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Menopause – October 1st, 2006

Dr Amirthavalli Ganesan, Malaysia

Being a woman has always meant dealing with changes: the excitement of menstruation and the grown up phase that it signals; the joys of motherhood and the responsibility of caring for a new life; and a fulfilling stage of menopause.

Menopause is a Greek word for cessation of periods. The menopause changes are not abrupt, but occur over a duration of few years. It usually starts when a woman reaches her middle or late forties, but may begin as early as her late thirties. Periods usually become irregular or infrequent before they eventually cease altogether. In the average, women may have their last period when they are in their fifties.
The ovaries produce two female hormones: estrogen and progesterone. The estrogen is responsible for the change from childhood to womanhood. It produces the feminine shape. Estrogen stimulates the breast development and reproductive organs to grow and mature, allowing a woman to have children. Woman needs estrogen for healthy condition of skin and many other organs of the body. On the other hand, the progesterone builds up the lining of uterus (womb) during each menstrual cycle. An egg is released from one of the ovaries each month. If the egg is fertilized, it settles in the uterus and grows into a baby. If pregnancy does not occur, the uterus lining breaks down and results in menstrual bleeding.
When a girl reaches puberty, she has all the ova (eggs) in her ovaries that she will need for her reproductive life. As a woman gets older, she has fewer and fewer ova. Over time, she no longer produces estrogen and progesterone in her ovaries and her periods will hence cease. Most women live one third of their lives beyond menopause, thereby increasing the risk of heart problems, osteoporosis, Alzheimer’s disease and colon cancer.

Stages of menopause

Pre-menopause: Regular menstruation and the ability to have children
Peri-menopause: Irregular periods and/or other menopausal symptoms.
Menopause: No periods for a year
Post-menopause: A year after the menopause

Symptoms of menopause

1. Hot flushes, night sweats,
2. Vaginal dryness, pain during sex, loss of sexual desire,
3. Urinary disturbances,
4. Osteoporosis (brittle bones), backache, joint pain, muscle pain,
5. Loss of height (bent back),
6. Dry skin, new facial hair,
7. Headache, tiredness,
8. Irritability, and
9. Depression, lonely feeling.


There are certain health rules that we should follow throughout our life:
1. Balanced diet with intake of low fat, low salt and low sugar,
2. Adequate rest and relaxation,
3. Regular exercise.
If menstrual symptoms are very severe, discuss with your family doctor. He/she may prescribe hormone replenishment therapy (HRT) for you. HRT helps replace the estrogen that has been lost.

HRT can be administered in the following manner:

1. Intake of tablets,
2. Application of vaginal cream,
3. Skin patches,
4. Injections, or
5. Implants.
You may want to know whether every woman would need HRT? The answer is in the negative. Not all women need HRT. Neither is HRT a cure for-all. What it does is that it reduces the symptoms and health risk associated with menopause.

The advantages of taking HRT are:

1. Reduces hot flushes and night sweats
2. Reduces vaginal dryness allowing comfortable sexual intercourse
3. Reduces risks of osteoporosis
4. Reduces risks of heart attacks

However, the disadvantages are:

1. Nausea
2. Weight gain
3. Pigmentation
4. Breast tenderness
5. Leg cramps
6. Regular gynaecological check ups
7. Regular breast check ups
8. Costly drug

Women having the following problems should avoid administration of HRT:

1. Cancer of breast or uterus, large fibroids
2. Heart problems
3. Blood clots in veins or lungs
4. Stroke
5. Diabetes
6. Liver and gall bladder diseases
7. Severe headaches
Do bear in mind that choosing to take HRT is a personal choice. What you need to do is that weigh the pros and cons in consultation with your doctor.

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