Menopause

Menopause is a natural part of aging for women. Most women enter menopause when they are between 45-56 years old (50-51 on average). Women can recognize menopause when they have had no menstrual periods for one year, without pathological etiology. Although menopause is a natural phenomenon, it can have negative impacts on health and quality of life. Proper care can help women entering menopause become healthy and have a good quality of life.

Why Do Women Have No Menstrual Periods During Menopause?

Menstruation is due to the functions of the ovaries. During each menstrual cycle, the ovaries are stimulated to produce an egg, the female reproductive cell, and hormones called estrogen and progesterone. Estrogen will trigger the production of endometrium cells, thickening the endometrium. When ovulation occurs, the ovaries produce progesterone, causing optimal changes to the endometrium in preparation for implantation if there is a fertilization.  If there is no implantation, the endometrium sheds, causing menstruation. As women age, the production of eggs and hormones from ovaries gradually decreases. When women enter menopause, the egg production will stop. There is no estrogen stimulating the growth of endometrium and the ovulation stops. Therefore, the endometrium becomes thin, and menstruation no longer occurs.

Effects of Low Estrogen

Not only estrogen stimulates the growth of endometrium but also cellular functions of the body’s systems, such as cardiovascular, nervous, skeletal, muscular, female reproductive, and metabolic systems. 

Symptoms of low estrogen include hot flashes, palpitations, excessive sweat, moodiness, insomnia, anxiety, depression, and forgetfulness. Low estrogen levels can result in abnormal cholesterol levels, increasing the risk of coronary artery disease and myocardial ischemia. This is because estrogen increases the elasticity of the vessel wall, resulting in reduced plaque build-up. Low estrogen levels also decrease bone mass, leading to osteoporosis and increasing the risk of fractures. Having low estrogen levels for a long time can result in vaginal dryness, causing pain during sexual intercourse and decreased sex drive. As a result, sexual activity and relationships can be affected.

Why Does Menopause Require Treatment?

Many women in menopause do not experience hot flashes, palpitations, excessive sweat, moodiness, and insomnia. They may have mild symptoms and can alleviate them with basic remedies, including wearing loose clothes, staying in airy places, avoiding hot food, and doing hobbies or meditating to ease anxiety or depression. However, some women develop such symptoms or painful sexual intercourse due to vaginal dryness. In this case, treatment is necessary, whether hormone therapy or non-hormonal treatment. In addition, low estrogen levels increase the risk of cardiovascular disease and osteoporosis. Without warning, fractures can occur despite minor injury. We can perform an early diagnosis of osteoporosis. Modifications of diet, exercise, and lifestyle can prevent osteoporosis. Hormone placement therapy and vitamin and mineral supplements can also help with the prevention.

Basic Guidelines for Treatment of Menopause

Women in menopause can take care of themselves initially by making changes in the abovementioned aspects to ease the symptoms and by eating a healthy and balanced diet. Women in menopause require 1,000 milligrams of calcium a day. Good sources of calcium include milk and small soft-boned fish. Typical dishes for Thai people contain only 300-400 milligrams of calcium. Therefore, calcium supplements are necessary for the prevention of osteoporosis. Moreover, women in menopause with low vitamin D levels should take vitamin D supplement as it increases calcium absorption from the intestine and calcium storage in bones. They also need to maintain a healthy weight and avoid carbohydrates, fat, caffeine, smoking, and other substances that lower bone mass. Menopausal women should exercise to strengthen muscles, lose weight, improve agility, lower blood cholesterol levels, and reduce body fat.

What Additional Care Can a Physician Provide? 

A physician may order some tests, such as a health checkup, body mass index, monitoring of blood glucose and cholesterol, bone mineral density test, and mammogram or breast ultrasound. In addition, patients may be asked about menopause symptoms and their severity for the assessment of the need for treatment. A physician may explore the indication and contraindication of hormonal replacement therapy, track treatment outcomes, assess potential complications, provide advice on self-care, and prescribe vitamin and mineral supplements. The purpose of these measures is to help every woman in menopause achieve good health, quality of life, and capability of self-care.