Menopause is one of those life chapters that every woman eventually turns the page to, yet it’s often spoken about in hushed tones or brushed aside as “just part of ageing.”
For many, the journey begins in the late 40s or early 50s, though the timing varies from woman to woman. Some move through it with little disruption, while others find themselves wrestling with hot flashes, sweating, mood swings, or changes in skin, losing hair, and energy levels that demand a whole new self-care routine.
Dr Maina Muriithi, an obstetrician–gynaecologist at Aga Khan University Hospital, describes menopause as a period marked by cessation of menses for twelve consecutive months.
The average age of menopause for an African woman is 51 years, though not a static figure, and it could occur earlier in some women and later in some.
“Some women might experience mild symptoms of menopause, while others might experience severe menopausal symptoms, and some might even go through the period unknowingly, only noticing that their menses have disappeared. These changes could start from the age of 45 years. Experiencing the symptoms before 40 years is called premature ovarian insufficiency and is abnormal,” he says.
The earliest and most common symptom of menopause is hot flashes, which come as sudden, intense heat all over your body, particularly in the upper part, such as the face and neck.
Menopausal symptoms can interfere with a woman’s ability to work, care for others, and participate in community life.
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“These tend to occur mostly at night, causing disturbance in sleep,” he says, noting that up to 80 per cent of people going through menopause experience hot flushes, but they tend to go away within one to two years. Common triggers for hot flushes are caffeine, alcohol, and spicy food.
“Changes in the menstrual cycle include irregular and less frequent periods or experiencing heavy menstrual bleeding," he says. “Persistent heavy or painful menstrual bleeding, however, should be checked as other conditions like adenomyosis [where womb lining grows into the womb muscle, causing painful, heavy periods] often present in the pre-menopausal period.”
Other body changes that occur include breast atrophy which is shrinking or loss of fullness of the breasts, vaginal dryness and thinning, fat redistribution, weight gain and wrinkling of skin. The appearance of white-greyish hair that comes with ageing occurs when hair cells lose the black pigment-producing cells called melanocytes, typically from the age of 40 years, and is not reversible.
“Some people might experience bone and joint pains as a result of loss of bone density and the weight gain,” says Dr Muriithi. “Cognitive and emotional changes such as forgetfulness and poor concentration, are commonly termed as menopause brain fog, irritability and bouts of sadness.”
Some women also experience low libido during menopausal transition. These changes, in the extremes, can be quite distressing. However, some lifestyle changes can ease the transition to menopause by relieving symptoms. Such changes include eating healthy, maintaining a good weight, exercising, hydrating, wearing loose clothing at night, avoiding spicy food and caffeinated drinks and practising breathing exercises and mindful meditation.
“That said, in extreme cases that refuse to improve even after lifestyle changes, it becomes necessary to include hormonal replacement therapy (HRT) and other adjuncts of menopause management,” says Dr Muriithi.
“HRT replaces the hormones oestrogen and progesterone, which fall to low levels as you approach the menopause. Prior to initiation of HRT, one has to undergo medical check-up to ensure that they are eligible to use it.”
Conditions that would prevent one from using HRT include a history of heart disease, active cancer of the breast, uterus or ovary, history of clots, uncontrolled blood pressure, liver disease or pregnancy.
“For those who do not qualify for hormone replacement therapy, non-hormonal adjuncts containing soy isoflavones (plant-based compounds found in legumes like yams), antidepressants and anti-anxiety medication that have a significant effect in lessening the symptoms of menopause. Doctors may also recommend psychotherapy and behavioural therapy to understand one’s body better,” Dr Muriithi says.
