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Symptoms and Problems associated with Menopause
OSTEOPOROSIS
CARDIOVASCULAR DISEASE
These are generally divided into three groups namely: Vasomotor
symptoms, Metabolic/genital symptoms and Phychological symptoms.
VASOMOTOR SYMPTOMS:
Vasomotor refers to the effects of certain nerves influencing
the contraction and dilation of the blood vessels.
Hot flushes:
These are probably the most common of symptoms in menopausal
women, in which the woman experiences a sudden surge of heat
around the face, neck and chest area. It is most often
accompanied by reddening of the skin and sweating, which only
adds to the discomfiture of the sufferer. The intensity and
frequency of hot flushes, vary from one woman to the other -
occurring several times during the day and night, or several
times during an hour, and lasting for a couple of minutes or
seconds.
The cause for hot flushes has not yet been fully established,
however it is thought to be due to oestrogen deficiency causing
a hormonal imbalance which, in turn, causes an imbalance in the
brain's temperature-regulating center. Flushing may occur a few
years prior to the cessation of menstrual periods, thus
suggesting that the woman is in the pre-menopausal stage, and
often indicating that menopause is not far off. If left
untreated, they are experienced by 75% to 80% of all menopausal
women. Approximately 20% to 50% of women suffer hot flushes for
5 years or longer.
Palpitations:
This refers to the unpleasant awareness of exceptionally rapid
or irregular beating of the heart, which may also be accompanied
by a tingling sensation of the skin and faintness. Palpitations
often occur together with the hot flush, and in this case their
exact cause remains unknown.
METABOLIC/GENITAL SYMPTOMS:
This generally refers to the manner in which cells, organs and
structures maintain their function.
Irregular heavy bleeding
The decrease in hormones and ovulation may cause irregular heavy
bleeding in many women - a seven to ten day bleeding period is
not unusual, nor is bleeding throughout the entire month. This
is a particularly dangerous condition, as it can result in
anaemia, or alternatively be early signs of a more severe
condition, e.g. fibroid tumours, uterine or cervical cancer.
This phase leading up to menopause can be treated through a
simple surgical procedure, known as a dilation and curettage
(D&C). The cells that are removed during this procedure will
then be analysed for any abnormal patterns.
Loss of periods
Failure to menstruate for at least 6-12 months in the older
woman, would usually indicate menopause. This may occur quite
abruptly, with there having been little or no irregularity to
the periods beforehand or more commonly, where menstruation
occurs less frequently and the duration of each period being
shorter.
Loss of elasticity to external genitals:
Approximately 1 in 10 women develop genital problems, which is
often reported to be even more distressing than the discomfort
and embarrassment of hot flushes. In this case the skin of the
vulva (external genitals surrounding the opening of the vagina)
may become thin, and shrinkage of the vaginal opening may occur.
However this is much more a feature of the elderly women, those
well past the menopausal stage.
Painful intercourse:
Vaginal dryness may be the most troublesome symptom for a
sexually active woman. This together with possible thinning of
the vaginal skin, often results in painful sex, which may in
turn lead to the development of a host of psychosomatic
symptoms. 30% of women experience vaginal dryness or itching and
thinning of vaginal tissue after manopause has occurred. This
can lead to increased chances of infection (such as 'thrush').
Weakening of the ligaments and tissues that support the uterus:
The ligaments and tissues that surround and support the uterus
may become weakened, thus resulting in prolapse of the uterus. 'Prolapse',
literally means the displacement of an organ from it's usual
place, and in this case would refer to the condition whereby the
uterus has slipped downwards in the vagina. This could probably
be due to weaknesses in the pelvic floor following the delivery
of a number of babies, or from the weakening effects of low
oestrogen levels on the ligaments.
Symptoms of prolapse:
A 'descending' sensation in the vagina
Feeling a lump at the opening of the vagina, especially when
coughing or sneezing
Difficulty in urinating and emptying the bowels
A 'full' sensation, even after emptying the bladder and bowels
Urinary incontinence during times of particular strain
Feelings of 'obstruction' during intercourse
Reduction in breast firmness and size:
Seeing that oestrogen is responsible for the development of the
breasts at puberty, and also maintaining the firmness and
glandular functions thereafter, it is no wonder that a woman's
breasts lose their shape, and the nipples become smaller and
less erectile during menopause. These changes do not tend to
cause direct symptoms, although many women have difficulty in
coming to terms with the effect it has on their bodily
appearance.
