The experience of menopause may vary widely. Some women glide through the menopausal transition without seeming to have very many symptoms, whilst other have severe symptoms which can substantially interfere with their quality of life.
WHAT IS MENOPAUSE?
Menopause is the time when a woman permanently stops having menstrual periods. It is not a disease, but merely life's natural transition, from the reproductive to the non-reproductive phase of a woman's life. However, menopause cannot be satisfactorily defined as a a "permanent stopping of menstrual periods" because it is what happens to the ovaries that is key to menopause, as opposed to what happens to the uterus (which is secondary).
To illustrate, let us say the uterus of a young woman is surgically removed. She would no longer be able to have any menstruation, but she is not menopausal, because her ovaries continue to produce hormones. On the other hand, if both her ovaries are removed surgically, or destroyed through chemotherapy, she would immediately be in menopause.
Thus, menopause occurs with the the cessation of hormone production by the ovaries.
CAUSES OF MENOPAUSE
1. Natural or physiological menopause:
Occurs as part of a woman's normal aging process. It marks the end of a woman's potential childbearing years, brought on by the ovaries gradually slowing down their function. FSH (follicle-stimulating hormone) is a hormone produced by the brain, and it is responsible for stimulating the growth of the woman's eggs. As menopause approaches, the remaining eggs become resistant to FSH (hence FSH levels increase) and the ovaries reduce their production of estrogen significantly (hence, estrogen levels decrease). It is this fluctuating and rapidly declining estrogen levels that is responsible for many of the symptoms associated with menopause.
2. Induced Menopause:
This can be caused by surgical removal of both ovaries or disruption in normal ovarian function due to chemotherapy or radiotherapy.
PROBLEMS ASSOCIATED WITH MENOPAUSE
Symptoms can range from mild to severe, with each woman experiencing it differently. Some symptoms will be very bothersome, whilst others are quite manageable. The most common symptoms include hot flushes, mood changes and vaginal dryness.
1. MENOPAUSAL SYMPTOMS:
dyspareunia (pain during intercourse)
urinary incontinence and burning sensation on urination
thinning of skin
breast changes (menopause may cause changes in shape of the breasts)
loss of concentration
Rapid bone loss occurs during the perimenopausal and postmenopausal years. Bone loss in itself is painless, but it can lead to osteoporosis with increased fracture risk.
3. ISCHAEMIC CARDIOVASCULAR DISEASE
Non-smoking pre-menopausal women rarely suffer for cardiovascular disease. However, within 10 years of menopause, they catch up with the heart attack incidence of their male counterparts.
DIAGNOSIS AND INVESTIGATIONS
The diagnosis of menopause is usually made in retrospect - once it has been 12 months since your last menstruation, you are deemed to be in menopause. Occasionally, your doctor may do some laboratory tests to check the levels of certain hormones. This would include Follicle Stimulating Hormone (FSH) and Estradiol levels.
Other tests which may be done include:
Thyroid Stimulating Hormone - because thyroid disease can mimic the symptoms of menopause.
Cardiovascular Risk assessment - cholesterol levels, checks for diabetes, echocardiogram etc.
Assessment of Osteoporotic risk - DEXA scan for those at increased risk of osteoporosis.
Menopause is not a disease that requires treatment. However, short term Hormone Replacement Therapy may be prescribed in women with severe symptoms. Treatment is also prescribed for the associated effects of menopause eg. Osteoporosis, increased cardiovascular risk, urinary incontinence etc.
Dr Ang C.D. is has been in medical practice for over 12 years. He graduated with an M.B.B.S. degree from the National University of Singapore in 1997 and subsequently completed his post-graduate diploma in Family Medicine. He has had training in Emergency Medicine, Internal Medicine, Geriatric Medicine, Orthopaedic Surgery, Obstetrics & Gynaecology, Neurosurgery, General Surgery, Colorectal Surgery and Urology.
Dr Ang currently practices in a family clinic in Singapore, seeing a good mix of paediatric, adult and geriatric patients. With the goal of providing local and international patients with a resource for specialist care in Singapore, Dr Ang has founded SingaporeDoc.com, a Web Directory of Specialists in Private Practice in Singapore.