The menopause usually occurs between the ages of 45 and 55. The follicles in the ovaries stop producing ova (eggs) and less oestrogen (female hormone) is produced. It is this reduced level of oestrogen that causes the problems associated with menopause. Other hormonal changes include increased amounts of gonadotrophin hormones and androgen hormones in the blood.
It is unfortunate that very few doctors/nurses may not know the signs and symptoms as early as possible. Sometimes if the medics do not listen carefully to the over 50 year ladies we may subject them to unnecessary batteries of investigations. Hot flushes and night sweats occur in 70 per cent of all menopausal women. They occur with varying frequency and severity. Women usually have flushes for between two and five years, but sometimes longer.
In about 25 per cent of women flushes are so severe that medical help is sought. Vaginal dryness is the major symptom of 20 per cent of menopausal women. It occurs because the vaginal skin thins and its secretions diminish with the fall in oestrogen levels. The vagina itself shrinks, loses elasticity, and becomes prone to minor infections; sexual intercourse may be more difficult and painful due to dryness.
The neck of the bladder and urethra undergo similar changes, which result in the “urethral syndrome”, in which
a need to empty the bladder frequently is felt. Psychological symptoms, ranging from poor concentration, tearfulness and loss of interest in sex to a full depressive illness, are often attributed to the menopause.
But it is not clear to what extent these are due to lack of oestrogen or are a reaction to life changes in middle age. Changes in metabolism (internal body chemistry) also occur during the menopause, but may not cause symptoms until later. The bones become thinner, especially in the first two to five years of the menopause, over a period of ten to 15 years.
Osteoporosis (a decrease in density and increase in brittleness of the bones) may develop. Other metabolic effects include increased levels of fats in the blood, which may cause an increase in atherosclerosis (narrowing of arteries by fatty deposits) and higher incidence of coronary (heart) artery disease and stroke (kiharusi, same called mdudu in Zanzibar and Pemba).
Please note, this is the period for the whole family especially and in particular the husband (spouse) to know these changes happening to his wife if they are in the same age group and are happily married (penopause the male menopause) changes may creep in their sexual life.
A bit of poor performance from both sides needs to be understood and discussed. Members of the family begin to complain mama or bibi (granny) is easily annoyed and is losing her temper unnecessarily. The mama as usual may think she has early manifestations of a disease which she may not understand. Sometimes in a medical jargon we say the lady may suffer from Hapa hapa syndrome (Dacosta’s syndrome) an anxiety neurosis of some kind.
Talk to your doctor and discuss with your spouse and do medical checkups. It is not unusual to find that the lady may have either high blood pressure and or may be diabetic. It is not uncommon during menopause or pre menopause the two chronic diseases to creep in. What treatment in place do we have in our communities if we do not know about the menopausal syndrome (mlimbiko dalili kwa hali ya utu uzima wa mwanamke).
Hormone replacement therapy has proved effective in relieving both physical and the psychological symptoms of the menopause. It has been proved to prevent the development of osteoporosis and to reduce the risk of heart disease. As the advantages seem to outweigh any drawbacks, many doctors recommend all women to take hormones for a year or two
after the menopause.
Some recommend longer-term treatment especially for those with family history of osteoporosis, and those at risk through having an early menopause or having a slight build. The most important thing to do is to exclude other diseases in a lady who thinks it is in her menopause. What else can a lady do in the absence of hormonal replacement therapy? Avoid alcohol, chocolate, coffee and spicy foods. They can all make hot flushes worse.
Get regular exercises, which can reduce the number of hot flushes and help prevent heart disease. Light weight-training may protect the bones. If you can afford, soak in a tepid bath for 20 minutes each morning. Some women find that this routine prevents hot flushes all day long. If you have a medical condition, talk to your doctor before taking supplements like Soya isoflavone supplements may help to minimize the side effects of menopause, especially for women who don’t regularly eat soya products.
It is important to eat soya beans (maharagwe ya soya) like the Koreans, to them soya is a major food component. Any ladies reading this article please give it to your spouse to understand the coming effects of menopause.