Introduction

The Menopause is an essential event in the life of biologically assigned females. It is the termination of egg production in the ovaries and the total cessation of the menstrual cycle. When a woman passes through this phase of life, she loses the ability to be fertile and get pregnant.

Understanding the Menopause:

We will understand the whole phenomenon through the example of Mrs Ahmad:

Mrs Ahmad is 50 years old. She belongs to an eastern joint family system where all family members live together. As she is the elder daughter-in-law of the family, there are a lot of responsibilities that she handles. A few months before, she faced irregular menstruation along with hot flushes and sleep deprivation, which disrupted her daily life routine a lot. She felt mental as well as physical health distortion and thought to consult her lady doctor.

The Biology of Menopause:

Mrs Ahmad is undergoing menopausal progression, or in simple words, we can say she transit to the stage of menopause.

It is the time that indicates cessation of the monthly menstruation cycle. A woman is considered to be menopausal when it is complete 12 months without menstruation.

Menopause is a physiological aspect of the female aging process. Menopause is itself not a pathological condition; rather, it indicates the initiation of aging of the reproductive system.

How does Menopause initiate?

• As we discussed earlier, menopause is not a disease; instead, it is a natural physiological mechanism that starts to occur due to the natural deprivation and aging of oocyte reserves found in the ovaries.
• It also causes a decline in the granulosa cells of the ovary, which are the leading site of estradiol and inhibin production, as the decreased production of both hormones, as mentioned earlier, causes increased levels of circulatory FSH and LH.
• The low estrogen levels disturb the hypothalamic-pituitary-ovary axis, causing the inability to develop the endometrium and, as a result, metrorrhagia until menstruation stops completely.
• It is also assumed that the diminished oocyte reserves cannot respond adequately towards FSH, so as a consequence, no LH surge and ovulation doesn’t occur, which will also result in the reduction of estrogen and cessation of menstruation.

What are the phases of menopause?

Menopause is not a transient event; instead, it is a slow process and consists of three phases:

1. Perimenopause:

• Perimenopause started several years before the menopause. This phase begins in the late 30s to 40s when the activity of ovaries starts to decline, producing less estrogen, and ends till menopause when there is a complete stoppage of egg production by the ovary.
• At the same time, there is also a spike in estrogen production during the perimenopausal phase, so there is a possibility of conceiving.

2. Menopause:

• Menopause is the phase during which the ovaries stop releasing eggs and most of their estrogen production.
• There is no menstruation for a complete year, which is considered a menopause.

3. Postmenopause:

• This phase is the time after menopause occurs. The later whole life is considered post-menopausal with associated symptoms.
• Hot flushes, osteoporosis, and heart disease are some of the symptoms of post-menopausal life.

What is Menopause age?

• The menopause age varies from woman to woman; however, the transition towards menopause begins in the late 40s.
• The average menopausal age is from 42 to 52 years.

What are the 1st signs of Menopause?

• Irregular menstruation (cycle too long or too short) is considered as 1^st sign of menopause.
• The frequency and pattern of the cycle are also disrupted.
• Some experience vasomotor symptoms like hot flashes.

What are the worst menopause symptoms?

The severity of signs and symptoms always vary from woman to woman. Most women experience minor symptoms that are not so irritating and treated with some lifestyle modifications. On the other side, some women suffer from an intensifying series of signs and require medical assistance.

Some of the most experienced list of signs and symptoms related to menopause are:

• Hot flashes (sudden feeling of hotness all over the body)
• Irregular menstruation (alteration in frequency and intensity)
• Profuse sweating (especially at night)
• Breast sore to touch (tenderness)
• Atrophic vaginitis (dryness of the vagina due to low estrogen)
• Insomnia (sleep deprivation)
• Bladder incontinence
• Change in mood (mood swings, depression)
• Change in skin texture (dryness, acne)
• Anxiety
• Headaches
• Increase growth of facial hairs
• Palpitation
• Libido
• Thinning of hair or hair fall

What are the diagnostic tests for Menopause?

• Your doctor will ask about your menstruation history and the details about the intensity and frequency of flow.
• To check the ovary functions, it is usually recommended for the FSH, Progesterone, and Estrogen levels through serum.

What are the long-term health-related complications of Menopause?

The post-menopausal symptoms indicate the termination of reproductive-associated events. It sometimes has some complications associated with the menopausal transition:

1. OSTEOPOROSIS:

It is a bone disorder in which the bone density becomes less, more fragile, and susceptible to fracture. Estrogen is responsible for maintaining bone density. So, menopausal women are more prone to have osteoporosis.

Estrogen is responsible for enhancing osteoblast cells, which promote bone formation.

Doctors recommend a good diet and high calcium intake to make bones more robust and tolerate any stress.

2. CARDIOVASCULAR DISORDERS:

Cardiovascular disorders are the major complication factors associated with menopause. As the estrogen levels decline in menopause, it will enhance the risk of CV disorders. Estrogen is responsible for the downregulating of inflammatory markers, including chemokines and cell adhesion molecules, thus helping to minimize CVD.

It is also proven that estrogen has an impact on oxidative stress, which is associated with a variety of cardiovascular disorders like atherosclerosis, heart failure, and hypertension.

Estrogen is responsible for the upregulation of the overall antioxidant status of the body as well as minimizing the serum lipid peroxide level concerning oxidative stress.

3. URINARY INCONTINENCE:

It is also an essential complication of menopause. Sometimes, after the onset of menopause, many women experience less control over the urinary bladder (involuntary incontinence), a strong urge to urinate, or urine flow while coughing or lifting something (stress incontinence).

Estrogen is responsible for safeguarding the tissues of the bladder in a healthy state. A decline in its level will cause weaker pelvic floor muscles and reduce the elasticity of the urinary tract, leading to the issues mentioned above.

4. VAGINAL ATROPHY:

The thickness, lubrication, and elasticity of the walls of the vagina are maintained with the help of estrogen hormone.

With the onset of menopause, its levels drop down, which results in the thinning, drying, and inflammation of vaginal walls. It also causes libido (decreased desire for intercourse due to lack of sensation).

5. OBESITY:

Some women experience obesity during and after menopause as the rate of metabolism slows down, and low levels of estrogen increase the prevalence of obesity in women.

6. EXCESSIVE FACIAL HAIR GROWTH:

As estrogen levels are reduced in menopause, the level of testosterone and other androgen increases or is related to estrogen, resulting in excessive hair growth on the face and other body parts.

Estrogen (estradiol) is chiefly responsible for altering hair follicle growth and cycle through estrogen receptor binding and promoting aromatase activity (converting androgen to estrogen).

Now, several modern technologies have evolved to get rid of these hairs wholly and permanently.

Conclusion:

In conclusion, the menopause is a natural phase in a woman’s life when her body changes significantly. While it can be a bit tough, many women find ways to manage the symptoms and continue to live healthy and fulfilling lives. Support from healthcare professionals, family, and friends can make the journey through menopause a lot smoother. Remember, menopause is a unique experience for every woman, and it doesn’t mean the end of a vibrant and active life – it’s just a new chapter in the beautiful story of womanhood.