Menopause literally means the end of monthly menstruation cycle. More accurately menopause is the cessation of the primary function of the ovaries, i.e. when women no longer ovulate, signaling the end of the fertile phase in women’s life cycle. Menopause usually begins around the age range of 42–58. The transition from reproductive to non-reproductive phase occur due to the reduction in the production of female hormones (estrogen, testosterone and progesterone ) by the ovaries. In many women this transition may be accompanied with various mental and physical signs and symptoms (menopausal syndromes), that in some cases may disrupt their daily activities and sense of well-being.

Menopausal Syndrome : The cause of menopausal syndrome is the body’s response to falling natural hormonal levels. Some common menopausal syndromes are given below :

  • Vaginal atrophy or Atrophic vaginitis : The cause of vaginal atrophy is the decrease in the level of estrogen. The common symptoms are due to thinning and shrinking of vaginal tissue, inflammation and itching in vagina and outer urinary tract, overall dryness and decreased lubrication of the said area. This can cause abnormal vaginal discharge, pain with intercourse, dry vagina, itching, irritation, urinary incontinence, increased susceptibility to infection like vaginal candidiasis and urinary tract infections.
  • Hot flashes : Another most common symptoms are hot flashes. The symptoms of hot flashes are feeling of intense heat with sweating and rapid heartbeat. The condition aggravated during hot weather or in an overheated room. The main cause of hot flash is lower level of oestrogen. Hot flashes may also happen due to a change in the temperature controlling process, that regulated by hypothalamus.
  • Night sweats : Excessive sweating in night or during sleep.
  • Decreased cognition; foggy thinking
  • Fatigue; lack of motivation
  • Decreased libido, or sexual drive/desire
  • Decreased ability for orgasm
  • Migraine or headaches
  • Back pains, joint pains, muscle pains
  • Breast tenderness and swelling
  • Overall thinning of the skin with drier less elastic skin
  • Skin itching, burning or prickling sensations
  • Psychological problems like anxiety, depression, mood swing and memory loss.
  • Insomnia or sleepiness
  • Painful intercourse

Some medical problems that can occur due to lack of these hormones include:

  • Atherosclerosis or gradual thickening of arterial wall due to the deposition of cholesterol and triglycerides.
  • Osteopenia and increased risk of osteoporosis
  • Increased risk of developing Alzheimer’s disease and dementia
  • Arthritis and degenerative joint disease.
  • Decreased risk of colon cancer

Management :

Hormone replacement therapy : The most effective treatment of menopausal syndrome is hormone replacement therapy (HRT). HRT can improve the quality of life in the women suffering from menopausal syndrome.The aim of HRT is to reduce the discomfort associates with menopause due the diminished circulation of estrogen and progesterone hormones. Generally estrogen, and progesterone are given but testosterone may be added for further enhanced therapy.

Estrogen is the most important female sex hormone. During premenopause, estrogen is responsible for improving the lining of the uterus for receiving a fertilized ovum. If no conception occurs, menstruation occurs and the cycle repeats itself. Some other functions are controlling bone density, skin temperature and keeping the vagina moist. The decrease in estrogen levels with menopause causes hot flashes, vaginal dryness, osteopenis or osteoporosis and decreased libido.

Progestorone is also a female sex hormone, that helps to prepare the uterus for pregnancy and supports the pregnancy. It also helps to protect the endometrium or lining of the uterus when estrogen is given potsmenopausally and thus decreases the risk of developing endometrial cancer. Progesterone may not be given if the woman had a hysterectomy, i.e. surgical removal of the uterus.

Progestin is a synthetic progestogen (a groups of steroid hormones similar to progestorone). The two main functions of progestin are hormonal contraception (birth control methods that act on the endocrine system) and to prevent the excessive proliferation of the cells of the endometrium or endometrial hyperplasia, that caused due to the high level of oestrogen. It is given to oppose the excess estrogen in HRT.

Testosterone is a vital hormone that is sometimes forgotten for women. When women are young, they have quite high levels of testosterone. As they get older, the levels drop every year, and are almost none existant in menopause. However, this drop can be associated with fatigue, decreased libido (sexual drive), decreased motivation, depression, lack of muscle tone, and foggy thinking. Replacing testosterone to levels of a young woman can reverse these problems and improve women’s quality of life.

BioIdentical Hormone Therapy (BHT)

The concept of BioIdentical Hormone Therapy is to use hormones that are structurally the same as those hormones of young women, and in doses to provide the similar hormonal levels as young women. Also called “natural” hormone therapy, this is the best method to provide adequate postmenopausal hormone therapy since it has a multitude of the same benefits of HRT as noted above, but at the same time does not have the potential side effects of synthetic hormone therapy. Thus, there is no increased risk of breast cancer nor stroke as one gets older, making its use safer for women.

Generally there are four ways for taking HRT.

  1. Topical application as a cream or gel : Applied topically to the skin or vagina.
  2. Tablet : Taken orally  (estrogen or progesterone).
  3. Implant : Small pellets of estrogen and testosterone are inserted under the skin of the tummy, flanks, buttock or thigh.
  4. Patch : A adhesive patch placed on the skin to give estrogen transdermally (through the skin to the blood stream).

Other therapies

Lack of lubrication is the most common problem during menopause. Application of vaginal gel may help to reduce the problem.

Antidepressants like as paroxetine, Fluoxetine hydrochloride and Venlafaxine hydrochloride may some time use to treat the hot flashes, depression and mood swing associated with menopause.

Gabapentin is also effective for the treatment of hot flashes.

Selective estrogen receptor modulators, also called SERMs, are a category of drugs used to reduce the some menopausal syndromes. However, they may increase other symptoms, such as hot flashes and night sweats. These drugs are either synthetically produced or derived botanically or from plant sources. Generally raloxifene and tamoxifen are prescribed.

Some studies suggests that phytoestrogen or the plant-derived xenoestrogens are useful for the treatment of menopausal syndromes but it is not yet proven.

Lifestyle measures such as drinking cold liquids, avoiding hot and crowded room, using fans, staying in cool rooms, wearing light and cotton clothing may help in managing hot flashes.

Cessation of smoking, regular intake of vitamin D and calcium help to lower the risk of developing osteoporosis after menopause.

It is important to remain well informed about menopause and menopausal syndromes and the effects lack of hormones have on the body. One should seek proper treatment and therapies to improve not only their health but their quality of life as they get older.