Menopause and associated complications

Menopause is the cessation of menstrual bleeding which occurs on average at 50 years. It signals the end of reproductive life in a woman. At menopause, a woman’s ovaries stop making eggs and produce less hormones. This period is preceded by the perimenopause which is typically characterized by irregular menstrual cycles over a few years.

Some women experience symptoms such as hot flashes, night sweats, disturbed sleep patterns and a low sexual drive & vaginal dryness.

Due to very low hormones, women may be predisposed to complications such as weak and brittle bones, heart problems and memory and learning disabilities. These complications are rare.

Heart Disease

Post-menopausal women are more likely than men to have a heart attack. This is due to the decline in estrogens produced by the ovaries.

Adopting a healthy lifestyle by eating a heart-healthy diet filled with whole grains, fruits, and vegetables, will provide a strong defense against heart problems. Smoking cessation and reduction in alcohol intake is strongly recommended.

Osteoporosis

This is where bones become weak and brittle such that a fall or even mild stress such as bending over or coughing can cause a fracture. Commonly, fractures occur in the hip, wrist or spine. Bone is living tissue that is constantly broken down and replaced a process regulated by adequate oestrogen levels which is lacking in menopause. Osteoporosis occurs when there is decline of estrogen in creation of new bone doesn't keep up with the loss of old bone.

Sexual function and vaginal atrophy

Vaginal dryness from decreased moisture production and loss of elasticity can cause discomfort and slight bleeding during sexual intercourse. Also, decreased sensation may reduce your desire for sexual activity (libido).

Water-based vaginal moisturizers and lubricants may help. If a vaginal lubricant isn't enough, many women benefit from the use of local vaginal estrogen treatment, available as a vaginal cream, tablet or ring.

 Urinary incontinence

This is much more common in older than younger women. Although not entirely due to low hormone levels, a lack of oestrogen may worsen bladder symptoms. Testing for a urinary infection and thorough assessment by doctors is recommended. You may be offered vaginal oestrogen preparations in some instances to help with the symptoms, especially when recurrent.

In other instances, strengthening pelvic floor muscles with Kegel exercises may help relieve symptoms of incontinence. Hormone therapy may also be an effective treatment option for menopausal urinary tract and vaginal changes which can result in urinary incontinence.

​Sleep problems

After menopause, hot flashes and night sweats may keep you up at night causing a feeling of exhaustion and fatigue. Regular exercise, a healthy lifestyle and taking hormone replacement may alleviate this.

Mood and certain emotional changes

Changes around midlife can be overwhelming and predispose to mood and emotional problems. Oestrogen production also helps to support certain types of brain functioning, such as cognition and a decrease may cause some women to have occasional episodes of forgetfulness, or “fuzzy-brain,” which may lead to frustration, negatively affecting mood. Mindfulness, exercise and a healthy lifestyle are usually helpful. Occasionally, your doctor may prescribe medications for this.

Whereas symptoms for the menopause may be debilitating, they are fortunately temporary and long-term complications may be prevented by appropriate medical advice.

​By Dr Charles Muteshi, Consultant Fertility Specialist at Aga Khan University Hospital