Menopause and the vagina: What you should know?

Genitourinary syndrome (GSM) (aka vulvovaginal atrophy) is incredibly common among peri- and post-menopausal women. The most common symptoms include vaginal dryness, irritation or itching, and painful sex, with a prevalence of 13% to 87% among different populations. Yet, a majority of women suffer in silence due to the conditioning that such discomfort is part of aging and must be endured or due to the lack of awareness regarding treatment options. Therefore, these symptoms are under-reported, under-diagnosed and under-treated.

The need for fulfilling relationships and intimacy in midlife and beyond is dismissed or even shamed in community settings. Therefore, seeking treatment for vaginal atrophy is looked down upon despite debilitating symptoms, pushing women to self-medicate, which may not always be beneficial and safe. Beyond physical discomfort, these symptoms can deeply impact emotional well-being, self-confidence, relationships and quality of life (mood changes due to pain and irritation). 

 

And then, there is fear of hormonal treatment. Many women and their families are apprehensive of hormonal options for fear of side effects. But here’s what you should know: Extensive research shows that low-dose vaginal hormone therapy is significantly safer than systemic hormone therapy—even for women with high-risk conditions like hormone-sensitive cancers.

Why does the genitourinary syndrome of menopause (GSM) occur?

 

GSM is the manifestation of the pelvic changes that occur due to estrogen loss during peri- and post-menopausal phases. As tissues and neurons in pelvic organs like the urinary bladder, uterus, cervix, vagina, and external genitalia are estrogen-sensitive, the lack of circulating estrogen causes structural and functional changes, altering the entire pelvic environment. 

 

Eventually, when the vaginal wall thins down with age or severe hormonal depletion, the estrogen receptors present on the surface decrease in number and activity, leading to both physical degeneration and reduction in estrogen sensitivity (as they are mutually dependent).

 

Alterations in the vaginal mucosa i.e. flattening of the vaginal skin surface and loss of texture causes a decline in the beneficial vaginal bacteria that maintain an acidic pH to keep infections at bay in a healthy condition. Changes in the vaginal microbiome allow abnormal bacterial species to flourish, which can have long-term health implications on reproductive health. It can also lead to recurrent UTIs.

 

Collagen and elastin production is disrupted, affecting the integrity of connective tissues and smooth muscle contractility. The secretion of hyaluronic acid, a natural moisturizing agent in the vagina, also declines. The nerve distribution in the vagina is also directly impacted by estrogen levels.

What to expect?

The above-mentioned estrogen-dependent processes can result in a myriad of changes in the vulvovaginal area, including but not limited to: 

 

• Loss of fat in the external genitalia, causing shrinkage of the labia (vulval lips) and vulval opening

• Reduction in vaginal wall thickness

• Cracking of the vaginal surface 

• Loss of vaginal rugae (ridges) 

• Shortening/ narrowing of vagina due to stiffness 

• Loss of sensitivity in the vagina and clitoris 

 

A combination of genital, urinary and sexual symptoms may occur simultaneously and their severity can vary with time, activity and hormonal changes. The non-specific nature of symptoms can be confusing and frustrating. For some women, vulvovaginal symptoms may start very early on in perimenopause even when their cycles are regular, while some others may experience them at later stages or never at all. 

How is GSM diagnosed?

As many of these symptoms overlap with other medical conditions, diagnosis can be challenging. However, GSM is diagnosed based on a combination of urinary and vaginal symptoms, as well as by eliminating other possible conditions.

 

There is anecdotal evidence that women do not bring up genitourinary symptoms unless specifically asked. As the diagnosis is primarily based on self-reported symptoms, medical history and physical examination, open conversations with the care provider are critical. In specific cases or when symptoms persist after initial treatment, pH testing, vaginal smear (biopsy) or microbial culture tests may be prescribed. 

How to prevent/ minimize the symptoms?

Avoid using cosmetic products on your genitalia, your vagina is a self-cleaning organ. Genitals and the skin around them can be (mostly will be) darker than the rest of your body due to friction and hormonal influence. It is best to make peace with this fact and not perceive it as a lack of cleanliness. 

 

Avoid douching. In fact, they can be harmful to the vaginal microbiome and increases the risk of vaginal infections. In case of an unpleasant odor or abnormal discharge, it is best to consult a gynecologist. 

 

Exercising the vaginal and pelvic muscles regularly. Orgasms are the best way to improve blood circulation and maintain healthy vaginal secretion!

