Menopause or climacteric was considered the end   for many women. Their reproductive years were over Numerous pregnancies, hard work and a poor diet took their toll, and only a few women lived into their sixties or seventies.

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This, however, is no longer true. Life expectancy of women in India has increased. This has spawned a whole new generation of  who spend almost half their life after menopause.

Regular menstruation and reproduction is controlled by the pituitary gland and involves periodic release of eggs from the ovaries. It is mediated by pituitary and ovarian hormones released in the correct proportions.

During menopause, the levels of the pituitary hormones, LH (luteinising hormone) and FSH (follicle stimulating hormone) rise while the levels of the ovarian hormones, oestrogen and progesterone fall. Eggs are no longer released and the woman ceases to menstruate or be fertile.

Menopause is defined as the cessation of menstruation for a year. It usually occurs between the ages of 41 and 55 years. Menopause often occurs when the woman is already finding life difficult as her children have grown up and left the house and her husband is busy with his career.

Some women sail blissfully through menopause without missing a beat, whereas in others the altered hormone levels makes them symptomatic. Extraneous social factors often aggravate the symptoms.

Typically they complain of   hot flushes.  This is a sensation of heat and burning which starts in the chest, progresses upwards and lasts a few minutes. It is followed by drenching sweats or chills. The flushes may occur several times a day or just a few times a month. They cause sleep disturbances, irritability, mood swings, headaches and memory loss. The result is the stereotyped unreasonable, ill-tempered postmenopausal woman.

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The hormonal changes slow down the metabolism and weight may slowly creep upwards. The skin may also become thin and dry producing itching. Libido may be altered. Vaginal dryness may make sex painful and unpleasant.

Some of the symptoms of menopause may be mimicked by other medical conditions such as thyroid or pituitary malfunctions, or simply weight gain that seems to be a common feature during middle age.

Absence of menstruation may be due to pregnancy. Approaching menopause is heralded by changing menstrual patterns in an older woman.

During the time of menopause :

* Have a complete gynaecological evaluation including a pap smear for cervical cancer.

* Have a baseline mammogram. If it is normal, repeat it every three years. In the interim, perform breast self examinations once a month

* Rule out other medical problems like hypertension, diabetes and lipid abnormalities.

Once menopause has set in:

* Keep yourself busy. Develop new interests, have a hobby, learn something new.

* Weight should be maintained within normal limits. BMI (Body Mass Index — weight in kg divided by height in metre squared) should be as close to 25 as possible. The waist should be 34 inches or less.

* Prevent osteoporosis by doing 45 minutes of aerobic exercises like jogging or fast walking every day. Calcium supplements are also needed as diet is often deficient. A bone density test can be done to determine if alendrolate or raloxifene is needed in addition to calcium.

* Keep the muscles strong by doing muscle strengthening exercises using a “baby” dumbbell weighing ½ to 1 kg. Strong muscles help to maintain balance and prevent falls and injuries.

* Maintain flexibility with regular stretches and yoga.

*To tackle hot flushes, dress in cotton and other natural fabrics. Drink plenty of water. Avoid alcohol as it aggravates hot flushes.

* Creams containing oestrogen (Premarin Evalon) are safe and can be applied locally in the vagina to overcome dryness, itching and pain during intercourse. They should not be used if there is undiagnosed post menopausal vaginal bleeding.

HRT (hormone replacement therapy) was very popular and widely prescribed. It was assumed that by tackling the deficiency of oestrogen with tablets, all the symptoms and ill effects of menopause would disappear. HRT does help in women who have severe hot flushes. But it should not be continued for more than six months because after that, the risks and side effects may out weigh the benefits.

The symptoms of menopause are apparently less among Japanese and Chinese women. Although this may be cultural, it has been attributed to the consumption of soya, which contains the plant oestrogens called phytoestrogens. Soya is now one of the natural products recommended to control the symptoms of menopause. Soya products can be consumed as chunks, nuggets, flakes, flour, tofu or milk.

Natural supplements with extracts of black cohosh, ginseng and other herbal products are also believed to be beneficial. But they should be taken only after consulting a physician.

Menopause is inevitable but it can be tackled.

Source:The Telegraph (Kolkata,India)

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