The menopause stages and symptoms-Dr.Maninder Ahuja

The menopause stages and symptoms-Dr.Maninder Ahuja

Dr. Maninder Ahuja

MHT and Mid life

Menopause is the normal, natural transition in life that begins on average at the age of 55 Years. During this time, your ovaries get smaller and stop producing the hormones estrogen and progesterone that control the menstrual cycle, your eggs are depleted and fertility Declines.

Perimenopause/before

The 3-5 year period before menopause when your estrogen and hormone levels begin to drop is called perimenopause. You typically enter into perimenopause in your late 40’s and could begin to experience irregular menstrual cycles and symptoms such as

  • Hot flashes
  • Sleep disturbances / insomnia
  • Night sweats
  • Elevated heart rate
  • Mood changes – irritability, depression, anxiety
  • Vaginal dryness or discomfort during sexual intercourse
  • Urinary issues

There is still a chance that you could get pregnant during this time and if you want to avoid this, a form of birth control is recommended until one year after your last period. A form of progestin therapy may also be an option to control menstrual bleeding and address vasomotor symptoms. Lifestyle changes are often recommended to help relieve other unpleasant symptoms.

Early menopause

Certain events other than natural aging can result in an earlier menopause

  • Hysterectomy (uterus removed) – symptoms appear gradually
  • Oophorectomy (ovaries removed) – symptoms appear immediately
  • Premature ovarian failure (POF) – underactive or inactive ovaries due to genetics, surgery, or cancer treatments, such as radiation therapy or chemotherapy. Pof can also be due to ovarian dysfunction or insufficient follicles, which mature into eggs.

Menopause/during

On average, most women are about 51 to 52 years when they enter menopause. Technically, you are in menopause after you’ve missed your period for 12 straight months without experiencing other causes, such as illness, medication, pregnancy or breastfeeding. The transition from perimenopause through menopause to post menopause can take 1-3 Years. It’s important to remember every woman is unique and will experience menopause differently. Some women experience few, if any symptoms, and for those who do, the symptoms can vary widely.

Postmenopause/after

On average, most women are about 51 to 52 years when they enter menopause. Technically, you are in menopause after you’ve missed your period for 12 straight months Without experiencing other causes, such as illness, medication, pregnancy or breastfeeding. The transition from perimenopause through menopause to post-menopause can take 1-3 Years. It’s important to remember every woman is unique and will experience menopause differently. Some women experience few, if any symptoms, and for those who do, the symptoms can vary widely.

  • Hot flashes
  • Night sweats
  • Elevated heart rate
  • Sleep disturbances-insomnia
  • Mood changes – irritability, depression, anxiety
  • Urinary issues
  • Vaginal dryness – which can lead to discomfort during sexual intercourse

Additionally, due to the decrease in estrogen, there’s an increased risk of heart disease, osteopenia, and osteoporosis.

Androgens

Androgens are male hormones. The principal androgens are testosterone and androstenedione. They are, of course, present in much higher levels in men and play an important role in male traits and reproductive activity. other androgens include Dihydrotestosterone (DHT), dehydroepiandrosterone (DHEA) and DHEA sulphate (DHEA-S).

In a woman’s body, one of the main purposes of androgens is to be converted into the female hormones called estrogens.

Androgen levels in women peak during their 20s. Then a decline in daily production begins That continues throughout a woman’s life. The only time a sudden drop-off in androgen levels occurs is in women who have their ovaries removed (about half of all androgens are produced in a woman’s adrenal glands and half in her ovaries). By the time a woman reaches menopause, blood androgen levels are about half of what they were at their peak.

Low sex drive and vaginal dryness are two common symptoms experienced by some women during the transition to menopause this can make having sex uncomfortable or painful. These changes have been related to low estrogen as well as low androgen levels.

How depleted hormones can impact you

Brain and nervous system

Estrogen depletion can bring on a combination of hormonal and biochemical fluctuations that can lead to changes in your brain and nervous system. You may experience mood swings, memory loss, problems focusing, irritability, fatigue, hot flashes, night sweats, stress, anxiety, and depression. Physical symptoms, such as hot flashes, mixed with cognitive
Changes, such as irritability and memory loss, can create more opportunities for emotional changes and mood swings, although no research to date shows a direct link to depression due to menopause. some researchers believe that estrogen depletion can affect your memory and may impact one’s risk for the development of Alzheimer’s disease, but more
research is needed.

Heart

Due to estrogen depletion, women are put at an increased risk for cardiovascular issues, such as heart attacks, strokes, or other heart-related problems. If you have undergone a hysterectomy (removal of the uterus) and / or oophorectomy (removal of ovaries) and have experienced early menopause, you are at an even greater risk for heart problems. In addition to menopause-related estrogen depletion, your age, family history, diet, and
Lifestyle also plays a key role in your heart health.