 

What are the treatment options?

 

Although many formulations containing a host of skin care ingredients are marketed as remedies for vaginal dryness, it is best to adhere to medical recommendations because not all of these ingredients are tested for long-term safety and efficacy. Here are some widely prescribed treatment modalities for GSM. If other menopausal symptoms co-occur with GSM, the need for systemic hormone therapy (HT) may be evaluated.

The choice of treatment is subjective to your symptoms, severity and underlying medical conditions. It is important to openly discuss your medical history with your doctor so they can prescribe the best-suited treatment option(s) for you.

 

Water-based lubricants and moisturizers: These are available over the counter, can be used without a medical prescription. Products containing hyaluronic acid are known to be great for mild to moderate vaginal dryness. 

 

Vaginal low-dose estrogen: Pessaries (vaginal tablets) and creams of very low-dose estrogen are used to ensure local action of estrogen and minimal absorption into the bloodstream. The amount of estrogen that enters circulation is almost negligible and hence this option is considered safe for high-risk candidates and as an add-on module for systemic HRT.

 

Vaginal DHEA (precursor of testosterone): Mainly prescribed for women with estrogen-sensitive breast cancer and those who are already on systemic HRT yet have genitourinary symptoms or sexual dysfunction (low libido).

 

Ospemifene: Binds estrogen receptors and activates them to provide symptomatic relief.  

Some light- and energy-based therapy options (laser and radiofrequency) have shown promise in stimulating collagen production and the formation of new blood vessels in degenerated genitourinary organs in menopausal women. However, further research and data are necessary for them to be widely offered as treatment modalities for GSM.

 

Menopause symptom management is not a part of the medical curriculum in many regions (recently included in some countries), so many gynecologists may not be comfortable treating certain symptoms (especially if they are persistent) and can refer you to a urogynecologist or endocrinologist with specialization/ training in this area. Some experiences may test your perseverance. It is critical to keep up your hope, look out for empathetic medical practitioners and advocate for yourself. Only when there is a demand, more doctors will come forward to get trained in this specialty.

 

 

 

The Hysterectomy-Menopause Connection: A Comprehensive Guide

 

Hysterectomy (the surgical removal of the uterus and other reproductive organs, as necessary) is a major gynecological surgery that is recommended for certain conditions when other treatments do not work. 

 

Some of these conditions include but are not limited to

• Uterine fibroids

• Chronic infection 

• Gynecological cancers

• Endometriosis (the tissue lining the inner uterine wall grows outside the uterus)

• Adenomyosis (lining of the uterus growing into the muscle of the uterus)

• Childbirth complications (if the surgery can be life-saving)

• Uterine prolapse

• Gender affirmation (in transgender/ non-binary individuals)

Types of hysterectomies

Depending on the condition and its severity, the different parts of the uterus and other reproductive organs may be removed.

 

Total hysterectomy: The entire uterus and the cervix are removed.

 

Sub-total hysterectomy (aka partial or supracervical hysterectomy): the uterus is removed completely or partially while preserving the cervix. If a part of the uterus is retained, regular or occasional menstruation is possible post-surgery.  

 

Radical hysterectomy: the uterus, cervix and the upper part of the vagina are removed.

Note: The cervix is the narrow end of the uterus that connects the uterus and vagina. The uterus, cervix and vagina are not hormone-producing organs.

 

 

Does a hysterectomy always lead to menopause?

 

Ovaries are the main producers of reproductive hormones (estrogen and progesterone) in a female body; some secondary organs produce estrogen too, but at very low levels.

 

When one or both ovaries are removed (termed oophorectomy) along with the uterus, there is an abrupt interruption of hormone production and circulatory levels. 

 

Unilateral oophorectomy: When one functional ovary is preserved, though the hormone levels dip, the effect is mild to moderate. 

 

Bilateral oophorectomy: When both ovaries are removed, the effect is immediate i.e. the person is considered to be in induced or surgical menopause. 

 

When both ovaries are removed along with the uterus, the sudden decline in estrogen in the body can bring on severe menopausal symptoms as the body would not have time to adjust. Depending on the individual’s health conditions, age and certain other criteria, post-oophorectomy individuals are more likely to be prescribed hormone replacement therapy (HRT). HRT is generally ruled out if the surgery is done in post-menopausal women.

