Menopause

What is Menopause?

Menopause is a natural stage of a woman's life. When a woman reaches the age of 45 to 55, her ovaries produce less oestrogen and progesterone, and this affects the monthly thickening, sloughing and discharge of the endometrium. Menstruation becomes irregular in timing and amount. Generally, these changes persist for a period of time until menstruation stops completely. When a woman has not had menstruation for over one year, she is considered to have reached menopause.

Common Signs and Symptoms

The lowering of oestrogen levels in menopausal women results in other physiological and psychological changes. Some common menopausal symptoms are:

Hot Flushes

The face and upper or whole body can experience a sudden sensation of heat and discomfort, lasting for a minute or two. Sweating and rapid heart rate may accompany these hot flushes.

Vaginal Dryness

With the lowering of oestrogen levels in the body, the vaginal tissue becomes thin and loses some of its moisture and elasticity. The vagina is more prone to infection and itching, and sexual intercourse may be painful. In some women, the urinary tract is also affected with deterioration in bladder function leading to incontinence.

Osteoporosis

Gradual drop in oestrogen levels in the body from the age of 40 onwards leads to loss of calcium and causes bone structure to become more porous, thus increasing chances of developing osteoporosis. Back pain is a common symptom and fractures may occur in more severe cases of osteoporosis.

Coronary and Arterial Changes

In menopausal women, cholesterol has a higher tendency to remain in the arteries, predisposing them to atherosclerotic and coronary diseases.

Mood Swings

Some women experience mood swings with occasional emotional depression and higher levels of irritability, anxiety and absentmindedness.

A positive attitude reduces tensions

Healthy Diet

A balanced diet is good for people of all ages. To prevent osteoporosis, the diet should be rich in calcium. Milk and bean products such as cheese, yogurt, and beancurd are high calcium foods.

Refrain From Smoking and Drinking Alcohol

The nicotine in cigarettes inhibits oestrogen production by the ovaries and affects bone cell formation. Alcohol affects the liver's regulation of oestrogen metabolism. Women approaching menopause should therefore stop smoking and limit alcohol intake.

Appropriate Exercise

At least three exercise sessions each week, with weight bearing exercises such as walking and jogging ,can strengthen the bones. Walking in the sun also helps the body produce Vitamin D, which promotes calcium absorption.

Coping With Hot Flushes

Loose garments made of light cotton are preferred. Spicy foods, alcohol, strong tea and coffee can enhance hot flushes and should be avoided. A warm shower can bring relief from the discomfort of hot flushes.

Understanding Menopause

Some women are upset by the physiological and psychological changes of menopause. Through educational talks, women can increase their understanding of menopausal changes and so be psychologically prepared. They can also learn some relaxation exercises to ease the stress. Sharing feelings of anxiety and depression with family members, close friends or medical personnel can help to alleviate pressure and enable women to cope positively with their menopause.

Strengthening Self-Image

Menopause is not a sign of old age. Instead, it is the beginning of a new phase of life. Women should actively set fresh goals, develop new interests and learn new skills to extend and enrich their own sphere of living.

Osteoporosis

We often see people who are incapacitated by bone fractures or hunchback, mostly elderly women. This is related to osteoporosis - a common chronic disease. Statistics show that about 100,000 people in Hong Kong suffer from this condition.

  • Women after menopause, especially those who have premature menopause or surgical removal of ovaries before the age of 45
  • People with a family history of osteoporosis
  • Patients on long term use of drugs such as steroids and thyroid hormone
  • Alcoholics and smokers
  • Those who lack exercise and exposure to sunshine
  • People deficient in calcium, especially those with little dietary intake of calcium and dairy food since childhood
  • Thin and small-boned people

Osteoporosis is mainly caused by the loss of calcium in bone due to lowered levels of oestrogen after menopause. Osteoporosis may lead to bone pain, hunched back, and fractures. Fractures commonly occur in the femur, spine and wrist.

Generally a person requires an average daily calcium intake of 1,000 mg. However, the intake of calcium among Chinese is often insufficient because of dietary aversion to milk and dairy products. Smoking, lack of outdoor activities and long term steroid intake will also affect the body's absorption of calcium.

"Prevention is better than cure". To prevent osteoporosis, post-menopausal women should have a physical check-up including measurement of blood pressure, blood sugar, liver function, cholesterol, breast examination or mammography, pelvic examination or ultrasound and bone densitometry, etc. If she is otherwise healthy, she can receive Hormonal Replacement Therapy to help replenish calcium levels. A calcium-rich diet containing dairy and bean products and fish are recommended. Outdoor exercises and exposure to sunshine also help the body produce Vitamin D, which promotes calcium absorption.

Bone Densitometry

Bone densitometry measures the density of spine, femur or wrist using computer technology and high resolution imaging. Post-menopausal women and people at risk of osteoporosis can consult their health care provider to arrange for such an examination.

Hormone Replacement Therapy

Hormone replacement therapy can alleviate the various symptoms caused by a rapid decrease in the body's hormone levels, including hot flushes, vaginal discomfort and mood swings. Osteoporosis and heart disease may also be prevented.

There are four forms of hormone replacement therapy: oral tablets, subdermal implants, gels or adhesive patches, and vaginal suppositories. The most common form is oral tablets containing oestrogen, progesterone and testosterone.

Hormone replacement therapy has side effects such as breasts tenderness, fluid retention causing weight gain, nausea, etc. The woman should therefore consult her doctor and undergo a detailed physical check-up before starting hormone replacement therapy.

Generally speaking, for most healthy women during their menopause, a balanced diet, appropriate exercise, a positive and optimistic attitude to life, together with regular physical check-ups, are better than medication in preparing them for the next stage of life.

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