• A pause on menses, fertility

By Doris Obinna
Averagely, females menstruate between the age of 12 and 51. Within the period, they are prone to getting pregnant. However, not all girls start menstruation at the same age, but it is usually from eight years to 15.
At 52, in most women, menstruation ceases permanently. This means the woman has gone into menopause, also known as the “climacteric.” When this happens, such women would no longer have her monthly “period” or bear children. In any case, menopause usually occurs between 49 and 52 years of age.
Menopause is a natural, biological process that occurs in every woman’s life. It marks the permanent end of monthly periods (menstruation) and fertility. This means the woman is no longer able to have children. During this transition period, a woman’s ovaries stop making eggs and her body produces less estrogen and progesterone. Menopause is confirmed when a woman has no period for 12 months in a row.
According to a gynaecologist, Dr. Gabriel Omonaiye, menopause is established when menses have been absent for one year. It could be physiologic (natural) due to decreasing ovarian function or iatrogenic, as a result of surgical removal of the ovaries to cure certain gynaecological problems such as cancer of the ovaries, he said.
According to Dr. Omonaiye, “the average age for menopause is 51 years. The range, however, is from 35 to 55 years. During the few years before and into menopause, the fertility of the woman drops, oestrogen and progesterone levels fall and the ovarian size reduces.”
A report by the National Institute on Ageing revealed that the average onset of menopause in the United States is age 51, but the normal range is between 45 and 55. Some women enter this stage of life before the age of 40. This is called premature menopause. Many factors cause premature menopause, such as: autoimmune disorders, smoking, damage to the ovaries and surgery (such as a hysterectomy).

Stages of menopause
From the time a woman begins puberty, until she enters menopause, she generally has a period around the same time every month. Of course, irregular periods happen from time to time. Pregnancy and other medical conditions interrupt your period.
During the first half of a woman’s normal menstrual cycle, the ovaries, two glands located on either side of the uterus, produce higher levels of the hormone estrogen. This causes the lining of the uterus to thicken to prepare for possible pregnancy. An egg in one of the ovaries also starts to mature during this time.
Near the middle of a woman’s menstrual cycle (typically day 7 to 22, or day 14 for women on a standard, 28-day cycle), the mature egg is released in a process known as ovulation. After the egg is released, the ovaries make more of the hormone progesterone. If the egg is not fertilised, the levels of estrogen and progesterone decrease, leading the body to shed the lining of the uterus. This causes a period.
As a woman approaches menopause, her ovaries produce less estrogen, which can cause irregular periods. The term “menopause” is defined as a woman’s last menstrual cycle. After a woman’s final period, a year without further periods, confirms the permanent end of fertility.
Dr. Omonaiye said there are stages of defined menopause, which happen over series of months or even years. He listed them as, peri-menopause, which is a few years before menopause; early menopause, menopause and Post-menopause: a few years after menopause.
Said he: “In the peri-menopause, the menses begin to be irregular, initially more frequent followed by a decrease (oligomenorrhea), but any pattern is possible. Conception is possible during peri-menopause.
“Climacteric refers to a longer phase in which women loose reproductive capacity; it begins before peri-menopause.
“The physiologic explanation for the phenomenon of menopause is the unresponsiveness of the aging ovaries to the pituitary gonadotrohins follicle stimulating hormones (FSH) and luteinizing hormone (LH). The woman has fewer ovulations. Eventually, the ovarian follicles do not respond, producing little oestrogen. The level of androgen reduces, but has little or no effects on her.
“Premature menopause, also known as premature ovarian failure, is cessation of menses due to noniatrogenic (non medical) ovarian failure before the age of 40. The contributory factors may include smoking, living at high altitude and under nutrition.
“Latrogenic (artificial) menopause results from medical interventions, such as oophorectomy (removal of the ovaries), chemotherapy and pelvic irradiation.”

Signs and symptoms
Although menopause is a completely natural stage of a woman’s life cycle and not a disease, a series of uncomfortable physical and emotional symptoms usually accompany it. Various forms of treatment can typically lessen these symptoms.
Symptoms may include hot flashes, weight gain or vaginal dryness. Vaginal atrophy contributes to vagina dryness. With this, there can be inflammation and thinning of the vaginal tissues, which adds to uncomfortable intercourse.
Menopause can also increase your risk for certain conditions, like osteoporosis. You may find that getting through menopause requires little medical attention. Or you may decide you need to discuss symptoms and treatment options with a doctor.
Omoniaye said: “Hot flushes and sweating due to vasomotor instability affect 75 to 85 per cent of women. This begins before the menstruation ceases. Hot flushes may continue from less than one year to more than five years. The severity varies in different women.
“The woman feels hot, or warm, may sweat and the core temperature increases. The skin becomes warm and red especially the head and neck region. The episode of the flush could last between 30 seconds to five minutes and may be followed by chills. Flushes may manifest at night as night sweats.”
He said flushes could be triggered by smoking, alcohol, hot beverages, caffeine, spicy food and food containing nitrites and sulphites.
The doctor said: “The atrophy causes irritation, difficulty in having sexual intercourse (dyspareunia), painful urination. The clitoris, labia minora, uterus and ovaries reduce in size. Some have periodic light headedness, palpitations, and parasthesias.
“Nausea, constipation, diarrhoea, joint and muscle pain, cold hands and feet do occur. Weight gain, abdominal obesity and decreased muscle mass do happen. Other may experience fatigue and irritability.
“The bone density may reduce (osteoporosis) with the risk of pathological fracture. The diagnosis of menopause is clinical. Hormonal assay could be carried out,” he added.
Another expert said the symptoms of menopause vary from one woman to another, even in the same families. The age and rate of decline of ovary function differ tremendously. This means you’ll need to manage your menopause individually. What worked for your mother or best friend may not work for you.
“Talk to your doctor if you have any questions about menopause. They can help you understand your symptoms and find ways to manage them that work with your lifestyle,” he advised.

Treatment
Treatment of menopause could be done in different ways. It could be hormone replacement and non-hormonal treatment.

Hormone replacement
Several hormone therapies are Food and Drug Administration (FDA) approved for treatment of hot flushes and prevention of bone loss. The benefits and risks vary depending on the severity and your health. These therapies may not be right for you.

Non-hormonal treatments
Hormone therapy may not be the right choice for you. Some medical conditions may prevent you from safely using hormone therapy or you may choose not to use that form of treatment for your own personal reasons. Changes to your lifestyle may help you relieve many of your symptoms without need for hormonal intervention.
Lifestyle changes may include, weight loss, exercise, room temperature reductions, avoidance of foods that aggravate symptoms and dressing in light cotton clothing and wearing layers
Other treatments such as herbal therapies, self-hypnosis, acupuncture, certain low-dose antidepressants, and other medications may be helpful in decreasing hot flashes.
Several FDA approved medications could be used for prevention of bone loss. These may include: bisphosphonates, such as risedronate (actonel, atelvia) and zoledronic acid (reclast).
Also, there could be selective estrogen receptor modulators, like; raloxifene (evista) and calcitonin (fortical, miacalcin).
Others are; denosumab (prolia, xgeva), parathyroid hormone, such as teriparatide (forteo) and certain estrogen products.
However, counseling cannot be over-emphasised. This is why an expert declared: “In the treatment of menopause, counselling plays a significant role. The explanation of the physiologic changes occurring in her body is important. For hot flushes, avoiding the triggers is helpful. Regular exercise and the use of multivitamins are useful.”