The removal of ovaries along with the uterus was a norm in the past. With emerging evidence on the significant roles of estrogen and progesterone in the overall health of the individual, current medical policies across the globe strongly recommend the preservation of ovaries as much as possible. This decision is conditional on the pros and cons concerning the individual’s medical needs. For example, in the case of cancers in the fallopian tube or even in parts of the uterus closer to the ovaries, the tube and ovaries (one or both) may need to be removed along with the uterus in a precautionary or life-saving surgery, termed hysterectomy + oophorectomy (or salpingo-oophorectomy).

Discussion points with your healthcare provider

When presented with a hysterectomy as a potential treatment option for your condition, it is important to discuss the below points with the treating doctors to gain clarity. Gaining this knowledge can go a long way in mentally preparing yourself for what’s to come.  

Need and plan for the surgery: It is essential to understand the reasons for considering a hysterectomy as the best solution to your issues. Some questions to ask before giving consent:

• What are the risks involved? Are there alternative treatments that can work as effectively?

• How urgent is the surgery? 

• Will it eliminate all my current symptoms or only some?

• What organs are being removed?

• Will I get periods after the surgery? Are my ovaries being left behind?

• What will be my post-operative treatment modules, if any?

Health status of the ovaries (pre- and post-op): This is the top factor, as you must have gathered from the above sections. Here are some questions you may want to ask if the retention of ovaries is considered:

• Is the status of my ovaries appropriate to my age?

• How can I follow up on their status post-surgery when I won't get my periods (which is the ultimate indicator of their activity)?

• Will I experience menopause immediately after the surgery or earlier than usual?

Mode of the procedure: Hysterectomy can be through a 

• vaginal incision 

• abdominal incision or

• laparoscopy procedure

The post-operative procedures and recovery will vary accordingly. If presented with more than one option, you may want to discuss the pros and cons of each procedure to arrive at a mutually agreeable decision. 

Need for hormone replacement: This will be necessary if you are ovulating (before the surgery) and one or both ovaries are removed during the surgery.

Mental health support: Most women who undergo hysterectomy go through mental struggles both in the decision-making stage and post-surgery. The need for mental health support should also be considered on a need basis.

Pap smear/ HPV vaccination: Post-hysterectomy women with the entire or partial cervix retained are candidates for regular pap smears (at intervals appropriate to age, pre-existing conditions and family history) as anyone else. 

Menopause tracking after hysterectomy (without oophorectomy)

When one or both ovaries are preserved during a hysterectomy, the ovarian function (aka hormonal cycles) may 

1. Continue for years until natural menopause: Periods and/or PMS/PMDD can be experienced in a cyclical manner depending on whether the person has a partial uterus or not, respectively.

2. Stop sooner than usual after the surgery (premature ovarian insufficiency): This usually happens due to disturbance to the blood supply to the ovaries. Recent research on small cohorts of women has shown that women who underwent hysterectomy experienced ovarian failure (menopause) 4 years earlier than their natural menopausal age and with more severe symptoms than those who did not undergo the surgery. However, this need not be true for everyone. There is anecdotal evidence that insufficient blood supply to the ovaries is generally compensated by the formation of new blood vessels in younger women undergoing hysterectomy than in older women. It is possible that the age at which the hysterectomy is performed can be a significant determinant of early ovarian failure. This association is, however, yet to be confirmed by research. 

 

Here are some ways to keep track of ovarian function post-hysterectomy.

 

Menopause symptoms: Those who menstruate regularly may see variations in frequency and/or volume of bleeding. Those who do not menstruate post-hysterectomy have to rely on other symptoms of menopause- physical and psychological (detailed here). 

 

FSH test: A yearly test of the levels of follicle-stimulating hormone (which would increase with age and steeply during the menopausal transition) can give a fair idea of ovarian function. Your gynecologist can guide you in this regard. 

 

Ultrasound imaging of ovaries: Ovaries with mature eggs can be visualized prominently by ultrasound imaging. The size of your ovaries can indicate if they are functional.

 

Frozen Shoulder: A Disabling Dilemma in Perimenopausal Women

Adhesive capsulitis (the technical term for frozen shoulder) is an unfortunate reality for many women during perimenopause and menopause. Some people are more prone to it than others: those with diabetes, for example, and people of Asian descent.

 

In fact, it is so common among Asians that it is often known as the “fifties shoulder” or “fifty-year shoulder".

 

In India, one specific cross-sectional study of 100 postmenopausal women above the age of 45 found that 67 women were affected on the right shoulder, 27 on the left shoulder and 6 on both sides. 

