Michael Abrahams | The menopausal life

I recall the first time I witnessed a woman experiencing a hot flash. I was a resident in obstetrics and gynaecology at the University Hospital of the West Indies at the time. The woman in question was a senior nurse working at the institution, and we were having a conversation in the parking lot by the Department of Pathology when she announced, “It’s coming on now.”

All of a sudden, her face became drenched with sweat. The sweating was so profuse that it soaked the upper portion of her clothing. I had studied menopause and understood what it was and the symptoms associated with it, but this was the first time I had witnessed this phenomenon in real time. I was amazed but also filled with empathy for the nurse, wondering what it must be like having to live like that, at least for a while.

There are three naturally occurring situations where a female will experience hormonal changes that have the potential to affect their quality of life negatively: during menstrual cycles, during pregnancy, and around menopause, also known as the climacteric. A woman is officially in menopause when she has not had a period for a year, the cause being a significant drop or the cessation of the production of the female sex hormone oestrogen from her ovaries.

The average age at which women enter menopause is 51 years, but some women enter it significantly earlier or later. When menopause occurs before the age of 40, it is referred to as premature menopause. It is difficult to predict the age at which a woman will enter natural menopause. If her mother entered menopause naturally, the age at which she did may indicate when the woman may become menopausal herself. Also, tobacco smoking can hasten its onset. The four to five years preceding the menopause is referred to as perimenopause or premenopause, and after a woman has reached menopause, she is in postmenopause.

LOSS OF OVARIAN FUNCTION

The decline or loss of ovarian function causes menopause and not merely the cessation of periods. When a woman undergoes a hysterectomy (removal of the uterus), she will no longer have periods. However, if she still has her ovaries and they were functioning normally before surgery, the operation will not push her into menopause. However, if functioning ovaries are surgically removed, or if the ovaries stop functioning after radiotherapy or chemotherapy or the use of certain other drugs, or because of some medical disorders, menopause will occur.

Some women go through this period of life unscathed. The only change they notice is that their periods stop. But some are tormented. Hot flashes (a feeling of intense heat and sweat in the face, neck, and chest, sometimes accompanied by chills and a rapid heartbeat), mood swings, brain fog (confusion, forgetfulness, and a lack of focus and mental clarity), insomnia, fatigue (resulting from sleep disturbance), skin changes, weight gain, decreased libido, and pain or discomfort during intercourse due to vaginal dryness can make some women’s lives miserable. Another factor that can cause torment in some women, and relief in others, is that menopause signals the end of the reproductive phase of their lives.

What makes this time scary for some women is that they may have distressing symptoms and not realise that menopause is the cause. I recall a patient of mine telling me she thought she was going crazy. She was experiencing severe brain fog and fatigue and visited several doctors before it was eventually realised that she was perimenopausal. Many women know about menopause and its potential symptoms but do not realise that these symptoms can begin several years before their periods stop.

Health is defined as physical, mental, and social well-being. Menopause is a natural process. However, the symptoms that can accompany it have the potential to adversely affect all aspects of a woman’s health. Since the main factor contributing to the discomforts of menopause is a fall in the level of oestrogen, hormone replacement treatment (HRT) utilising oestrogen with or without other hormones can significantly alleviate symptoms.

NATURAL PROCESS

Being a natural process, just because a woman is in or is entering menopause is not an indication to take HRT. It must be noted that any pharmacological intervention can have adverse effects, and HRT is no exception. For example, it may increase breast cancer risk in some women depending on the hormonal combination, duration of time it is taken, and certain predisposing factors. Whether symptomatic or not, a holistic approach is desirable to manage this phase of a woman’s life as the falling oestrogen levels increase a woman’s risk of heart disease and osteoporosis (a condition that causes a decrease in bone density and bone mass) with the latter increasing the likelihood of sustaining fractures.

It is, therefore, essential to pay particular attention to diet, exercise, and stress management and to avoid behaviours such as tobacco smoking that may intensify symptoms and increase the risk of events such as heart attacks and strokes. The use of some herbs and supplements may also be of value in alleviating unpleasant symptoms. Fortunately, in most women who experience these symptoms, they usually do not persist for the remainder of their lives, lasting for an average of four to five years.

If you are a woman reading this and are having some of the above-mentioned symptoms and are affected negatively by them, do not be afraid to discuss these with your physician. Not only will they be able to help you, but you may also need to be investigated as there is an overlap between menopausal symptoms and the symptoms of other conditions, such as depression and chronic fatigue syndrome.

If you are a man reading this, be grateful that you do not have to contend with these changes. Also, appreciate the fact that you may be surrounded at home and at the workplace by women who are going through some of these changes but keep soldiering on.

Michael Abrahams is an obstetrician and gynaecologist, social commentator and human-rights advocate. Send feedback to columns@gleanerjm.com and michabe_1999@hotmail.com, or follow him on X , formerly Twitter, @mikeyabrahams.