The
menopause is now considered a normal part of the life cycle
of the vast majority of women. This is a fairly recent concept
in the history of human kind upon this planet. In primitive
society, most women would usually have died before they reached
the menopause either as a result of disease or in childbirth.
The menopause - the cessation of the production of eggs by the
ovaries, the end of childbearing potential and the cessation
of menstruation -usually occurs between the ages of 45 and 55.
It may be earlier or later, much earlier in some women in whom
an artificial menopause has been created, either medically or
surgically, in the treatment of a severe illness - the removal
of the uterus and ovaries in a young woman with cancer of the
cervix, for example. In some women, the periods can stop suddenly
never to return, in others, they may gradually get less in length
and frequency over a period of time. Because of the change in
body hormones, particularly the fall in oestrogens, the menopause
is accompanied by physical and emotional symptoms such as hot
flushes, palpitations, vaginal dryness, weight gain, loss of
libido, lack of energy, anxiety and depression. In some women
these symptoms are fairly slight, and transient, in some they
are so severe, the whole quality of life is threatened. The
fall in oestrogen levels makes women more vulnerable to loss
of bony tissue (osteoporosis) and more prone to conditions such
as coronary artery disease from which the oestrogens, previously,
partially protected them. The cessation of periods does not
necessarily correspond with the end of ovulation and it is not uncommon for women who think they are menopausal to become pregnant.
Contrary to what, particularly the popular press may say, many women do not require HRT (hormone replacement therapy), indeed, some women are made to feel worse by using such medication. An acceptance that the symptoms are usually transient is sufficient for many women not to request HRT, particularly the knowledge that the treatment does not abolish the menopause but only delays it until the time the treatment ceases. Attention to general physical fitness, emotional health, attention to diet, the use of a vaginal lubricant can all be helpful. Medications that are non-oestrogenic can be used for the treatment of hot flushes and osteoporosis. That having been said, many women find the menopause a very uncomfortable time and the replacement of body hormones with HRT in the form of tablets, patches, or implants can be very helpful. This particularly applies to women who, for whatever reason, have had an abnormally early menopause. In women who have not had a hysterectomy the prescribing of an oestrogen alone ("unopposed oestrogen") can lead to cancer of the uterus, so some progesterone-like hormone is needed in the HRT. This meant, previously, that these women continued to have periods and, sometimes, premenstrual tension (see Premenstrual tension). Modern preparations are now available where this kind of bleeding has, mostly, been abolished. Women who have had hysterectomies are under no such restrictions and can take unopposed oestrogens almost indefinitely. |