 

Knowing more about this condition is the first step towards managing it effectively. Here’s all you need to know about the impact of a frozen shoulder in menopause and strategies to prevent and combat it.

 

What causes frozen shoulder(s) in perimenopause?

 

The scientific link is not firmly established, but it is thought to be related to the hormonal fluctuations during perimenopause and menopause. Additionally, poor sleep, depression, fatigue, etc., can further exacerbate inflammation and joint stiffness in those who already have this condition.

 

How do perimenopausal symptoms increase the risk of frozen shoulders?

 

Declining estrogen. Estrogen plays a crucial role in bone and joint health. In fact, studies show that estrogen deficiency affects joint tissues including the synovial lining and capsules (lubricating structures surrounding the joints), muscles and ligaments. This could very well impact the shoulder joint capsule thereby making it stiffer and less elastic, and increasing the risk of developing a frozen shoulder. 

 

 

 

Sleep disturbances. Hot flashes and night sweats can disrupt sleep patterns, leading to fatigue and impacting regular physical activity contributing to stiffness. Additionally, lack of sleep also impairs the body's ability to repair and regenerate tissues, including those of the shoulder joint.   

 

Muscle weakness. Hormonal imbalances also directly and indirectly affect muscle strength and coordination, which weakens a woman’s ability to maintain proper posture and flexibility.  One of the major joints affected in this process is the shoulder joint.  

 

Psychological Factors. It is a well-known fact that mental health can contribute to muscle tension and pain. Mood swings, anxiety, depression and other psychological factors that are common in menopause can hasten the progression of shoulder pain symptoms eventually leading to a frozen shoulder.   

 

Is it curable? 

 

Yes, it is. But it can be a long-drawn process that can take months or even years. Preventing it altogether or managing the pain is an easier task and most lifestyle changes typically focus on this. 

 

A 2023 retrospective study of 1,952 female patients between 45 and 60 years of age revealed that those who didn’t use hormone therapy had a 99% greater chance of receiving a frozen shoulder diagnosis as compared to those who did; indicating that hormone therapy may be a promising cure. However, more expansive research is needed to confirm this.

 

What are the lifestyle changes I can make to manage this condition?

 

• Movement and Physical Therapy. This is the foundational treatment for a frozen shoulder. Dynamic movements such as swimming, dancing and weight-bearing exercises when done regularly can help prevent this condition. For treatment, a personalized set of exercises designed by a physiotherapist and targeted at improving range of motion, strength, and flexibility can make a difference. In fact, a controlled trial of 62 perimenopausal women with diabetic frozen shoulders revealed an improvement in pain intensity, disability level, shoulder flexion, abduction and external rotation range of motion with physical therapy in just 4 weeks.

 

• Posture Correction. This is especially important in the modern lifestyle where women are constantly hunched over their phones or laptops, thereby increasing stress on the shoulder joint. Consciously focusing on good posture, investing in ergonomic furniture and performing posture improvement exercises regularly are needed to combat this. 

 

• Pain Relief. Over-the-counter pain relievers like ibuprofen or acetaminophen can help manage pain, which is the top reason for people missing out on their physical therapy protocols. Even creams and gels containing menthol or capsaicin can provide localised relief. Stronger treatment options, such as corticosteroid injections directly into the shoulder joint, can reduce inflammation as well as pain.   

 

• Supporting Therapeutic Modalities. Heat therapy, ice therapy, massages and ultrasound are some other ways to manage pain and inflammation and enable women to adhere to physical therapy. Heat packs are used to relax muscles and reduce pain, whereas cold packs can numb the area and reduce inflammation. Sports massages, especially before physical activity, can improve circulation and the range of motion more effectively.

 

• Sleep & Stress Management: Maintaining a regular sleep schedule and adopting stress management techniques like meditation or deep breathing can help alleviate sleep disturbances and promote tissue healing and recovery.

 

Are there any specific nutrients that can help with inflammation and healing? 

Yes, there are. The role of certain nutrients in supporting overall joint health and reducing inflammation is well established and these could potentially benefit those with frozen shoulders too.

1. Omega-3 Fatty Acids. These are commonly found in fish, flaxseeds, sea algae and walnuts and are well-established as anti-inflammatory agents.

2.  Curcumin. It is the active compound in turmeric and has potent anti-inflammatory and antioxidant properties. It can be consumed with milk or honey, or added to vegetables and dishes, as commonly done in Indian cooking.

