Dr. Purnima Nadkarni
Infertility
I am Dr Purnima Nadkarni, Director of Nadkarni group of hospitals at Pardi, Vapi ,Surat . I am a Gynaecologist and Ivf Specialist practising since 40 years.
I believe in giving holistic care to every woman and I am a firm believer of the fact that aging is not lost youth but a new stage of opportunity and strength.
Here, I take the opportunity to discuss the changes after 35 years of age in a woman and how should we tackle them in stress free manner. Let’s start with the basics of female physiology from puberty onwards. A female menstruates every month. The median menstrual cycle is from 21-35 days beginning with the 1st day of menstrual bleeding and ending just before the subsequent menses.it occurs under the influence of hormones FSH &LH. Mid of the cycle there is ovulation. This is the time of maximum fertility. After ovulation hormones Estrogen & Progesterone fall and a female gets her menses in 14 days. If pregnancy occurs, hormone levels are maintained and she misses her periods.
Usually this menstrual cycle is regular between 15-35 yrs. of age. After around 40 yrs. of age ovaries get exhausted or in medical terms ovarian quality and ovarian reserve decreases. Then you will get irregular menses or less/heavy flow.
Now coming to hormonal changes with age, Ovaries produce decreasing amount of estrogen, progesterone and androgen slowly and gradually menses stop and a woman is menopausal around 45-50 yrs. While menopause is normal and happens in all women, some symptoms can be irritating and even dangerous. To list a few, a woman may experience hot flushes, mood swings, and vaginal dryness. I shall be covering each and every change and how to combat those.
As you go through menopause, you might notice that your libido, or sex drive, is changing. Some women may experience an increase in libido, while others experience a decrease. Not all women go through this libido decrease, though it is very common. In most cases, a lower libido during menopause is due to decreased hormone levels. These decreased hormone levels can lead to vaginal dryness and tightness, which can cause pain during sex. Menopause symptoms can also make you less interested in sex.
Menopause, which officially begins one year after your last period, can bring with it some noticeable changes to your skin and hair. As hormone levels plummet, your skin can become dry, slack, and thin. You may notice more hair on your face and less on your scalp. If you’ve spent ample time in the sun without sun protection, you’ll likely see the effects now. Age spots and larger areas of darker skin can appear on your face, hands, neck, arms, or chest.
sun without sun protection, you’ll likely see the effects now. Age spots and larger areas of darker skin can appear on your face, hands, neck, arms, or chest.
In menopause, skin loses some ability to hold water, so skin can get quite dry. This can be especially noticeable when the air is dry. Skin becomes more lax and wrinkles develop.
The loss of ovarian function during the menopausal transition has a profound impact on female skeletal health. Osteoporosis is an age associated disorder which is influenced by genetic and environmental factors. Age is a high risk factor for osteoporosis. Vitamin D deficiency and reduced calcium absorption are common in elderly. Also less mobility, coordination defects promotes fall and fragility. Currently it is estimated that one in every two Asian women will experience an osteoporotic fracture during her lifetime.
The loss of ovarian function during the menopausal transition has a profound impact on female skeletal health. Osteoporosis is an age associated disorder which is influenced by genetic and environmental factors. Age is a high risk factor for osteoporosis. Vitamin D deficiency and reduced calcium absorption are common in elderly. Also less mobility, coordination defects promotes fall and fragility. Currently it is estimated that one in every two Asian women will experience an osteoporotic fracture during her lifetime.
It’s long been known that young women have a lower risk of heart disease than men, but that risk rises substantially after a woman’s estrogen levels drop with menopause. Estrogen protects the heart and keeps it resilient. While aging itself does not cause heart failure, it does lower the threshold for the disease. A woman who sometimes feels her heart racing or missing a beat could have menopause heart palpitations. This is a common symptom of perimenopausal age. Heart palpitations are a direct result of lower levels of the female hormone estrogen, which leads to an overstimulation of the heart.
An estimated 35%–50% of perimenopausal women suffer sudden waves of body heat with sweating and flushing that last 5–10 minutes, often at night as well as during the day. They typically begin in the scalp, face, neck, or chest and can differ dramatically among women who have them; some women feel only slightly warm, while others end up wringing wet. Hot flashes often continue for a year or two after menopause. In up to 10% of women, they persist for years beyond that.
