ASK DR LUVUYO BAYENI | Menopause – What really pauses for women

You often hear men defending, rather than enforcing, their self-acclaimed need in women’s lives by teasing about some names.

It so happens that some of these names are reproductive health-related or defining names such as “women”, “menstruation”, “female”, and “menopause”.

Of course, iimbokodo have stood up against these as egostic statements, which they ravish back and say they are strong With Out Men or that Men Orchestrate Pause in their lives.

I was taken aback when a seasoned, successful, and professional elderly lady said, “We are never prepared or educated on what to expect towards or during menopause, and instead it is assumed women know.”

Her sentiments are supported by literature, as documented by the World Health Organisation (WHO), which states, “menopause is often not discussed within families, communities, workplaces, or health-care settings”.

As such, a public health concern has been raised regarding both awareness and access to menopause-related information and services, remaining a significant challenge in most countries.

WHO defines menopause as a point in a continuum of life stages for women which marks the end of their reproductive years. They further characterise this change as marked by the end of monthly menstruation due to loss of ovarian follicular function.

Biology and Body Functioning

People assigned female at birth go through menopause. Natural menopause is deemed to have occurred after 12 consecutive months without menstruation for which there is no other obvious physiological or pathological cause and in the absence of clinical intervention.

The regularity and length of the menstrual cycle vary across a woman’s reproductive life span, but the age at which natural menopause occurs is generally between 45 and 55 years for women worldwide. The main risk factor is reaching menopause. Other risk factors include surgery to remove the ovaries or certain cancer treatments.

Perimenopause can last two to eight years. The average is about four years. The age of menopause onset is genetically determined, but some factors can accelerate ovary decline, resulting in earlier menopause. These can include smoking, alcohol use, and less physical activity.

Menopause can result from:

• Natural decline of hormones. As you enter your late 30s, your ovaries start making less of the hormones that control your period. These are called oestrogen and progesterone.

• Surgery that removes the ovaries, called an oophorectomy. Ovaries make hormones, including oestrogen and progesterone, that control the menstrual cycle.

• Chemotherapy and radiation therapy. These cancer therapies can cause menopause. They can cause symptoms such as hot flushes during or shortly after treatment.

• Primary ovarian insufficiency. About 1% of people who have menopause get it before age 40. Premature menopause may result from the ovaries not making the usual levels of hormones. It can happen from gene changes or an autoimmune disease.

Impact and Changes

Perimenopausal and postmenopausal symptoms can be disruptive to personal and professional lives, and changes associated with menopause will affect a woman’s health as she ages.

The hormonal changes associated with menopause can affect physical, emotional, mental, and social well-being, including the level of discomfort that affects their quality of life.

Socially, a woman’s experience of menopause may be influenced by gender norms and familial and sociocultural factors, including how female ageing and the menopausal transition are viewed in her culture.

Body composition and cardiovascular risk can also be affected by the significant decline in oestrogen levels after menopause. Menopause can also result in the weakening of the pelvic support structures, increasing the risk of pelvic organ prolapse. Loss of bone density at menopause is a significant contributor to higher rates of osteoporosis and fractures.

Effects – symptoms and presentations

The symptoms experienced during and following the menopausal transition vary substantially from person to person. Some have few, if any, symptoms. For others, symptoms can be severe, affecting daily activities and quality of life. Some can experience symptoms for several years. During the transition, the amount of hormones your ovaries make varies.

The hormone changes can cause symptoms such as:

• Hot flushes and night sweats. Hot flushes refer to a sudden feeling of heat in the face, neck, and chest
• Changes in the regularity and flow of the menstrual cycle, culminating in cessation of menstruation;
• Vaginal dryness, pain during sexual intercourse and incontinence;
• Difficulty sleeping/insomnia; and
• Changes in mood, depression and anxiety.

Not every hot flush experience is associated with menopause, as some hot flush triggers can include:

• consuming alcohol or caffeine
• eating spicy foods
• feeling stressed
• being somewhere hot

Need for safety measures

Pregnancy is still possible during perimenopause. Contraception is recommended to avoid unintended pregnancy until after 12 consecutive months without menstruation. Pregnancy after menopause is unlikely without fertility treatment that involves the use of donor eggs or previously frozen embryos.

During perimenopause and following menopause, it is still possible to acquire sexually transmitted infections (STIs), including HIV, through unprotected sexual contact, including oral, anal, and vaginal sex. The thinning of the vaginal wall after menopause increases the chances of lesions and tears, thereby increasing the risk of HIV transmission during vaginal sex.

Periods sometimes return after chemotherapy. Then you can still get pregnant. So you might want to keep using birth control.

Call for action

It is not possible to predict when an individual woman will experience menopause, although there are associations between the age at menopause and certain demographic, health, and genetic factors.

Symptoms that impact health and well-being should be discussed with a health-care provider to identify available management options, with consideration of medical history, values, and preferences.

Perimenopausal women need access to quality health services and communities and systems that can support them. Perimenopausal care plays an important role in the promotion of healthy ageing and quality of life.

• Dr Bayeni is a medical doctor and host of DR B Talks, a weekly health conversation platform focused on empowering communities through accessible health education.