3. Vitamin D. Although not easily found in foods, vitamin D is not a hard nutrient to get, as long as you expose yourself to sunlight most days of the week. It has a proven role in calcium absorption and musculoskeletal health.

4. Magnesium. It naturally occurs in whole grains, legumes, dark green leafy vegetables, and pumpkin seeds. It plays a role in relieving muscle tension and spasms and promoting nerve function.

 

Summary 

 

While the exact relationship between perimenopause/menopause and frozen shoulders is not fully understood, there is a strong association between the two. Management strategies are effective, but patience is key when dealing with a frozen shoulder as it may take several months for symptoms to improve. Combining good nutrition with regular physical therapy and professional guidance can help regain full shoulder function. 

 

Hormonal Havoc: Navigating Migraines in Perimenopause

Hormonal fluctuations can trigger migraines in perimenopause

Perimenopause, the transitional phase leading up to menopause, is marked by hormonal fluctuations that can significantly impact physical, mental, emotional and social health (relationships and adaptability). One of the common and often debilitating symptoms experienced during this time is an increase in migraine frequency and severity. Migraines are different from regular headaches.

 

Menstrual migraine affects about 20–25% of female migraineurs in the general population, and 22–70% of patients presenting to headache clinics. Additionally, in women diagnosed with menstrual migraine, perimenstrual migraine attacks are associated with substantially greater disability than their non-menstrual attacks. 

Another study of 237 women aged 30-34 showed that more than 1 of every 5 female migraineurs have migraine in ≥50% of menstruations. 

 

According to the Headache Classification Committee of the International Headache Society, migraine is a common neurovascular syndrome, which is typified by intense, unilateral, throbbing and pulsatile headache attacks, lasting for 4–72 hr and accompanied by anorexia, nausea, vomiting, photophobia and/or phonophobia. In about 15% of patients, an aura (visual disturbance) may precede the migraine headache within about 1 h (classical migraine; migraine with aura). 

 

While the exact cause remains unclear, there is strong evidence suggesting that both the timing and frequency of migraine attacks are influenced by hormone-related events. The most widely proposed “estrogen withdrawal hypothesis” suggests that the fall in estrogen levels is responsible for this. Other female sex hormones have shown involvement in studies too, but their mechanisms of action are obscure. Taken together, female sex hormones are thought to influence/ trigger migraines through a complex interplay of central and peripheral neurological pathways.

 

Risk Factors

 

Pre-existing migraines - during menstruation or otherwise

Family history - particularly female relatives

Sleep disturbances - both in quality and quantity of sleep

Stress - physical, mental or emotional

Medical interventions - hormonal therapy can increase risk for some women

Type of menopause - interestingly, migraines seem to reduce in a substantial faction of women after spontaneous menopause but can worsen after surgical menopause due to abrupt hormonal decline.

 

While there is no direct cure yet, several strategies can help improve the quality of life during this time.

 

Management Strategies - Therapeutic Interventions

 

• OTC or prescription medication: This includes non-steroidal anti-inflammatory drugs (NSAIDs), dietary supplements like Mg, riboflavin and Co-Q10, triptans as well as antidepressants, anticonvulsants, or beta-blockers in cases of severe headaches.

 

• Hormone Replacement Therapy (HRT): HRT may be helpful but it has pros and cons in migraine management. Talk to your doctor about its potential risks and benefits.

 

• Behavioral therapy is an umbrella term for practices to relax the mind and body consciously. It includes mental and muscle relaxation techniques. In some cases, Biofeedback therapy is advised. This involves learning to control physiological responses like heart rate, muscle tension, and skin temperature, which can help manage stress and reduce migraine frequency. It should only be done under the supervision of skilled professionals.

 

• Neuromodulation devices: Prescription-based devices (headband or armband electrodes) and implantables have shown promising effects in migraine management. These work by delivering electrical currents to stimulate or modulate nervous system responses. However, these devices are still in their early stages of development.

 

Management Strategies - Lifestyle Changes

 

• Regular, restful sleep: This is undoubtedly the most helpful intervention for managing migraines. Aim for 7-8 hours of uninterrupted sleep each night to regulate your body's internal clock and reduce stress

• Combating stress: Relaxation techniques, meditation, deep breathing or progressive muscle relaxation can also prevent migraine triggers.

• Regular exercise: Moderate-intensity physical activity most days of the week can improve overall health and reduce stress. It is ok to listen to your body and skip exercise during a menses or migraine episode if you don’t feel up to it. 