Reproductive system

Your reproductive ability decreases with age due to the loss of ovarian function and estrogen depletion. The monthly menstrual cycle that you’ve had since puberty ends with menopause and you’re no longer able to conceive.

Skin

The body’s largest and most visible organ, your skin, undergoes changes during menopause. The reduction of estrogen at menopause decreases the water-holding ability and elasticity in the skin, leading to dryness, itching, and an increase in wrinkling and sagging. Your skin becomes more susceptible to injury, such as bruising. Estrogen appears to help your skin heal faster when wounded and researchers are beginning to study its possible connection to melanoma, a serious type of skin cancer.

Urinary system

As with the vagina, estrogen depletion can cause the lining of your urethra to become drier, thinner and less elastic. This can lead to feeling the need to urinate more often, an increased risk of urinary tract infections (UTIs) and involuntary leaking of urine (incontinence) when coughing, laughing or lifting heavy objects.

Vagina

Low estrogen levels can lead to vaginal dryness, irritation or discomfort. This lack of estrogen can cause vaginal atrophy an inflammation of the vagina as a result of the thinning and shrinking of the tissues, along with a decrease in lubrication. Sometimes this thinning and dryness can lead to discomfort during sexual activity and make your vagina more vulnerable to infection.

Other causes of low androgens include

  • Use of the oral contraceptive pill switches off testosterone production
  • Systemic oral glucocorticoid therapy suppression testosterone production
  • Panhypopituitarism inadequate or absent production of the anterior pituitary hormones
  • Anti-androgen therapy drugs that block the actions of testosterone
  • To exclude other potential causes we recommend you talk to your healthcare professional.

Androgen treatments and how they can help treat menopause

Testosterone declines with age in general, not menopause. However, as the natural ageing process occurs and women go through the menopause, androgen treatment may be a suitable option for some.

Current replacement options include transdermal testosterone administration (skin patches) or DHEA treatment (oral pills), both of which have been shown to result in significant improvements, in particular in libido and mood, while effects on body composition an muscular function are not well documented.

It is important to keep in mind that the number of randomized controlled trials is still limited and that currently none of the available preparations is officially approved for use in women. As such, androgen replacement is reserved for women with severe androgen deficiency due to an established cause and matching clinical signs and symptoms.

The apparent link between testosterone and female sexuality has recently fuelled interest in androgen therapy in women. Female androgen deficiency has quickly evolved both in the perception of the healthcare community and the general public. This development comes shortly after the results of the Women’s Health Initiative have brought the concept of postmenopausal estrogen/progestin replacement to a standstill. However, in contrast to the proven and definitive loss of ovarian estrogen synthesis in physiological menopause, it is far from certain that the ovary invariably loses its androgenic capacity during the menopausal transition.

Choosing both a convenient and efficient mode of androgen administration in women remains a challenge as these are off-license for use in women however, this is likely to

change soon. It will be key to achieving a more precise diagnostic consensus for female androgen deficiency and to provide answers to the questions ‘whom to treat, why, when and for how long’. Androgen replacement seems to be a promising option for the treatment of women with established causes of severe androgen deficiency including surgical menopause or adrenal insufficiency if they concurrently suffer from symptoms of impaired mood and libido.

Importantly, a low sex drive is multifactorial in origin and in most cases is not associated with evidence of androgen deficiency. Therefore, the diagnosis of hypoactive sexual desire disorder (HSDD) does not automatically lead to justification of androgen replacement, as androgen deficiency is not necessarily associated with this condition. It is important to acknowledge that physiological menopause in women with intact ovaries is not associated with a sudden loss of testosterone, unlike the steep drop in ovarian estrogen production. As a result, postmenopausal women do no routinely require androgen replacement. The slow, age-associated decline in DHEA, DHEAS and active androgens observed over a woman’s lifetime does not represent an indication for replacement per se but may well represent a physiological, protective mechanism e.g. preventing increased sex steroid action in breast tissue. More long-term studies in larger cohorts of women with severe androgen deficiency are needed comprehensively to assess both potential beneficial and adverse effects.

Top questions to ask

Top questions to discuss with your healthcare professional if you answer yes to one or more questions below to see if you may be suitable for androgen hormone therapy

  • Have you noticed that it takes longer for your vagina to become lubricated before or during sex?
  • Have you noticed that the amount of vaginal lubrication is less?
  • Do you have discomfort or pain during vaginal penetration?
  • Do you have sex less frequently?
  • Do you and / or your partner wish you had sex more often?
  • Are you less responsive to sexual stimulation?
  • Do you have difficulty reaching orgasm?
  • Has your desire for sex decreased?

If you have any concerns about any of the information discussed in this leaflet, please visit your healthcare professional.

References

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