How do I manage menopause? Tell yourself, ‘Me, no pause’


What are the unknown symptoms of menopause that women may overlook?

Female hormones, oestrogen and progesterone, are responsible for a woman’s femininity, sexuality, her reproductive career and her general wellbeing. When a woman achieves menopause (which is, 12 months after she has had her last period), the level of these hormones decreases. This has an effect on almost every system on her body. However, not all women have all the symptoms of menopause all the time. For most, the transition is smooth, others have mild symptoms that can be managed by lifestyle changes. Only a few have major symptoms that need medical management.

There could be body odour, dry eyes, dry mouth, dry and chapped skin as well as chills (not the kind that is associated with fever but a sensitivity to temperature differences), hair loss, bloating (the body tends to retain fluid as oestrogen levels fall) and unnecessary fatigue. Low levels of oestrogen also slow down metabolism that results in weight gain. Melatonin, the hormone that’s released by the pineal gland to regulate our sleep-wake cycle, dips, causing insomnia. Since your hormones are in a tangle, it is a good idea to get yourself checked for thyroid disorders, even if you have never had them earlier.

Why am I gaining weight?

Women often wonder why they gain weight even if they are eating the same amount of food and exercising regularly. This is because the metabolism slows down with menopause and age. This means you have to work doubly hard to maintain optimal weight. Some women feel bloated, more so when the hormones are fluctuating in the peri-menopausal phase. This is a period of upheaval before periods actually stop, usually between 45 to 52 years of age. Mood swings are common because the production of the feel-good hormone serotonin depends on the production of oestrogens while sleep problems arise because of the effect it has on the sleep hormone melatonin. Hot flashes, depression, joint pains, frequent urination also contribute to insomnia and irritability; the underlying cause needs to be treated for a refreshing sleep and improved mood.

Why do you need to get rid of belly fat immediately?

That’s because accumulating fat layers around the abdominal region could lead to cardiac problems and diabetes, both of which need to be beaten back with vigorous exercise.

Should one take Hormone Replacement Therapy (HRT)?

As for HRT (hormone replacement therapy) now called Menopausal Hormone Therapy (MHT), it is not the elixir of youth, the panacea for all ills, as once thought. It could have side effects that can, at times, include uterine and breast cancer. It has to be used under strict medical supervision, only in specific situations for the shortest possible period.

So, I wouldn’t recommend it unless in exceptional circumstances when menopause sets in earlier than 40. Oestrogen protects the heart and so anybody who experiences menopause earlier than usual needs oestrogen supplements. Or else low oestrogen could push up bad cholesterol or LDL levels, raising the cardiac risk in women. Such therapies have to be medically supervised and adjusted. For other unmanageable conditions like vaginal dryness and extreme hot flashes, there are specific medicines. You have oestrogen creams for vaginal dryness that can be easily administered with an applicator.

Can I get a urinary infection with menopause?

What you get is a leaking bladder and urgent calls of nature. That’s because the vaginal wall and the urinary bladder are made of the same tissue.

When do I know that I have moved from pre-menopause to menopause? Should I worry about late menopause?

You can consider yourself menopausal only when there has been a 12 month gap after your last periods. This is preceded by the perimenopausal stage, when there are irregularities in your period cycle. You might experience longer gaps between your period cycles but the fact that they are happening means you still have some way to go before they stop. Generally, we allow a window between mid-40s to mid-50s. Incidentally late menopause (after the age of 54) is largely beneficial though the incidence of breast and genital cancer increases slightly. If your period cycle doesn’t stop by 55, then we check for endometriosis, when uterine walls thicken.

What about menorrhagia or excessive bleeding?

A person may feel very tired and experience continual pain and cramping. In some, heavy periods lead to too much blood loss and cause anaemia. Menstrual cups typically absorb more blood than tampons or pads, so a person may need to empty their cup less often than they would need to change a pad or tampon. Take rest, have plenty of fluids and iron and vitamin C supplements to prevent iron deficiency. You can take anti-inflammatory drugs for pain management.

How do you deal with symptoms like hot flashes in social situations?

You may experience sudden heat waves coursing through you or break out into cold sweat. That’s because low oestrogen levels affect your body’s thermoregulation ability. Some quick hacks for handling hot flashes would be keeping a glass of cold water nearby, wearing layered clothing that can easily be taken off and taking deep breaths. Take medication to manage the condition only when you find it totally unmanageable. And considering that low oestrogen levels push down levels of serotonin, what we call one of the happy hormones, it is important that you keep a positive mind and don’t overthink about your condition. There is just a body transition you are making and in time the body does settle down. Remember you have transitioned through stages in your life and menopause is one such phase which doesn’t compromise your life but raises you to a new level of self-awareness. In fact, all your life, you tend to live up to expectations of you as a woman. Now you get to determine your own sense of self.

Besides, take up a new activity should you feel that you are not doing enough. Do you hear women in the villages talk about menopause as a major health issue?

They are so busy in their lives and tasks that they do not even realise that they are going through changes.

Should you be taking any medication?

Considering that your bone health weakens, start taking calcium supplements as recommended by the doctor. Certainly, do not try out herbal medicines which promise relief, which are unregulated and do not comply with industry standards of producing drugs. I have had cases of women reporting post-menopausal bleeding because of taking such supplements.

As more and more women are spending a third of their lives in the post-menopausal period, it is important that they do not pay for the increase in the number of years by a decrease in the quality of life. Even embarrassing conditions like leakage of urine on sneezing or painful intercourse due to vaginal dryness have a cure and they do not have to suffer in silence. Maintain a balanced lifestyle and sign up for yearly check-ups going forward.

My final advice to the lovely ladies out there is do not obsess over your looks; you are beautiful as you are. The lines mapping your face have a history to tell, while the wrinkle-free skin of youth is a blank canvas on which life has yet to leave its imprint. As for your weight, do not pay heed to detractors for ‘a recent study discovered that women who carry a little extra weight tend to live longer than the men who mention it.’

(Dr Amrinder Bajaj is the author of Live Your Best Life, Understanding Menopause for a Wiser, Happier and Healthier You, published by Penguin)

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