• Prioritising vitamins and minerals: Anti-inflammatory foods like ginger and turmeric, green leafy vegetables, nuts and seeds, whole grains and legumes rich in vitamins and minerals (especially folate, riboflavin and magnesium) can help.

• Hydrating well: Drink enough fluids to prevent dehydration, which can initiate headaches.

• Limiting known triggers: Identify and avoid potential migraine triggers, such as certain foods, drinks, strong odors, loud noises or bright lights.

 

Management Strategies - Alternative Therapies

Ice or heat therapy: Applying a cold compress to the forehead or back of the neck can help alleviate pain. Alternatively, a warm compress can relax tense muscles.

 

Essential oil application: Topical administration or inhalation of lavender and peppermint oils are often used for headaches.

 

Massage Therapy: Regular massage can help reduce tension and muscle pain, while improving blood circulation.

 

Take care

Remember, early diagnosis and appropriate treatment can help improve the quality of life for women experiencing this challenging phase of life. Talk to your healthcare provider for personalised treatment approach if your condition is particularly debilitating or difficult to manage.

 

PCOS and Menopause: A Complex, Evolving Relationship

PCOS affects an estimated 8–13% of reproductive-aged women worldwide, but up to 70% of affected women remain undiagnosed. In India, the prevalence ranges from 3.7-22.5% depending on the population studied and the criteria used for diagnosis. 

 

This makes it imperative for us to understand the interplay of PCOS and menopause, and how navigating this hormonal roller coaster is the key to optimal physical and emotional health. 

 

What is PCOS? 

It is a complex condition involving an imbalance in the hypothalamic-pituitary-ovarian (HPO) axis, leading to increased androgen production and irregular ovulation. The exact causes remain unclear, but genetic, environmental, and lifestyle factors play a role. There is no direct, confirmatory test to diagnose this condition; it is usually diagnosed based on a combination of factors, such as the prevalence of symptoms, hormone tests, irregularity of menstrual cycles and ultrasound of the ovaries. While there is no cure, lifestyle changes and treatments for symptomatic relief can help. 

 

How does PCOS impact health during menopause?

Research studies on the impact of this combination on health are conflicting, with some suggesting no significant correlation with health risks and others showing a noteworthy link. 

 

Therefore, presented here, is data from a more recent study, a systematic review and meta-analysis from 2023, in which a comparison of controls with peri- and postmenopausal patients with PCOS showed that the women with PCOS had:

• Increased circulating total testosterone, free androgen index and androstenedione (male hormones) due to changes in hormone turnover and the feedback mechanism

• Increased BMI, waist circumference and waist-to-hip ratio together with increased insulin resistance and odds ratios for diabetes 

• Decreased HDL and increased triglycerides, even though total cholesterol and LDL values were similar 

• Increased risk of hypertension, myocardial infarction and stroke

 

Another study from 2021, specifically looking at women above age 40, showed that women with PCOS:

• Reached menopause 4 years later than their age-matched controls

• Had reduced HDL levels and increased triglycerides in middle-age

• Cardiovascular risk normalised with age, except in a subgroup of PCOS women with high androgen levels even after menopause for whom the cardiovascular risk increased

• Had less frequent hot flushes and sweating but vaginal dryness occurred more often

• Presented less prevalence of hypothyroidism (hypothyroidism in postmenopausal women can amplify the symptoms of menopause and increase the risk of developing other health conditions)

• Inflammatory and metabolic parameters worsened with age

 

How can I manage these combined challenges?

Given that PCOS does not disappear with menopause, it is best dealt with through a multifactorial approach that includes some or all of the strategies mentioned below:

 

Lifestyle modifications: In addition to diet and physical activity to maintain 

 

optimal weight: growing research points to the significance of adequate, restful sleep and effective stress management in improving insulin sensitivity and CVD risk, thus also alleviating symptoms of both conditions. Practical tips are provided in the next section.

 

Medications: These usually target specific symptoms and underlying etiology rather than catering to the umbrella condition itself. Commonly used medications include hormonal therapies, insulin sensitisers, androgen blockers, pain relief or medications to address cardiovascular risk factors.

 

Hormone replacement therapy: HRT may help alleviate menopausal symptoms in general but there isn’t enough research to indicate additional benefits of HRT in women with PCOS.

 

Regular symptom monitoring: Regular tracking of symptoms and check-ups with a healthcare professional are essential to monitor progression and keep symptoms in check.

 

You can book Perimenopause/Menopause consultation or Midlife reset program

 

What are some of the lifestyle modifications that can help?

