Menopause is a natural procedure that occurs when a woman’s menstrual cycle ends, and she can no longer experience pregnancy naturally.  The process usually begins between the ages of 45 and 55, but age may vary for each women. Periods typically begin to become less frequent over a few months/year and finally stop altogether. Though it is a natural process, certain uncomfortable physical symptoms, such as hot flashes and emotional symptoms of menopause may disrupt sleep, lower energy or might affect emotional health.


    Each woman may confront menopause differently. It can last for several years, and are categorised into three stages:


    1. Perimenopause is the intervening time that starts before menopause and includes the twelve consecutive months that follow a woman’s last period.

    2. Menopause usually starts either twelve months after the last period or when menstruation has ended for a medical reason, such as the removal of the ovaries.

    3. Postmenopausal refers to the years after menopause, although it can be quite challenging to know when menopause will finish and postmenopausal begins.




    In the time period leading up to menopause (perimenopause), a woman might experience the following signs and symptoms:


    • Hot flashes
    • Irregular periods
    • Vaginal dryness
    • Chills
    • Night sweats
    • Sleep difficulties
    • Mood swings
    • Weight gain
    • Slowed metabolism
    • Thinning hair and dry skin
    • Loss of breast fullness
    • Depression and anxiety
    • Increased urination
    • Headache
    • Joint pain
    • UTIs
    • Racing heart


    Causes of menopause


    Menopause is a natural phenomenon that occurs as the ovaries age and produce less reproductive hormones. Menopause can result from:


    Natural decline of hormones: As women approach their late 30s, their ovaries start producing lesser amount of estrogen and progesterone. These are the reproductive hormones that regulate menstruation and decline fertility. In their 40s, menstrual cycle may become irregular such as longer or shorter, heavier or lighter, and more or less frequent.  Eventually, on average, by entering the 50s, women's ovaries stop producing eggs; hence, the menstrual cycle ends permanently.


    Hysterectomy: A hysterectomy is the removal of uterus. But the ovaries usually doesn't cause immediate menopause. Although a woman will no longer have periods, her ovaries still release eggs and produce hormones (estrogen and progesterone). Surgery involving the removal of both uterus and ovaries (total hysterectomy and bilateral oophorectomy) does cause immediate menopause.  Menses stop immediately, and a woman probably has hot flashes and other menopausal signs and symptoms, which can be moderate to severe, as these hormonal changes occur abruptly in hysterectomy.


    Primary ovarian insufficiency: Few women experience menopause before age 40 (premature menopause). Menopause can be a result of primary ovarian insufficiency. This is a condition when the ovaries fail to produce an adequate amount of reproductive hormones.  For these women, hormone therapy is usually recommended at least until the natural age of menopause. This is done to protect the brain, heart, and bones.


    Chemotherapy and radiation therapy: These are cancer related therapies can induce menopause, causing symptoms such as hot flashes during or soon after the course of treatment.




    After menopause, there is an increased risk of certain medical conditions. Examples include:


    Heart and blood vessel (cardiovascular) disease: When estrogen levels reduce, the risk of cardiovascular disease increases. Heart disease is one of the leading causes of death in women as well as in men. So it is important to be physically active, eat a healthy diet, and maintain a healthy weight. Keeping blood pressure, cholesterol, and sugar levels are equally important to reduce the risk of cardiovascular disease.


    Osteoporosis: The condition causes bones to become fragile and weak, leading to an increased risk of fractures. During the initial years after menopause, a woman may lose bone density at a rapid rate, increasing the risk of osteoporosis.


    Urinary incontinence: As the vaginal and urethral tissues lose elasticity, a woman may experience sudden, strong urges to urinate. This is followed by an involuntary loss of urine (urge incontinence), or the loss of urine while coughing, laughing or lifting (stress incontinence). Urinary tract infections (UTIs) are more common in these conditions.


    Sexual function: Vaginal dryness from low moisture production and loss of elasticity can cause soreness, irritation, and slight bleeding during sexual intercourse.


    Weight gain: Many women experience gain weight during the menopausal changes and after menopause because of a slow metabolism rate. Women need to eat less and do some exercise in order to maintain a healthy weight.



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