Menopausal Transition: 
How to navigate life through perimenopause and menopause with confidence?
The menstrual cycle, associated with hormonal change, is the characteristic of the reproductive phase in a woman’s life. In this period, the ovaries produce hormones essential for reproduction and a woman’s well-being. For example, in the reproductive phase, female sexual hormones protect cardiovascular health, making it rare for young women to have heart attacks. In addition, estrogen helps use calcium to increase bone strength and maintain cholesterol levels in the blood. With ageing, the ovaries stop producing eggs, menstruation ceases, and female hormone levels decline. Twelve consecutive months of not having a period are defined as natural menopause and are a natural part of ageing. The average age is 46 years in India, less than women’s counterparts in the West (51 years in the United States).
Perimenopause is the time before periods stop and can last up to 8-10 years. Historically, this phase was considered a tumultuous time in a woman’s life, as she underwent unpleasant menopausal transition symptoms like hot flashes, night sweats, mood changes, depression, insomnia, anxiety, difficulty concentrating, and genitourinary and sexual function changes. At this stage of life, irregular or heavy periods requiring medical or surgical intervention are also standard. In addition, weight gain, hair loss, dry skin, breast changes and an increase in facial hair add to low self-esteem often associated with facing the reality of ageing. Menopause increases blood pressure, higher LDL (bad cholesterol) levels and lower HDL levels (good cholesterol). These are the risk factors for developing heart disease. Osteoporosis or brittle bones, which tend to fracture easily, are another long-term effect of menopause. Women lose 25% of their bone mass from the time of menopause till the age of 60.
Dr Sunita Varma – Director – of Obstetrics & Gynaecology, Fortis Hospital Shalimar Bagh, shares ten ways in which this menopausal transition can be made more accessible:
1) Regular exercise a daily exercise routine will not only control weight and help insomnia, osteoporosis and heart disease. Endorphins (neurochemicals released in the body with activity) will elevate mood and reduce irritability. In addition, tranquillity brought on by yoga and meditation can help dispel mood swings, fear, and anxiety.
2) Diet healthy eating is suitable for general well-being, but some modifications can specifically help with menopausal symptoms. Specific triggers like caffeine, spicy foods, smoking and alcohol can set off uncomfortable hot flashes, and avoiding them is better. Some foods contain plant estrogens called isoflavones, e.g., soybeans, chickpeas, lentils, flaxseed, fruits, and vegetables. Including these in the diet can help with the uncomfortable symptoms. Adequate daily calcium consumption is essential for reasonable bone health calcium requirement in menopausal women is more than required in pregnancy (1.5 gms/day Vs 1.2 gms/day). Calcium supplements might be a good idea if diet alone does not meet this daily requirement. Since reproductive hormones also keep cholesterol in check, a low-cholesterol diet is essential for cardiovascular health in menopausal.
3) Hot flashes can also be triggered by hot weather, tight clothes, anxiety and stress. Wearing loose, comfortable clothing and keeping the house (especially the bedroom) cool and well-ventilated can help with these distressing hot flashes and ensure better sleep.
4) Dealing with anxiety, depression, mood changes, irritability and energy loss can be difficult. If lifestyle modifications do not help, seeking a doctor’s advice would be a good idea. Sometimes antidepressants or hormone therapy may be required. Support groups and counselling can also be helpful tools in dealing with these symptoms.
5) Sometimes, difficulty concentrating or minor memory lapses can be a part of the menopausal transition. Activities like crossword puzzles, word games, sudoku, reading etc., can help keep the brain stimulated.
6) Getting pregnant becomes impossible after menopause, but in the perimenopausal period, there is a possibility. Therefore, some contraception should be used until menopause is fully achieved.
7) Decrease in sex drive and vaginal dryness causing painful intercourse sometimes makes it difficult for menopausal women to enjoy sex. Vaginal dryness can be treated with hormonal gels, making it possible to have intimacy again. Emotional support from one’s partner at this stage is paramount.
8) Hormone replacement therapy (HRT) with estrogen or a combination of estrogen and progesterone is prescribed to help women tide over this transitional phase if symptoms are severe. However, some risks associated with HRT include increased endometrial or uterine cancer and thrombo-embolism ( formation of blood clots leading to deep vein thrombosis, pulmonary embolism or stroke). Therefore, it is only recommended to relieve menopausal symptoms such as hot flashes, vaginal dryness or urinary symptoms – under strict medical supervision, taking into account your medical history, family history and risk factors.
9) Regular checkups of blood cholesterol levels, sugar levels, blood pressure and bone densitometry can allow for specific, timely pharmacological interventions for controlling osteoporosis, hypertension, diabetes and high cholesterol. These would help in preventing heart disease and fractures later in life.
10) Visiting the gynaecologist regularly are a top priority and not only allows doing a clinical pelvic and breast examination along with a pap smear, but it is an opportunity to discuss menopausal issues and make informed decisions about the best form of therapy.
In conclusion, if tackled correctly, perimenopause can be a positive period in life. Lifestyle interventions like exercise and diet, regular health checkups, support groups and pharmacological medications can improve quality of life. Always be open with the healthcare provider so that she can help optimize the sense of well-being and minimize long-term health hazards.