• A diet low in processed foods: The more processed food, the higher the likelihood that it is devoid of essential nutrients and facilitates insulin resistance. Swap out packaged snacks, processed meats, sugary treats for a Mediterranean-style diet rich in fruits, vegetables, whole grains, lean protein and healthy fats.

• Regular exercise: Regularity in physical activity is the key to optimal health. While weight-bearing exercises are most helpful, you can even participate in activities that you may enjoy such as yoga, dance, swimming, walking, cycling, etc. - try Menoactive program

• Stress relief and adequate sleep: Techniques like meditation, guided relaxation and deep breathing can alleviate stress and improve the quality of sleep.

• Stay strong and disciplined

 

Understanding the complex relationship between PCOS and menopause has only recently gained scientific ground. What is clear is that the coexistence of these two conditions tends to increase the risk of various health conditions in women. But, with awareness and knowledge of management strategies and with adequate lifestyle modifications, there can be a significant improvement in quality of life.

 

Preparing For Medical Menopause: A Basic Guide

Why this article?

“Medical menopause should include specialist input from both medical, psychological teams, a plan regarding managing the menopause should be in place, even before the surgery/ cancer treatment happens, which is something that doesn't happen right now every time. Early diagnosis, not dismissing symptoms, quick referral to healthcare is really key to avoiding any delay, issues, or a drop in the quality of life. HRT is recommended for early menopause until 50 years of age. Thereafter, it's again the individual’s choice to stay on it or come off. And the biggest thing is we still need to understand more for the non-Caucasian population. There's plenty of research needed for Southeast Asian, African, and other ethnic women and other socioeconomic backgrounds. There's plenty more to know about their symptomatology, transition and which forms of treatments these women respond better to.”

• Dr Vikram Talaulikar MBBS MD FRCOG PhD MICOG (in an interview with Miyara Health)

[Menopause specialist @ Menopause Clinic, London; Specialist in Reproductive Medicine at University College London Hospital; Hon. Associate Professor in Women’s Health at University College London]

This article is intended to create much-needed awareness so that women undergoing said treatments can have relevant discussions with their medical team and make informed decisions.

 

What is Medical Menopause?

Menopause is a natural biological process of hormonal changes, particularly a decline in estrogen, that marks the end of a woman's reproductive years. This phase can span many years and most women will undergo this transition gradually. However, for some women, medical interventions or underlying health conditions can cause premature and abrupt menopause to occur. This is termed as medical menopause.

 

Depending on individual cases, the menopausal phase can be temporary, that is, the ovaries start producing hormones normally when the situation is resolved. In other cases, permanent menopause is induced earlier than it would naturally occur in that person. In either case, it can be a debilitating experience, but you can manage it more readily by being prepared for it. 

Why Does It Occur?

Medical menopause is the cessation of estrogen and progesterone production before the natural age of menopause (typically around age 50). The ovaries are the major production sites of these hormones. Therefore, any procedure/health condition that affects the ovaries has the potential to cause medical menopause. Some reasons are:

• Surgical removal of both ovaries (oophorectomy): This is usually done to treat/ prevent cancer (more particularly in those with genetic risk of hormone-sensitive breast or ovarian cancer), endometriosis, or other reproductive health conditions.

• Chemotherapy or radiation therapy: This can cause damage to the ovaries thereby hampering hormone production and leading to premature menopause.  

• Arterial embolization: In rare cases, when the blood supply is cut off to arrest fibroid growth, blood vessels that supply the ovaries can be damaged during the procedure, leading to premature menopause.

• Use of certain medications: Some medications, such as those used for breast cancer treatment, can also suppress estrogen production.

What Are The Signs And Symptoms?

They are similar to those experienced during natural menopause, as the symptoms are mostly brought on by changing hormonal levels and declining estrogen. They include:

• Hot flashes and night sweats

• Vaginal dryness and discomfort

• Decline in sexual drive

• Bladder problems

• Mood changes  

• Sleep disturbances

• Bone and joint pain and stiffness

• Weight gain

• Skin and hair changes 

• Brain fog

The main difference in medical (vs natural) menopause is that, very often, the transition is abrupt and there is no time for the body to adjust. Therefore, the symptoms can be more acute and severe than they normally would. occur.

Can It Be Treated?