The average weight gain in perimenopausal women was about 2 kg; however, 20% of the population they studied gained 5 kg or more. Not only is the weight increase from a drop in estrogen but it’s also because of a decrease in energy expenditure. Some women may notice an overall weight gain, whereas others may not see a difference on the scale.
Absence of estrogens may be an important obesity-triggering factor. Estrogen deficiency enhances metabolic dysfunction predisposing to type 2 diabetes mellitus, the metabolic syndrome, and cardiovascular diseases. Estrogen plays a vital role in fat storage and distribution. Before perimenopause, estrogen deposits fat in your thighs, hips, and buttocks. During and after menopause, the drop in estrogen leads to an overall increase in total body fat. There is an average weight gain of ½ -1 kg every year after 40 yrs. of age with same food and routine.
Menopause is the phase of life after your periods have stopped and your estrogen levels decline. In some women, menopause can occur as a result of surgery, when the ovaries are removed for other reasons. The hormones estrogen and progesterone affect how your cells respond to insulin. After menopause, changes in your hormone levels can trigger fluctuations in your blood sugar level. You may notice that your blood sugar level is more variable and less predictable than before. If your blood sugar gets out of control, you have a higher risk of diabetes complications.
Changes in hormones during menopause can lead to weight gain and make your blood pressure more sensitive to salt in your diet — which, in turn, can lead to higher blood pressure. Blood pressure may increase with age also.
Not to worry friends, I will talk about what you can do to prevent as well as detect at early stage.
Sleep disturbances:
About 40% of perimenopausal women have sleep problems. Some studies have shown a relationship between night sweats and disrupted sleep; others have not. The problem is too complex to blame on hormone oscillations alone. Sleep cycles change as we age, and insomnia is a common age-related complaint in both sexes.
Estimates put the number of women who experience mood symptoms during perimenopause at 10%–20%. Some studies have linked estrogen to depression during the menopausal transition, but there’s no proof that depression in women at midlife reflects declining hormone levels. In fact, women actually have a lower rate of depression after age 45 than before. Menopause-related hormone changes are also unlikely to make women anxious or chronically irritable, although the unpredictability of perimenopause can be stressful and provoke some episodes of irritability. Also, some women may be more vulnerable than others to hormone-related mood changes. The best predictors of mood symptoms at midlife are life stress, poor overall health, and a history of depression.
There is depression, irritation and mood swings. A woman might feel all alone as this is the time when kids also get busier in making their own world.
Now let’s come to management.
First of all, get yourself regularly investigated.
Rule out Diabetes by getting blood Sugar. Get regular BP monitoring.
Get the basic haemoglobin, Fasting and post lunch sugar, fasting lipid profile, Se B12,Se D3, Ferritin, Creatinine, Thyroid profileT3,T4< TSH
Now to prevent cancer and to detect at very early stage, where treatment is rewarding, do the following:
Now to keep yourself fit for running and swimming, get your joints checked.
Do a X-Ray knee, BMD and serum calcium.
Now the heart has to be right to let you age gracefully, so get a X-Ray chest, ECG, 2D Echo, TMT done as per your doctor’s advice and start running.
Let’s come to to life style changes which will be focussed on Diet, Exercises and Medications
Include flax seeds, soya bean, oats, legumes, nuts in your diet. These are a rich sources of phyto-estrogens, the natural estrogen.
Make exercise a part of your life. Walking, jogging, running at least 5 days a week for 30 minutes surely makes your body younger.
Now to avoid possible triggers of hot flashes, which include warm air temperatures, hot beverages, and spicy foods.
Meditate; give yourself time when you are just with yourself. This will surely help in overcoming all type of psychological changes.
Pop your medicines of Iron, Calcium and Vitamin D regularly.
Hormone replacement therapy ( estrogen &progesterone) helps in combating hot flushes, sweats, reduces fracture risk, reduces heart attack risk, and most importantly cancer risk.
Dr. Purnima Nadkarni, MBBS,MD,DGO,FCPS,FICOG
Director of Nadkarni group of hospitals
Dr. Vaibhav Nadkarni, MBBS, M.S, D.E (Germany), Fellow Repro Med. (ICOG)
Dr. Jini Gupta, M.S (Obs & Gyn), Fellow at Nadkarni Institute
Dr. Madhuri Thakur, M.D (Obs &Gyn), Fellow at Nadkarni Institute
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