Management of the menopause
Every woman goes through several changes in the way her body functions, which marks different stages in her life. With puberty, starts the menstrual cycle, where certain hormones control the monthly release of the egg and preparation for pregnancy. The termination of menstruation and fertility of women is known as menopause, and occurs 12 months after your last menstrual period, when you are in your 40s or 50s. Some women can experience menopause before their 40s, and the condition is known as premature menopause.
Menopause can be characterized by physical and emotional changes. Approaching the time of your menopause (perimenopause), you may experience irregular menses, dryness of the vagina, sagging of the breasts, dry skin, thinning hair, slow metabolism, weight gain, hot flashes, night sweats, problems with sleeping, and mood changes.
Menopause is a natural process that takes place in every woman’s like as you reach your early 40s or 50’s. The production of menstruation regulating hormones such as oestrogen and progesterone start to decrease. Eventually, your ovaries will stop producing eggs. This will make you experience changes in your menstrual pattern and bring an end to your periods.
There are some factors that can induce menopause. These include the following:
Cancer treatment: Chemotherapy (treatment with chemical agents) and radiotherapy (treatment by exposure to radiation) can cause menopause symptoms, and a temporary or permanent stop to your menstruation.
Failure of ovaries: Autoimmune diseases or genetic factors can cause your ovaries to produce less than normal amounts of reproductive hormones. This is known as primary ovarian insufficiency, and can lead to premature menopause.
Surgeries: Surgeries such as total hysterectomy and bilateral oophorectomy that involve the removal of your uterus and both ovaries will immediately stop menstruation.
Some of the possible complications associated with menopause include the following:
Your risk for heart and blood vessel (cardiovascular) diseases increases with the decrease in oestrogen production.
Your bone density may decrease, making them brittle and leading to a condition known as osteoporosis. This can make you more prone to fractures.
Your vaginal and urethral tissues will begin to lose their elasticity, and you may experience the sudden urge to urinate, or may lose control over your bladder (urge incontinence or stress incontinence). You may also become more prone to urinary tract infections.
The loss of moisture and elasticity of your vagina can cause discomfort during intercourse, and can affect your sexual desire (libido).
As the rate of your metabolism slows down, you may start gaining weight.
Your doctor can identify your transition to menopause with your signs and symptoms. To confirm the diagnosis, your doctor may order blood tests to check your levels of follicle-stimulating hormone (FSH) and oestrogen (oestradiol), as a decrease in the level of these hormones can project menopause.
Menopause itself needs no treatment, but treatment may be required to control its signs and symptoms. Your doctor will discuss the risks and benefits and may recommend any of the following depending on your condition.
Hormone replacement therapy: Your doctor may recommend treatment with hormones including oestrogen and/or progestin for your hot flashes and bone loss. It may also help prevent cardiovascular problems if started within five years of menopause.
Vagina oestrogen: Small doses of oestrogen in the form of cream, pills, or rings can help you manage vaginal dryness, urinary symptoms and discomfort during intercourse.
Antidepressants: Low-dose antidepressants can help you manage hot flashes when hormone replacement therapy is not advisable for you, and will also help improve your mood.
Medication treatment: You may also be prescribed medications to reduce your bone loss and risk for fractures.
Some of these lifestyle remedies can also help you reduce or prevent the symptoms of menopause.
Cool off hot flashes by drinking cold water or staying in a cool room. Identify factors that trigger your hot flashes, like hot beverages, alcohol, caffeine and spicy foods, and try to avoid them.
Use water-based vaginal lubricants to help you with vaginal dryness and discomfort.
Reduce stress, get adequate sleep, eat healthy, stay active and don’t smoke.
Exercise regularly. Certain exercises called Kegel exercises can help you strengthen your pelvic floor muscles and improve urinary incontinence.
Menopause is an unavoidable phase in every woman’s life. Its signs and symptoms can be often disturbing, but it is important to understand your body and learn ways to cope with your difficulties. There are various options available to successfully manage your distress, and your doctor will be the right person to guide you through.
Uterine polyps are noncancerous tissue overgrowths of endometrium, a tissue in the inner lining of the uterus, that extend into the uterus cavity. These may occur spontaneously or because of high levels of oestrogen hormone, although it is not known what actually causes it. Polyps grow faster during pregnancy and while using oral contraceptives or oestrogen replacement therapy. Although most of the polyps are noncancerous, the polyps that developed in women during or after menopause may turn out to be cancerous. Uterine polyps are more common in women aged between 40 and 50 years however occasionally may be seen in younger women of 20 years or less. Obesity, uncontrolled hypertension and certain drugs used to treat breast cancer may increase the risk of uterine polyps.
Most common symptom of uterine polyp is irregular menstrual periods. Menorrhagia or abnormal heavy menstrual bleeding, prolonged periods, bleeding between periods and bleeding even after menopause or during sexual intercourse are some of the other symptoms of uterine polyps. Infertility may also be an indication of the presence of a uterine polyp.
Uterine polyps are diagnosed based on the medical history and symptoms. Also, other diagnostic tests such as transvaginal ultrasound, sonohysterography, hysteroscopy, biopsy and curettage may be performed.
Smaller polyps that do not cause any problem need not be removed but should be assessed every 6 months to check their progression. However, if uterine polyps cause pelvic pain, heavy menstrual bleeding, or infertility or if there is previous history of miscarriage, then removal of uterine polyps (polypectomy) may be considered. Usually, polypectomy may be performed at your doctor’s office using hysteroscopy during which a long, thin rod with a video camera and light (hysteroscope) is inserted through the vagina and cervical opening. Then the polyp is caught hold and cut with a small scissor.
Larger polyps need to be operated in a hospital set-up under general anaesthesia. In order to remove the uterine polyp, laparoscopy may be performed along with a hysteroscopy. Laparoscopy involves use of laparoscope, a long rigid tube with a video camera and light which is inserted through a small incision made in the belly button. Through the laparoscope, special surgical instruments can be inserted that assist in removal of the polyp.