Just like natural menopause, this cannot be reversed, but it can be managed with a host of options. Depending on the severity of your symptoms, these strategies are likely to be effective:

• Hormone replacement therapy (HRT): Replacing oestrogen and progesterone, especially in women who are well below the natural menopausal age can be beneficial. For premenopausal women who have had a hysterectomy and bilateral oophorectomy, the benefits of estrogen therapy far outweigh risks and treatment can be life-preserving, and in some cases life-saving. The recommendation is to continue treatment until the age of natural menopause.

• Non-hormonal medications: These may include over-the-counter medications for hot flashes, lubricants for vaginal dryness or prescription medications for mood or sleep disorders.

• Over-the-counter supplements: Phytoestrogen/isoflavone supplements are known to be effective. However, their effectiveness may vary on a case-to-case basis. Though some people seem to find symptomatic relief with certain herbal remedies and complementary medicines, convincing scientific evidence of their safety and effectiveness is lacking. 

• Alternative therapies: Some women may find relief through practices such as acupuncture, hypnotherapy, and similar treatments. Of these, the most effective and widely researched strategy, especially for hot flashes and sleep disorders, is Cognitive Behavioral Therapy. This involves altering mental perspective and distraction techniques for symptom management. 

Do Lifestyle Changes Help?

 

Yes, absolutely! Regardless of your choice of treatment, lifestyle changes can be helpful to a large extent. Some of these include:

• Consuming adequate nutrients: Calcium, vitamin D and omega-3 fats are of particular importance. But overall a diet balanced in whole grains, animal or plant proteins, healthy fats, vitamins, minerals, probiotics and prebiotics is needed. Regular consumption of soybeans and soy products, as well as a plant-based diet, can help manage the symptoms.. 

• Being physically active: The most beneficial way is to practise progressive muscle strengthening, which will also help maintain bone and muscle health. Exercise can positively impact psychological symptoms, hot flashes, sleep and sexual health. Moreover, regular participation in sporting activities, walking, gardening, etc. will help too.  

• Creating a sound sleep routine: Sleep issues arise for many. However, a good sleep routine, which includes dimming the lights, a quiet environment, and a comfortable ambient temperature, can help you feel well-rested.

• Adopting stress-relieving techniques: Meditation and deep breathing are techniques of choice in this respect. But activities that make you feel happy and relaxed, such as painting, singing or crocheting, work too.

• Keeping a watchful eye: Since estrogen functions like fuel to a woman’s body and plays multifaceted protective roles, the body can be vulnerable to health risks unless supplemented adequately. While dosage adjustments will be made to best suit individual needs, it may take time and some trials to find the optimum combo or dose. Regardless, it is best to be in tune with your body cues, and record and report any abnormalities. Further, it is essential to do periodic health checks as necessary because you are the best judge of your (physical) well-being. 

What Emotional Challenges Can Be Expected?

Medical menopause can significantly affect your physical and emotional well-being. But coping with challenges is easier when you are adequately prepared to face them. Some of the emotional changes include: 

• Anxiety and depression

• Loss of confidence, usually associated with early aging

• Relationship challenges, especially with your significant other

• Feelings of loneliness or depression linked to infertility

How To Prepare To Handle Medical Menopause

Discuss your treatment plan ahead and the possibility of medical menopause with your healthcare provider: This is a crucial step as it prepares you mentally for the road ahead. Take counseling services if offered or ask for one if you feel overwhelmed.

• Know Your Symptoms Thoroughly: Educate yourself about the ins and outs of medical menopause and keep a journal to track your symptoms in detail. Identifying the problem is the first step to devising a solution.

• Seek Medical Advice When Necessary: Be regular with your check ups and doctor appointments. Also, research all treatment options available to you. Make a note of your questions beforehand and be sure to discuss any health concerns you may have.

• Start With Smaller Changes: Rome wasn’t built in a day. If you have a lot of lifestyle changes to make, start with the smaller, easier ones such as walking 1000 additional steps or eating 1 fruit a day. Even small wins can help boost your confidence.

• Rely On Your Support System: Be open with your loved ones about your feelings and experiences and make them a part of your journey to prepare for this phase of life. Connecting with online communities or support groups can help provide a forum to share experiences with others going through similar situations.

• Engage in Self-Care: Make time for yourself and what gives you happiness. Along with lifestyle changes and a good hair and skin routine, it is important to nourish your inner self too.

Conclusion

Medical menopause can significantly affect a woman's life, especially due to its sudden and impactful nature. While it may be challenging to adjust and adapt, if you are mentally prepared to face it, effective management strategies are available to maintain a good quality of life.