The menopause is described as the time when a woman stops having menstrual periods, and this occurs naturally as one grows older. Menopause usually takes place between the ages of 40 and 50; in Nigeria the average age is about 47. Typically, menstruation does not cease abruptly, but becomes irregular for a while, and symptoms of menopause begin to develop. This period is referred to as the perimenopause. Menopause is said to have occurred when there have been 12 completed months without a menstrual period. It officially means that pregnancy cannot happen naturally, except by assisted reproduction (IVF).

Menopause occurs because the function of the ovaries decline with age, so the amounts of hormones produced continue to drop. Apart from regulating the female reproductive system, the hormone oestrogen performs many functions in other parts of the body, which includes bone formation, blood clotting, reducing accumulation of fat, and helping the body to retain fat and water. Thus, all of these are affected at menopause.

A woman can also become menopausal if she has her ovaries removed surgically, in which case it happens immediately. Being exposed to chemotherapy and radiation can also cause one to become menopausal. In rare cases, a woman can become menopausal before the age of 40, and no cause is found. This is called Premature Ovarian Failure.

The common symptoms of menopause are as follows:

  • Irregular periods – Usually the periods begin to skip and do not happen every month. Sometimes they can be abnormally heavy, painful, or scanty during this time. Despite the fact that menopause is approaching, there is still a slight chance of getting pregnant, so if this is not desirable it is important to still use a form of contraception.
  • Hot flashes – This is a sudden feeling of intense heat or warmth associated with sweating that happens irrespective of the temperature of the environment. It is usually worst on the face, neck, and chest and can be brief and last only a few seconds or minutes, or remain for as long as 30 minutes. Hot flashes can happen many times in a day.
  • Profuse sweating at night
  • Feeling of dryness in the vagina
  • Difficulty sleeping
  • Mood changes
  • Loss of breast fullness
  • Decreased sexual drive
  • Dry skin and thinning hair
  • Weight gain
  • Feeling tired easily
  • Frequent urination
  • Difficulty holding urine (incontinence)

For many women, these symptoms are very mild and so go unnoticed. However, others may have challenges in coping with these changes.

Post-menopausal women are also at risk of developing any of the following:

  • Osteoporosis – This is a condition where the bones become weak and brittle, and therefore they break easily. This places a woman at a higher risk for factures, especially the hip and wrist
  • Cardiovascular disease – These are group of diseases that occur when there is a problem with the functioning of the heart and the blood vessels; it includes things like high blood pressure, heart attack.
  • Urinary incontinence – The muscles of the pelvis become weak, so there might be difficulty in holding urine
  • Reduced libido – The reduced lubrication and sensation of the vagina can make intercourse uncomfortable, and this can in turn cause a reduction in sexual desires.
  • Weight gain


Hormone Replacement Therapy

The type of treatment offered for menopause depends on the symptoms you might be experiencing and how seriously they affect your quality of life and daily activities. Most women are able to go through the menopause without the need for taking any drugs, and are able to cope with the symptoms by introducing some lifestyle changes. However, if the symptoms are unbearable or severe, the medications given for menopause are usually referred to as hormone replacement therapy (HRT). The principle of HRT is to provide a supply of the

hormones that the body is no longer producing. HRT is available in different forms, which include tablets, nasal sprays, skin patches, implants, and gels.

  • Oestrogen only HRT – These preparations contain only oestrogen, and can only be given to women who had a hysterectomy and so no longer have a womb. This is because taking only oestrogen at this time can increase the risk of cancer of the womb (uterine cancer).
  • Combined HRT – These preparations contain both oestrogen and progesterone, and is given to women who still have their womb.

Some side effects of HRT include headaches or migraines, bloating, nausea, and breast pain.

Lifestyle modifications

There are many ways to adjust your lifestyle in order to help you cope with the symptoms of menopause, and these include:

  • Pelvic floor exercises (Kegel’s) help to strengthen the pelvic muscles and thus can improve incontinence
  • Keep cool by dressing in light clothes and if possible in layers, so you can have the option of taking something off if hot flashes start, take cool baths as often as possible to relax
  • Use water based vaginal lubricants to improve sexual activity
  • Healthy diet
  • Regular exercise
  • Stop smoking