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Menopause- The “change of life”

Facing the challenge

A total of 130 million Indian women are expected to live into old age by 2015. This simply means that many Indian women will now spend several years of their lives, in the menopausal state. However, despite urbanization and education many women remain oblivious to the short- and long-term implications of this condition. Plagued with doubts about the myriad discomforting symptoms, unaware of the internal changes that happen, women very often go through this phase suffering silently.

In the first of the three- part article on menopause awareness, we discuss the spoken and unspoken symptoms of menopause.

Several generations ago, few women lived beyond menopause. Today, you may spend as much as half of your life after menopause. Menopause and the symptoms that go with it leave many with mixed feelings - of fear and uncertainty.

Understanding the internal changes that take place within your body will make you more comfortable in dealing with the variety of bothersome symptoms you may experience.

Understanding menopause

Menopause is not a medical illness. It is a natural biological process – a state of transition in a long, slow process of reproductive aging. For most women this process begins silently somewhere around the age of 40, when periods may start to be less regular and last into the 50s or even 60s.

Symptoms of menopause begin as the number of egg-producing follicles begins to shrink. The levels of both female hormones, estrogen and progesterone, begin to fall as the number of follicles decreases. The symptoms of menopause are mainly the result of falling levels of these hormones.

The degree to which each woman's body responds to these hormonal changes varies. While one fourth of women, are expected to manage the transition phase of menopause without any problems, about 50 % of women experience some menopausal symptoms, varying in intensity from mild to moderate, 25% of women have more severe disabling symptoms. Studies of women around the world suggest that differences in lifestyle, diet and activity may play a role in the severity and type of symptoms experienced by women during menopause.

The initial signs

Many women notice early symptoms while still having periods, when the hormone production is declining very gradually. This stage of gradually falling and fluctuating hormone levels is often called the "climacteric" or the "change" and often begins in the 4th decade and can last for several years.

Knowing the signs

Generally, as hormone levels fall, a woman's pattern of menstrual bleeding becomes irregular. Many women experience skipped, late or scanty periods for several months to a year before their periods stop altogether. Some women may experience heavier-than-normal bleeding.

When your menstrual periods become irregular, infrequent or scant, and if pregnancy is ruled out, rising blood levels of a hormone called follicle-stimulating hormone (FSH) help to establish or confirm that menopause has occurred.

Besides alterations in the menstrual cycle, you may experience odd symptoms that my make you wonder about your state of health. Am I fine? Am I suffering from a serious illness? What kind of check ups do I go for? What is happening to my body that my normal day to day activities are so disrupted?

From real life experiences of hundreds of women, a list of common symptoms that occur during menopause has been developed.

Are you beyond the forties? Are you experiencing any of the following? If yes, you may well be approaching menopause Consult your doctor, if you feel any of the following :

The long list of possible symptoms that say “the transition has begun”

  • Irregular periods; shorter, lighter periods; heavier periods, flooding; phantom periods, shorter cycles, longer cycles
  • Hot flashes, flushes, night sweats and/or cold flashes, clammy feeling
  • Mood swings, sudden tears. Depression, anxiety
  • Trouble sleeping through the night (with or without night sweats)
  • Loss of libido
  • Dry vagina
  • Incontinence, especially upon sneezing, laughing; urge incontinence
  • Aching, sore joints, muscles and tendons
  • Breast tenderness
  • Headache change: increase or decrease
  • Dizziness, light-headedness, episodes of loss of balance
  • Changes in body odor
  • Gum problems, increased bleeding
  • Tinnitus: ringing in ears, bells, 'whooshing,' buzzing etc.

Medically a woman is considered to be postmenopausal a full year after she has had her last menstrual period.

The unpleasant side effects of going through menopause may seem amplified by the meanings that menopause has for a woman. Some may see menopause as a sign of getting old; others may grieve the loss of their childbearing years. This phase of life may occur at the same time as other significant life changes: children may be entering college; parents may be getting older and may require more care. A holistic approach that addresses the physical, medical and emotional challenges that accompany menopause will ease the transition into what can continue to be a very enjoyable and rewarding time of life.

Osteoporosis - Is menopause responsible?

Behind the scenes story

Understanding the changes

A greater number of Indian women are expected to live into old age. To make the golden years more fulfilling, it becomes important that they are aware of the internal changes leading to menopause. Appropriate care during menopause and soon after can make the golden years truly healthy and joyous.

Menopause as commonly known; is typically the diminishing production of the key female hormone - estrogen by the ovaries.

Estrogen – otherwise known more for its functions in the reproductive phase of a woman's life reveals its role in woman's health, only during menopause.

Low estrogen levels in the body can affect several body systems, the most important being the heart, the blood vessels and the bones.

Estrogen and its relation to bone loss

Osteoporosis is a disease of the bones. In osteoporosis, bones lose density, become brittle and are prone to fracture. At the age of 65, about 30% of women have osteoporosis, and nearly all of them are unaware of their condition. After age 80, up to 70% of women develop osteoporosis.

Osteoporosis is the cause for spine and hip fracture. The lifetime risk of spinal fracture in women is about one in three and that for hip fracture is one in six. And if you consider this fact;

Between 10% and 20% of women who experience a hip fracture die within a year and about 25% require nursing home treatment, it is not really a good news.

As Estrogen is understood to play a critical role in preventing bone loss, there is a sudden speed up of bone breakdown and thinning as menopause sets in. And a tall and thin structure, less activity of the body makes one prone to osteoporosis easily and quickly.

