during menopause can make bones debilitate, making one more prone to be diagnosed with osteoporosis. Calcium and vitamin D have been associated with great bone well-being, so getting enough of these supplements by ensuring their inclusion within the diet is significant<a href="#accordion">[11]</a>. Satisfactory vitamin D admission during post-menopause is likewise connected with a lower chance of hip breaks from feeble bones. Numerous food sources are calcium-rich, including dairy items like yogurt, milk, and cheddar. Green, verdant vegetables, for example, kale, collard greens, and spinach are viable sources of calcium as well. Moreover, it can be found in generous and ample quantities in tofu, beans, sardines, and different food varieties. Furthermore, calcium-strengthened food sources likewise should be a basket addition, including specific oats, naturally extracted squeezed juices or milk options.

&nbsp;

<ul>
	<li>
	<h5>Sunlight</h5>
	</li>
</ul>

Daylight is the principal exposure of vitamin D since the skin produces it when presented to the sun. In any case, as there is progress over the years, the skin gets less effective at producing it. While prolonged and un-protective sun exposure has been linked to skin diseases, and considering how some individuals prefer covering and concealing their skin, taking an enhancement or upgrading food options by choosing those rich in vitamin D may lead to positive outcomes. Rich dietary sources incorporate sleek fish, eggs, cod liver oil, and food items braced with vitamin D.

&nbsp;

<ul>
	<li>
	<h5>Pilates</h5>
	</li>
</ul>

There exists significant proof to help advocate the different advantages of physical activity, for example, pilates-based practice programs<a href="#accordion">[1]</a>. These programs have several benefits such as stimulating energy and digestion, improving joints and bones, diminishing levels of anxiousness, and encouraging a more peaceful slumber. For instance, a study in Korea that heavily studied and analyzed the impacts of a 12-week walking exercise program found that the activity heightened physical and psychological wellness and general personal satisfaction in a gathering of 40 menopausal ladies.

&nbsp;

<ul>
	<li>
	<h5>Physical Activity</h5>
	</li>
</ul>

Regular exercise and physical fitness are likewise connected with an overall improvement in health and security against sicknesses and conditions including malignant growth, coronary illness, stroke, hypertension, type 2 diabetes, obesity, and osteoporosis. Menopausal individuals have a prominent risk of coronary illness. A few examinations show that regular and consistent physical activity might assist with diminishing the risk of such a vulnerability

&nbsp;

Doctors might be able to correctly predict whether menopause-related bone loss is now underway or going to start by estimating the level of a hormone that decays, as women approach their last menstrual period, new UCLA research states. The discoveries could assist doctors in deciding when, and how, to regard bone loss and degradation in women as they age before that bone loss causes critical medical problems. In particular, the investigation discovered that for women 42 and more established who are not yet postmenopausal, levels of the anti-Mullerian chemical, or AMH, can be utilized to decide whether they are encountering, or going to encounter, bone loss contingent on their transitional progress into menopause<a href="#accordion">[13]</a>.

&nbsp;

Key Points

<ul><li>While reaching menopause can be a frustrating and overwhelming period for some, it is important to remember that it is normal.</li><li>Menopause is the time after 12 months of the last menstrual cycle.</li><li>Common symptoms include hot flashes, fatigue, night sweats, insomnia, and irregular periods.</li><li>Maintaining a healthy diet, exercising daily, and establishing a secure sleep pattern may decrease the chances of premature menopause.</li><li>Treatment includes hormone therapy, medication for symptoms, non-hormonal therapy, and alternative methods.</li></ul>

[1] Agustín, A.-A., Fidel, H.-C., David, C.-D., Manuel, T.-C., José, D. J.-G., & Antonio, M.-A. (2019). Effects of Pilates training on sleep quality, anxiety, depression, and fatigue in postmenopausal women: A randomized controlled trial. Maturitas, Vol 124, 62-67.

[2] Cleveland Clinic. (2021, May 10). Postmenopause.

[3] Healthline. (2019, January 19). Menopause Tests and Diagnosis.

[4] Kuh, D., Hardy, R., & Wadsworth, M. (1997). Women’s health in midlife: the influence of the menopause, social factors, and health in earlier life. Br J Obstet Gynaecol, 104(8): 923-33.

[5] Malhi, T. M., Khan, Y. H., Khan, A. H., Mahmood, Q., Khalid, S. H., & Saleem, M. (2018). Managing Hot Flushes in Menopausal Women: A Review. Journal of the College of Physicians and Surgeons Pakistan Vol. 28 (6), 460-465.

[6] Mayo Clinic. (2022). Menopause.

[7] Mumusoglu, S., & Yildiz, B. O. (2019). Metabolic Syndrome During Menopause. Current vascular pharmacology, 17(6), 595-603.

[8] NHS. (2022, May 17). Menopause.

[9]Northwestern University. (2013). Stages of Menopause. Women's Health Research Institute.

[10] Office on Women's Health. (2021, February 22). Early or premature menopause.

[11] Pérez-López, F., Chedraui, P., & Pilz, S. (2020). Vitamin D supplementation after menopause. Therapeutic Advances in Endocrinology and Metabolism.

[12] Pichardo, G. (2022, June 12). Menopause. WebMD.

[13] University of California - Los Angeles Health Sciences. (21, June 2022). Levels of a certain hormone could predict or detect bone loss in premenopausal women. ScienceDaily.

[14] Welt, C. (2020, September 8). Clinical manifestations and diagnosis of spontaneous primary ovarian insufficiency (premature ovarian failure).

[15] Yang HJ, Suh PS, Kim SJ, Lee SY. Effects of smoking on menopausal age: Results from the Korea National    Health and Nutrition Examination Survey, 2007 to 2012. Journal of Preventive Medicine and Public Health. 2015;48(4):216-224. doi:10.3961/jpmph.15.021