Menopause

Menopause

Menopause can occur at any age

Menopause is defined as complete cessation of menses for at least 12 months duration. This menstruation cycle is controlled by a hormone called estrogen which is produced by growing eggs. As egg count decline, estrogen levels fall producing various symptoms.

Estrogen hormone controls beauty, vitality of women and is responsible for good heart, bone and sexual health. Estrogen depletion leads to variety of symptoms

SYMPTOMS

Estrogen depletion symptoms may be subtle like weight gain, acne, hair fall, constipation, short menstruation cycles, irritability, sleeping difficulty, confusion, difficulty remembering things, joint pains. In some it may be severe like irregular periods, hot flashes, palpitations, panic attack, anxiety, depression, vaginal dryness, loss of libido, frequent urine infections. Some women may present with inability to conceive.

Although monthly periods presumably signifies goods fertility, in some women menstruation continues to occur despite complete depletion of eggs. This may occur, as some amount of estrogen is also secreted by body fat. This causes a false assurance of adequate fertility.

Causes of Early Menopause

1. Genetics
2. Autoimmune disorders
3. Ovarian Cyst(endometriosis)
4. Past Genital Infections
5. History of Tuberculosis
6. Drug induced (Cancer drugs)
7. Ovarian surgery
8. Smoking

Testing for early menopause

1. Anti-Müllerian hormone (AMH)– this hormone to help determine whether you’re approaching menopause or have already reached your last menstrual cycle.
2. Estrogen–in menopause, estrogen levels decrease.
3. Follicle-stimulating hormone (FSH)-Consistently elevated FSH levels points towards menopause or approaching menopause.
4. Thyroid-stimulating hormone (TSH)-It is very frequent to find autoimmune disorders like thyroid problems in women with early menopause. If TSH is found deranged anti thyroid antibodies also tested.

Testing for early menopause

1. Women with family history of early menopause, past genital or tubercular infections, or pelvic surgery should get their ovarian reserve tested every year.
2. They can also plan for early motherhood or egg freezing through IVF to preserve their fertility
3. Any form of smoking, active or passive should be avoided
4. Regular exercises at least 45 mins of daily weight bearing exercise like walking, jogging, aerobics, yoga and strength training
5. Regular exercises and strength training, tone muscles and prevent osteoporosis
6. Healthy diet rich in protein and calcium like dairy-milk, yoghurt, eggs, use of millets like ragi, whole grains, beans, legumes, soyabean, flaxseeds, tofu should be used
7. Daily calcium in dose of 1200mg /day is recommended for all women in peri or post menopause stage
8. Low dose hormone replacement therapy under supervision is recommended for all women who achieve menopause before 40 years of age
9. Patients with severe anxiety and depressive symptom require expert psychiatric care

Fertility Issues

Women with menopause who wants to have children can opt for –

1. Adoption
2. Donor egg IVF
3. Ovarian rejuvenation with PRP

Ovarian rejuvenation with PRP is a research method that involves PRP injection onto ovarian cortex to stimulate growth of reserve oocytes. Currently not major benefit has been found with this method but it is open to further research and potential evolution in the future.