SYMPTOMS OF MENOPAUSE
The term, ‘menopause’ refers to the physiological cessation of menstruation at a certain age, usually between 45 – 55 years, in life. Although the term is used to describe all the various symptoms that occur at this stage, the actual meaning of the word is just what it says - ‘pause of menstruation’.
The right term for all the menopausal symptoms as well as menopause itself is ‘climacteric’. Climacteric is the transitional phase lasting for 1 – 5 years during which the reproductive tract changes in response to the decreasing activity of the ovaries.
Menopause usually starts by a gradual decrease in the amount of blood loss during each menstrual period and an increase in the gap between two periods.
It may sometimes be associated with excessive and prolonged bleeding due to the hormonal imbalances at this time. If excessive bleeding does occur, it should be thoroughly investigated to rule out some disease process.
Symptoms of Menopause
The symptoms of menopause occur due to the changes in the various organs of the body as a result of decreasing estrogen levels.
Symptoms of Menopause due to Changes in the Genital Organs
- Uterus : The uterus becomes small and fibrotic due to atrophy of the muscles after the menopause. Since the ovaries fail to produce any follicles after the menopause, the level of estrogens diminish in the blood and the endometrium (inner uterine lining) too becomes thin and atrophic. The cervix becomes smaller and appears to flush with the vagina. In very old women the cervix may be almost impossible to identify separately from the vagina. The vaginal and cervical discharge initially decreases in amount and later disappears completely, unless there is an infective process.
- Ovaries : The ovaries become smaller and shriveled in appearance. The ovarian blood vessels become thick and sclerosed. After a few years of menopause, the surface of the ovary looks white and smooth possibly as a result of decreased activity. The ovaries, which produces only a little androgens (male hormones) during the active reproductive life, begins to produce it in increasing amounts.
- Vagina : The vaginal mucous membrane becomes thin and loses its rugosity (typical wrinkles in the mucosa) after the menopause. The depth of the vaginal vault disappears. Decreased secretions make the vagina dry. Sexual intercourse becomes painful and difficult due to pain from the dry vagina. Pain during intercourse is one of the main symptoms of menopause.
There is an increased tendency to develop a type of non-infectious vaginitis called Postmenopausal Vaginitis (Senile Vaginitis). This vaginitis may cause severe itching of the vagina - one of the many common symptoms of menopause.
- Vulva or the external genital organs :
The fat in the labia majora and the mons pubis decreases and pubic hair becomes sparse. The vaginal opening becomes narrower.
- Breasts:
The glandular structure of the breasts atrophy but not the fat. So in thin-built women, the breasts become flat and shriveled, while in heavily built women, they remain flabby and pendulous.
Symptoms of Menopause due to Changes in the General Appearance
- Skin:
The skin loses its elasticity and becomes thin and fine. This is due to loss of substances like elastin and collagen from the skin. Wrinkles become more prominent. There may be a slight growth of hair on the face due to excess androgen production by the ovaries. Warts become more prominent and there may be deposition of melanin in the skin called 'age spots'. For many women, these symptoms of menopause are what causes the most distress.
- Weight:
Many women in menopause or perimenopause, tend to put on weight at this time.
Although it is believed that menopause itself causes an increase in weight, weight increase is more likely to be the result of irregular food habits due to mood swings. There is more deposition of fat around the hips, waist and buttocks. This weight increase can be kept in check by a good, low calorie diet and
proper exercises.
- Hair:
Hair may become dry and coarse after menopause. There may be hair loss due to the decreasing level of estrogens. Corresponding increasing level of androgens (male hormones) can cause a male pattern baldness to develop.
- Voice:
The voice becomes deeper due to thickening of the vocal cords.
Symptoms of Menopause due to Changes in the Metabolism of the Body
- Osteoporosis:
Osteoporosis occurs due to more calcium loss in the urine coupled with less calcium absorption from the gut. The calcium moves out of the bones, leaving them weak and liable to fracture at the smallest stress. Knee pain, joint pain and body aches are common. There is loss of height after the age of 65 due to increased curvature of the spine as well as a loss in the length of the spine. Many women come to the doctor with aches and pains in various joints of the body as the main symptom of menopause.
- Increased cholesterol levels in the blood:
Hyperlipidaemia or an increase in the level of cholesterol and lipids in the blood is common. This leads to a gradual rise in the risk of heart disease and stroke after the menopause.
- Digestive System:
Motor activity of the entire digestive tract is diminished after menopause. The intestines tend to be sluggish resulting in constipation. Digestion of nutrients from the gut also decreases - so the menopausal women should always be careful to take adequate vitamin and mineral supplements. Insufficient water intake and absorption can lead to dehydration, further contributing to constipation.
- Urinary System:
As the estrogen level decreases after menopause, the tissues lining the urethra and the bladder becomes drier, thinner and less elastic. This can lead to increased frequency of passing urine as well as an increased tendency to develop urinary tract infections. Urinary incontinence, stress incontinence and urge incontinence are other problems of the urinary tract that are common in women in menopause.
Symptoms of Menopause due to Changes in the Vasomotor System
- Hot Flashes:
Hot flashes are incidents where the woman in menopause gets a sudden feeling of warmth and flushing that starts in the face and quickly spreads all over the neck and upper body. These ‘hot flashes’ can occur at any time of the day or night. They can even keep her awake at night. They vary in number from 1 in one hour to as much as one in every 15 minutes. The hot flashes are often associated with profuse sweating.
- Night Sweats:
Night Sweats are closely related to hot flashes. Both usually occur simultaneously. Although sweats can occur at any time of the day or night, they are more common at night. The sweats can be severe enough to wake up the woman from a sound sleep and may make it difficult for her to go back to sleep. The sudden waking up from sleep can cause palpitations and sometimes panic attacks.
Symptoms of Menopause due to Changes in the Psychology of the Woman in Menopause
The psychological changes are mainly manifested by frequent headaches, irritability, fatigue, depression and insomnia. Although these are often said to be due to the changes in the hormonal levels, they are more likely to be related to the loss of sleep due to night sweats, conditions like diabetes and high blood pressure at this age, and stressful life situations around this time - like retirement, health problems etc.
The woman in menopause may also complain of occasional ‘pins and needles’ sensation on her palms and feet, more so at night. This sensation is more likely to be the result of a vitamin B deficiency or nerve problems due to diabetes or other medical conditions, rather than due to menopause itself.
Symptoms of Menopause due to Sexual Changes
Diminished interest in sex (libido) may be due to emotional upsets or may be secondary to painful intercourse due to a dry vagina (Postmenopausal Vaginitis (Senile Vaginitis)
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