Skin changes:
As women age (particularly after menopause), the elastic fibres
in their skin decrease, resulting in wrinkles and sagging around
the chin and neck area. Unlike skin changes to the vulva and
vagina, lack of oestrogen would not be the sole cause of these
problems, but more a combination between the effects of ageing
and oestrogen deficiency.
Effects on bones and joints:
Loss of bone substance - or osteoporosis as it is more commonly
known, increases with age, causing the bones to become porous
and brittle and so more liable to break. This is mainly due to
the lack of oestrogen, reducing calcium availability, and is one
of the most severe health problems that can occur during
menopause. Other factors that could increase your risk of
osteoporosis, would include - a diet high in salt, protein,
alcohol and caffeine, inadequate vitamin D intake, lack of
exercise and smoking.
Approximately 1% of calcium is lost from the bones each year,
after the age of 50, and 15% by the time the woman reaches 70.
Although this may vary drastically, as it often depends on the
age of the woman at onset. One out of four women will suffer an
osteoporotic fracture by age 60. By age 75, this fracture rate
will increase to one out of two women.
PHYCHOLOGICAL SYMPTOMS:
These would include a whole host of symptoms that are very real
to menopausal women, and not 'just in the mind' - as the name
may suggest. The severity of these symptoms would depend
entirely on the woman's social circumstances and to what extent
she 'allows' the symptoms of menopause to affect her well-being.
Headaches:
There is no evidence to suggest that headaches as such, are a
true symptom of menopause, and are often the result of a
response to stress, anxiety or when in need to evade an
unpleasant situation - such as avoiding painful intercourse.
Insomnia:
The inability to sleep is certainly a common complaint among
menopausal women, and could possibly be due to two main factors.
Firstly, it is necessary to bear in mind that as one ages, so
the need for sleep diminishes. Secondly, it may well be that the
discomfort of sweating and hot flushes is responsible for your
disturbed sleeping pattern.
Alteration in libido:
The decrease in the desire to have sexual intercourse during a
woman's middle years is likely to be due to external factors
rather than to a hormonal imbalance. Pain during intercourse,
resulting from the reduction in Ooestrogen levels, often leaves
the woman with little or no desire to make-love to her partner.
If left untreated, the situation worsens and will inevitably
result in some form of depression.
Stress and Depression:
Many women find the menopause to be psychologically upsetting,
and there probably are a multitude of reasons for her feeling
somewhat inadequate and unable to cope with the day-to-day
problems that arise. This state of despair may be due to a
number of factors namely:
Marriage:
By the time a woman has reached her middle forties, her partner
may have reached a peak in his profession, that requires longer
working hours, and less quality time spent with her. He is apt
to be tired on returning from work, and may not even notice the
changes taking place in her body - seeming more preoccupied with
matters other than their sex life, or appears to show no
interest whatsoever in his wife. This whole scenario places
immense stress on the woman, who may now suspect that her
husband is having an extra-marital affair, which only adds to
her poor self image.
Children:
Menopause often coincides with the children leaving home
resulting in somewhat of an 'empty-nest-syndrome'. There may
also be more serious worries to deal with, such as drug
addiction, teenage pregnancy or just general family feuds. As
children demonstrate their independence they begin to provoke
their parents in ways unimaginable, and this results in the
women feeling that she must have failed in some area of
child-raising.
Parents:
By the time the woman reaches the menopause, her own parents or
those of her partner are likely to be elderly and increasingly
dependent on her. Their need for constant support complicates
the woman's life even further, as her partner now feels he can
distance himself even more as his wife now has the company and
preoccupation of another.
Work:
More is likely to be demanded of the woman as she reaches a
senior position in the workplace, and fatigue, irritability and
depression result in her feeling inadequate and fearful of the
future. Alternatively, the woman whose children are becoming
more independent may feel the need to return to the workplace.
This is seldom as easy as it may appear to be at first sight.
Firstly because of the fact that she may have been unemployed
for quite some time, and battle to gain a suitable position, and
secondly because she may feel less effective than that of the
new generation of younger women. She may battle to cope with her
new role of 'house-keeper' and 'working woman', especially if
she insists on keeping her house and home functioning as
impeccably as before.
Health and Appearance:
Weight gain is a major downfall in middle age, and one just
cannot ignore the fact that a slim, youthful figure is more
attractive than an overly-sized one. Clothes are less easy to
find and often more expensive, adding to the battle of
self-acceptance and being presentable to others, especially
seeing that most designs and creations are aimed at the younger
generation. Her skin and hair may also deteriorate, thus needing
far more attention, and often resulting in great expense and a
sense of youth having slipped by.
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