Beating the odds: Making menopause bearable

KUALA LUMPUR, Malaysia – To be female ensures that at some point in our 40s, we will have to go through a tough time once our bodies decide to stop having their monthly periods.

Menopause is often advertised as that dreaded point in a female’s life when age finally catches up with her. From hot flashes to sagging skin, it’s not really something most women would look forward to.

But before every woman who is reading this article starts to freak out, here’s the good news. There is a lot we can do early on in our lives to keep our lady parts healthy which will in turn, make the journey through menopause a lot more easier.

Women’s Month officially ended on March 31st but Obstetrician and Gynecologist Dr. Rena Cristina Koa-Malaya says focusing on keeping our body parts that make us different from our male counterparts is something that we should be committed to all year round.

In a two-hour talk about women’s health at the Philippine Embassy in Kuala Lumpur, the obstetrician, gynecologist, and ambassador’s wife made time to explain how women can take better care of themselves.

Female members of the Filipino community and transient wards of the Migrant Workers and Other Filipino Workers’ Resource Centre in Kuala Lumpur eagerly listened and asked questions they are normally too shy to ask:  Am I too young to experience menopause? What happens to me physically and sexually once I hit mid-40s?

Reality check: Are you menopausal?

The average age for menopause for Filipinas is at 48 years old, well in between the age bracket that is considered by doctors to be the normal age for menstruation to stop which is between 46 to 54.

Some women go through menopause earlier, at around 40-45 years old, while some can get their period all the way to their late 50s. A small percentage of women (1-2%) can also go through premature menopause before they even hit 40. Koa-Malaya even shared an instance when one of her patients who was in her 20s experienced menopause due to a rare condition.

So how does one know if she’s menopausal? She says it all boils down to your menstruation’s frequency. Are you still getting it regularly?

Once your period stops for 12 months, then it’s quite safe to say that you are menopausal.

Throughout a woman’s life, her estrogen levels change. Estrogen is the primary female hormones and is mainly produced by the ovaries. Once a woman goes through menopause, production of estrogen is at an all time low and this can affect the way you feel and how you look.

Estrogen is mainly associated with reproductive health but Koa-Malaya explains that estrogen also plays a big role in bone formation, delay of memory loss, and even our skin’s elasticity and suppleness. Ever wondered why your mom suddenly looked much older when she told you she’s menopausal? It’s because of the immense estrogen drop that she experienced.

During our reproductive age, women carry as much as 500 picograms per milliliter (pg/mL) of estrogen during ovulation. During pregnancy, it can go up to as much as 40,000 pg/mL and by the time women go through menopause, it can go down to as low as 10-20 pg/mL.

Along with the rapid loss of estrogen also comes the major risk factors for cardiovascular disease, osteoporosis, and Alzheimer’s disease.

How menopause affects the body

Women in the Philippines often think of menopause as a natural phenomenon, thinking there is no need for a check up with a gynecologist.

“Yes, all women will go through it. But that doesn’t mean you should let it take over your life,” Koa-Malaya said during her lecture. “Not all women are lucky enough not to experience the dreaded symptoms,” she added.

Only 24% of women do not experience menopausal symptoms. These symptoms alone can drive women, their partners, and even their families over the edge.

Women going through menopause get tired easily, they are more irritable, and their libido tends to drop paired with vaginal dryness.

They also get mood swings, joint and muscle pain, they are easily confused, and they sleep quite poorly.

In the long term, these symptoms can lead to poor health and will affect a woman’s well-being – even her relationship with her husband. Studies show that 4 out of 5 Filipino men often complain about their partner’s lack of interest in sexual intercourse and their mood swings, saying such factors do affect the quality of their relationship.

Meanwhile, 3 out of 5 menopausal women in the Philippines experience the often-complained-about hot flashes. While most of our grandmothers would just dismiss hot flashes as a natural phenomenon that will eventually go away, what we should all be worried about is its lasting effects that will affect a woman’s quality of life.

Dr Koa-Malaya says hot flashes can cause:

• Poor verbal memory function
• Depression
• Dementia of the Alzheimer’s type
• Reductions in brain blood flow
• Increase in cholesterol level
• Increase in blood pressure
• It can also be a marker of underlying cardio vascular risk

Later on, the symptoms you have been feeling in the early and middle stages of menopause will also accelerate. Vaginal dryness will lead to soreness during sex, itching and irritation, and abnormal vaginal discharge. Needless to say, loss of sexual drive and satisfaction won’t be too far away as well.

Even your urinary activity is affected by menopause. During this period, there will be changes in its frequency and one will also be prone to urinary tract infection. Some women who are menopausal also complain about not being able to hold their urine long enough to get to the bathroom while others experience leakage when their laughing, sneezing, or coughing.

Managing Menopause

Koa-Malaya urges women not to dismiss the symptoms of menopause as natural ageing, not realizing that they could be prevented. Moreover, women should be made more aware of the effects of oestrogen deficiency.

“Estrogen deficiency will not be resolved on its own and over time, the damage will become apparent. At some point, the damage will even be irreversible,” she says.

To manage the discomforts and risk brought about by menopause, she says prevention is key. The younger you start, the better.

Start with a lifestyle change. Eat healthier and learn how to portion your food. Koa-Malaya recommends that ideally, each meal should be composed of 50% fruits and vegetables, 30% protein source, and 20% starch.

Smoking should be stopped and alcohol intake should also be reduced.

Exercising for 30 minutes, 3 to 5 times a week and taking daily supplements of 1,000-1,200 milligrams of Calcium and 800-1000 mg of Vitamin D will also keep your overall health at an optimum level so that when you enter your menopausal stage, there will be less complications to deal with.

Koa-Malaya adds that managing menopause is a partnership between a patient and her doctor. She adds that women should not stop visiting their gynecologists after they have given birth as reproductive health goes far beyond having children.

For those who are already experiencing menopause, their doctors may recommend hormone replacement therapy (HRT) through estrogen and progestin pills, low-dose oral contraceptives, or a drug called Tibolone.

Then there’s this myth: I’ll get cancer if I take hormone supplements.

Koa-Malaya says that when administered properly, HRT will not only relieve the vasomotor symptoms and urogenital atrophy associated with menopause, it can also treat osteoporosis, prevent cardiovascular disease, cognitive disorders, dementia, and skin atrophy, and improve a woman’s sexual libido and quality of life.

She adds that it is critical for women to get HRT early on so that they can enjoy its full benefits. It is recommended that women undergo HRT before they reach 60 or within the 10 years after menopause starts.

“Menopause is not a one-size-fits-all situation,” Koa-Malaya says. “All women are different and will need different ways to manage their menopause.”

It is important that women visit their gynaecologist regularly as they are the ones that can help recognise the signs and symptoms of menopause and how it can affect their work and lifestyle.

They can also talk about goals, adopting a preventive health and lifestyle program, and agree on a medical treatment after discussing the risks and benefits. – Rappler.com

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