Approaching menopause? Here’s a roadmap for your body’s changes

If you're nearing menopause and are unaware of the changes your body may go through, understanding the distinction between menopause itself and the transition leading up to it is crucial. This knowledge empowers you to take appropriate steps for your health and well-being.

What is Menopause?

Menopause is a natural part of aging, marking the end of a woman's reproductive years. It is officially diagnosed after you have gone 12 consecutive months without a menstrual period, with no other biological or physiological cause. It typically occurs between ages 45 and 55, with the average age being 51. The menopause transition, commonly referred to as perimenopause, typically begins about four years before your final menstrual period. This phase is characterised by significant hormonal fluctuations that can lead to a variety of symptoms and health changes.

During the transition, individuals may experience irregular menstrual cycles, hot flashes (flushes) and night sweats, sleep disturbances, mood changes and vaginal dryness and discomfort. This phase also involves significant internal changes that affect long-term well-being such as rapid bone loss and changes in lipid and cholesterol levels.

Also read: Menopause at 46 or 51? Your ethnicity may decide

Certain changes in the menstrual cycle can point to perimenopause. Some women may notice that their cycles are becoming longer, for example bleeding every 40-60 days instead of 28.  Other women may experience shorter cycles such as 21-24 days. As the transition continues, periods may become more and more erratic. 

For many, the amount of flow reduces. However, others may experience heavier or more prolonged bleeding, particularly those with conditions like uterine fibroids or obesity.

It is important to consult a gynecologist if you experience extremely heavy bleeding or periods lasting more than seven days. This evaluation is crucial to rule out other causes and may include a pregnancy test, pelvic ultrasound, Pap smear, or endometrial biopsy as needed.

Common symptoms

The most common symptom during the transition is hot flash, affecting approximately 80 per cent of individuals.

It typically involves a sudden, intense feeling of heat, often starting in the chest and face before spreading. This sensation usually lasts two to four minutes and is frequently accompanied by pronounced sweating, a feeling of heart palpitations and sometimes followed by chills.

The experience varies widely. Some may have only an episode or two per day, while others experience them hourly, often worsening at night (night sweats). Although their frequency usually decreases after menopause, hot flashes can persist for several years, and for some, may continue for as long as 20 years.

Irritability and a worsening of pre-menstrual symptoms are common. The risk of experiencing depression and anxiety also increases significantly during this transition. Sleep disturbances and insomnia can further contribute to mood changes.

Many individuals also experience forgetfulness, difficulty recalling words, and a feeling of "brain fog." It's important to know that these symptoms are a common part of the hormonal transition.

In the later stages, falling oestrogen levels often lead to vaginal dryness, reduced lubrication, and pain during intercourse.

Some individuals may also experience symptoms such as joint pain, breast tenderness, and increased headaches, particularly around the time of their menstrual period.

The hormonal changes during the menopause transition can have significant effects on long-term health:
•    Bone health: A rapid decline in bone density increases the risk of osteoporosis, making fractures more likely from simple falls. A loss of balance can further contribute to this risk.

•    Cardiovascular health: Risks for heart disease and stroke rise due to changes such as increased cholesterol and high blood pressure. It is crucial to note that cardiovascular events, like heart attacks and strokes, are the leading cause of death in women after menopause.

•    Body composition: Shifts in fat distribution often lead to increased abdominal fat, while a loss of muscle mass may also occur.

•    Skin changes: Skin may become drier and wrinkles may appear more prominent.

During the transition, levels of key hormones like follicle-stimulating hormone, anti-mullerian hormone and estradiol rise and fall frequently. Because of this variability, hormonal testing is not a reliable method to diagnose or time menopause. However, testing for other conditions such as thyroid disorders is essential if symptoms suggest an underlying hormonal issue.

Also read: ‘We need to speak openly’: The battle to break Kenya's menopause stigma

Pregnancy remains possible during perimenopause as ovulation can still occur irregularly. While less common, unintended pregnancies do happen. Therefore, the World Health Organization strongly advises continuing a reliable method of contraception until at least age 51.

It is important to seek preventative health care during the transition and even after menopause. These include pap smears, mammograms and colon cancer screening. Regular checks for blood pressure, cholesterol, thyroid function, and diabetes are essential.

Consult a healthcare provider if menopausal symptoms significantly impact your quality of life. This includes excessive bleeding or hot flashes, disruptive sleep disturbances, mood changes affecting daily life or relationships, low libido or painful intercourse.

A wide range of strategies can effectively manage symptoms and support long-term health: regular exercise, dietary modifications, specific supplements, hormonal or prescription medications.

Dr Muthaura is a consultant obstetrician/gynaecologist at Aga Khan University Hospital, Nairobi