Women at risk for osteoporosis should have a bone density test to measure their bone mass and then make a decision about treatment after consulting their physician.

Waking up to menopause

With the gradual lowering of the estrogen levels, the body makes a slow shift towards age related changes – weaker bones, losing mental agility, poor sight, wrinkling – all this and more.

Symptoms of menopause are nature's alert that there is a necessity to start paying more attention to the health. Taking proper steps towards improving lifestyle, paying greater attention to diet, and making appropriate lifestyle changes at an appropriate age, is critical to ensuring that one ages gracefully without the burden of chronic health problems.

Estrogen and the heart

  • Estrogen maintains a positive effect on cholesterol and other fats in the blood.
  • About two years before menopause, as estrogen levels begin to decline, the levels of the harmful low-density lipoprotein (LDL) cholesterol begin to rise and the advantageous high-density lipoprotein (HDL) levels decrease
  • In addition, estrogen has significant effects on smoothing, relaxing, and opening blood vessels, thereby increasing blood flow and reducing pressure.
  • Estrogen reduces blood viscosity (stickiness) and may enhance, the natural process for breaking down blood clots.

It is to be expected then, that once the protective cover of estrogen is removed after menopause, the heart disease risk may go up.

However, minor lifestyle changes, increased activity, regular exercise, and appropriate diet, considerably reduces the risk of heart disease in menopausal women.

Estrogen- other roles

Estrogen appears to have properties that protect against the memory loss and lower mental functioning associated with normal aging. Studies are also indicating that estrogen helps prevent glaucoma and other age related disease conditions of the eye. Estrogen may help prevent slackness and dryness in the skin and even reduce wrinkles and also help prevent certain dental and gum disorders.

Coping with Menopause

Facing the challenge

In the last of the three- part article on menopause awareness we discuss easy ways to cope with the distressing symptoms of menopause and ways to provide long term protection to your heart and bones

Even though the symptoms of menopause are varied – with some women experiencing severe symptoms and some none at all, the internal changes towards aging have, slowly, but surely begun. The onset of menopause thus, requires a conscious shift in your lifestyle. The best way to manage the immediate symptoms of menopause, and prevent long term risks is to have a healthy routine..

Clinical studies show that self-care through a healthy diet, regular exercise, stress reduction, and a nutritional supplement can provide significant relief from menopause symptoms without the need for prescription therapy. In fact, self-care is the foundation of any menopause management program

Here are some tips that will help improve your overall health and well-being, as well as help to alleviate the most common signs and discomfort associated with menopause.

Eat a low-fat vegetarian diet

Eating a healthy diet will help you look and feel better. Not only will a low-fat vegetarian diet help minimize the temporary symptoms associated with menopause, but more importantly, it will dramatically lower the risk of heart disease in the postmenopausal years and help prevent osteoporosis.


It is important to maintain a healthy weight. Metabolism slows as you age, so your body takes longer to burn up the food you eat. Making exercise a part of your life can pay off in many ways. Exercise can help you lose weight and keep it off. Aerobic exercises help protect against heart disease and diabetes, and weight-bearing exercises help prevent osteoporosis. Regular exercise improves circulation and reduces stress.

Nutritional supplementation

Check with your doctor on whether you need nutritional supplements

Remaining positive

It is important to understand that menopause is not a disease, but only temporary transition. Dealing with the symptoms of menopause positively, and taking sufficient care of yourself, can lead you to the most positive and fulfilling phase of your life.

Hormone Therapy

A question that arises in many minds is whether medication helps in dealing with the myriad of menopausal symptoms. Replacement of hormones has been in the news for several years. Referred to as “hormone replacement therapy” - HRT is a way of replacing estrogen that the body is no longer making. This replacement relieves the hot flashes, vaginal dryness and irritation and reduces urinary problems such as infection and incontinence. Hormone therapy has also been shown to help keep bones strong, and prevent osteoporosis.

Treatment with hormones however is not risk free. Estrogen therapy causes the lining of the uterus to grow and can increase the risk of uterine cancer. There is also an increased risk of breast cancer in women who use combined hormone therapy. Hormone therapy also appears to modestly increase the risk of heart attack, stroke and blood clots.

Moving towards nature- the role of phytoestrogens

Phytoestrogens are plant products containing “estrogen – like substances” As a group of compounds phytoestrogens have been shown to exhibit many properties and can behave by boosting estrogen effects even though the dose is minuscule.

These plant estrogens are thousands of times weaker than natural estrogen. Thus while providing the benefit of estrogen, these compounds are safe and devoid of the side effects seen with hormone replacement therapy. The plant that is richest by far in phytoestrogens is soybeans.

Numerous recent studies have endorsed the beneficial effects of soy in dealing with the short term and long term problems of menopause.

Finally, though the key to going through menopause is to look ahead to the next stage of life with confidence – as a beginning of a new and fulfilling life stage. As a women going through menopause said “ I think menopause has enhanced my concept of what womanhood is – it's made me aware of my body, it's made me aware of my hormones, it's made me aware of my life process…and it's an exciting process.

BOX items to be used between the text (practical tips to managing menopause)

Managing Hot flushes

  • Avoid hot places, wear light clothes
  • Avoid spicy food
  • Try and avoid stress

Caring for your bones and heart

  • Exercise at least 20 minutes 3 times each week;

Managing the bladder problem

  • Try Kegel exercises (for example, holding the urine flow back a few times while you are going, or tightening these muscles often during each day) to make the muscles near your bladder and vagina stronger;
  • Using a chart to fill in the times that you urinate or leak urine. Then you can plan to empty your bladder before you have a problem


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