Six important things women should know about menopause

Estimated reading time: 7 minutes

Menopause marks the end of a woman’s menstrual cycle and their reproductive years. When a woman hasn’t had a period for a year, it is called menopause. In the years leading up to menopause, the production of the female hormone estrogen drops, causing symptoms like hot flushes, night sweats, lack of sexual desire, vaginal dryness, and irregular periods.

Menopause can also impact a woman’s mental health, and make them vulnerable to depression, stress, and anxiety. Some women also see a reappearance of mental health problems during menopause if they have experienced them in the past.

1. What is Perimenopause?
2. What age does menopause happen?
3. Why do you have hot flashes?
4. Does menopause increase the risk of heart disease?
5. Are you more prone to osteoporosis after menopause?
6. Why does postmenopausal bleeding happen in some women?

Here are the six things associated with menopause, all women should know:

1. What is Perimenopause?

Perimenopause is the time leading up to menopause. There is no definite age that perimenopause starts; for some women it could be in their forties, but some could start seeing the signs in their mid-thirties as well. It is during perimenopause that women start experiencing symptoms like irregular periods, night sweats, and hot flashes. Women may also experience vaginal atrophy or the drying and thinning of the vaginal walls, which is a result of reduced estrogen production. This can cause pain during sex. Sleep disturbances, mood swings, and anxiety are common during perimenopause as well.

“Menopausal transition is a stage in life, when a woman goes from pre-menopause in her late 30s, early 40s to a stage of perimenopause. During  perimenopause, her period’s frequency and blood flow will fluctuate. This is when she will start experiencing some of the symptoms of menopause. Perimenopause can sometimes go on for years, where you’re still bleeding, but not regularly. The flow is not that heavy and you’re experiencing menopausal symptoms that can really affect the quality of life for women,” says professor Gita Mishra, professor, Life course Epidemiology; Head, Division of Epidemiology and Biostatistics; Deputy Head, School of Public Health, Faculty of Medicine, The University of Queensland.

On an average perimenopause lasts upto 3-4 years, but for some women it can go on for a decade. If the symptoms become unmanageable, women can seek treatment for them, and should consult their gynaecologist.

2. What age does menopause happen?

The average age for menopause in India is 46.2 years, this is slightly lower than their western counterparts at about 51 years. The age of menopause is likely to be inherited. However, about 5-10% of the women globally go through early or premature menopause. If menopause happens between the age of 40-45, it is referred to as early menopause; menopause before the age of 40 is premature menopause. Early menopause is associated with an increased risk of osteoporosis and heart disease.

“There are genetic factors like abnormal chromosomes, if you have Turner syndrome (a condition when one of the X chromosomes is missing or partially missing in women), or if you have been exposed to chemotherapy or radiation, cancer treatment,  they all affect your ovaries. There are also autoimmune causes like thyroid; arthritis; even sometimes when you have infections like mumps, or you have undergone hysterectomy, these all can lead to early menopause,” says Delhi-based gynaecologist Anuradha Sharma.

3. Why do you have hot flashes?

A hot flush essentially means an episode of intense warmth over the face, neck or chest, which may be accompanied by sweating. It could last about a minute or two, or for as long as an hour. In a study conducted in the U.S., women (undergoing menopause) reported having hot flushes daily, with some experiencing them as many as 10 times in a day. Some experts believe that hot flushes happen because the thermoregulatory system of the body – which regulates body temperature – is disturbed during menopause. This happens because of the hormonal changes which occur during menopause. Women may also experience something similar at night, referred to as night sweats.

Experts say that hot flushes are the most common symptom of menopause and are widely reported by women. Prof. Mishra says at least 50% of women will experience some kind of symptoms during menopausal transition. Former first lady Michelle Obama recently spoke about having a hot flash on Marine One, the presidential helicopter.

“…it was like somebody put a furnace in my core, and turned it on high, and then everything started melting,” she said in an episode of her eponymous Spotify podcast — The Michelle Obama podcast.

“…it was like somebody put a furnace in my core, and turned it on high, and then everything started melting”

4. Does menopause increase the risk of heart disease?

Cardiologist Dr. Sunil Kumar Maheshwari says that estrogen lends a protective cover to women. When estrogen levels are at their peak during the child-bearing years, there is a small incidence of heart disease in women. “Post menopause, as soon as the estrogen levels drop, that protective cover goes and women are at a higher risk of heart disease,” he says. Dr. Maheshwari also emphasises that smoking and diabetes can increase the risk of heart disease in women.

“Post menopause, as soon as the estrogen levels drop, that protective cover goes and women are at a higher risk of heart disease”

Prof. Mishra believes that menopause is an important marker of a woman’s past and future health. “There might be some genes that affect both the age of menopause and cardiovascular disease. So it is the genes that are making both things happen, but we see it as menopause causing cardiovascular disease. It is the third party that we need to constantly be aware of. In epidemiology, this is what we call a common cause factor,” she says.

So, how do women keep their heart healthy? Dr. Maheshwari recommends staying fit and active. He says about 40 minutes of brisk walking five days a week, adding grains, vegetables, fruits, fish, low-fat dairy, nuts, and seeds to your diet are excellent for the heart. Cutting down on sugar, salt, and red meat, and managing stress and hypertension are recommended as well. 

5. Are you more prone to osteoporosis after menopause?

Women are almost thrice as likely to have osteoporosis, a condition that makes bones fragile and more susceptible to breaking or fractures, compared to men. The risk of osteoporosis rises after women reach menopause. Dr. Abhishek Kumar Mishra, an orthopaedic and joint replacement surgeon at the Apollo Spectra hospital, says, “post menopause, women’s estrogen levels fall which impacts the strength of their bones. Estrogen plays a strong role in keeping the bones strong and keeping the metabolism of calcium to the bones adequate”. 

To protect yourself from osteoporosis, he recommends staying physically active, and taking calcium and vitamin D supplements, if their dietary intake is not adequate (only to be done in consultation with a doctor).

“Post menopause, women’s estrogen levels fall which impacts the strength of their bones. Estrogen plays a strong role in keeping the bones strong and keeping the metabolism of calcium to the bones adequate”. 

“After 55, women should undergo the DEXA scan or the bone density test at least once to determine the baseline level of the strength of the bones. And if they are diagnosed with osteoporosis and osteopenia, there have to be corrective measures. Osteopenia is a lower degree of osteoporosis. It is a harbinger of osteoporosis, it can lead to osteoporosis if not corrected,” he adds.

6. Why does postmenopausal bleeding happen in some women?

According to gynaecologist Dr. Sharma, postmenopausal bleeding happens to about 5-15% of women. And the reasons could be — endometrial atrophy (thinning of the uterine lining), polyps (mostly non-cancerous growth on the inner wall of the uterus), tumours, or other kinds of growth inside the uterus. According to a study published in the Journal of the American Medical Association (JAMA) Internal Medicine, postmenopausal bleeding occurs in about 90% of women with endometrial cancer; but only only 9% of women with postmenopausal bleeding were diagnosed with endometrial cancer.

Dr. Sharma recommends seeing a doctor immediately if women experience postmenopausal bleeding. “It is a sign of an emergency, it is an alert that you should visit your doctor. There is a likelihood of endometrial cancer, especially  if you are comorbid with diabetes or hypertension. Diabetics have a higher incidence of developing cancer if they have postmenopausal bleeding,” she says.

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