Menopause: Symptoms, Causes & Risk Factors, Complications, Diagnosis, Treatment & Prevention

Last Updated on October 17, 2023 by Shabnam Sengupta

Menopause is a decline in the feminine hormone estrogen that affects women after a certain age. Women experience symptoms such as tiredness, weight gain, mood changes, sleep disturbances and a decrease in sexual interest after menopause. A similar decrease in hormones can occur in men as they age, though the decline is much slower, occurring over many years. A doctor may diagnose this as andropause or “male menopause”. Men and women can both have some of the same symptoms.

Menopause is the cessation of a woman’s menstrual cycles. If a woman has not had a period for 12 months, she is said to have attained menopause. Menopause usually affects women in their 40s and 50s. It is a natural change occurring with age in women. Menopausal symptoms can disrupt sleep, lower energy levels, and negatively impact mental health. From lifestyle changes to hormone replacement therapy, there are a variety of effective treatments available. As men age, their testosterone levels also tend to decline. Between the ages of 30 and 40, testosterone levels begin to decline by 1-2 percent per year but usually remain within normal limits for most of life. This is known as “the andropause,” and it differs greatly from a menopause. Men’s testosterone production rarely declines completely. Hypogonadism or low testosterone is more common in older life. Obese people and people with type 2 diabetes are at a higher risk of developing andropause early.

Symptoms

You may encounter the following signs and symptoms in the months or years leading to menopause:

1. Unpredictable periods
2. Dryness in the vaginal area
3. Flashes of heat
4. Chills
5. Sweats at night
6. Sleep issues
7. Mood swings
8. Increased weight and decreased metabolism
9. Hair loss and dry skin
10.  Loss of fullness in the breasts

Causes

1. A natural reduction in reproductive hormones: Your ovaries begin to produce less estrogen and progesterone, the hormones that govern menstruation, as you enter your late 30s, and your fertility reduces.
2. Ovaries and/or uterus are surgically removed: Since the menstrual cycle is regulated by hormones produced by your ovaries, removal of the ovaries and/or the uterus results in menopause.
3. Chemotherapy and radiation therapy are two of the most common treatments in cancer and can results in the development of early menopause.

Risk Factors

Menopause normally occurs as a woman ages, but can occur early in some women:

1. Family history of early menopause. 
2. Women who smoke have a greater probability of developing early menopause than those who do not.
3. Diet: Women who do not have a well balanced diet are more likely to develop early menopause.
4. Thyroid disorders: Women with thyroid dysfunction can attain menopause earlier than others.

Complications

1. Cardiovascular illness: Risk of cardiovascular disease rises as estrogen levels fall. 
2. Osteoporosis. Brittleness and weakness of bones occurs, increasing the risk of fractures. This is due to decreased bone density after menopause.
3. Urinary incontinence can occur after menopause. You may experience frequent, abrupt, powerful impulses to urinate, followed by an involuntary loss of urine, as the tissues of your vagina and urethra lose suppleness.
4. Sexual performance. Reduced moisture production and suppleness in the vagina might cause discomfort and minor bleeding during sexual intercourse. 

Diagnosis

1. Most women can identify when they’ve started the menopausal transition by the signs and symptoms. 
2. Menopause is usually diagnosed without the need of tests. Rarely, your doctor may advise you to get blood tests to monitor your levels of Follicle-stimulating hormone (FSH) and estrogen (estradiol), since as you approach menopause, your FSH levels rise and your estradiol levels fall.
3. Thyroid-stimulating hormone (TSH) levels can be tested because hypothyroidism (underactive thyroid) can create symptoms that are comparable to menopause.
4. You can monitor your FSH levels in your urine with over-the-counter home testing. The tests could reveal whether you have high FSH levels and are approaching menopause, or if you are in its early stages. 

Treatment

Menopause is a normal process of ageing and does not require treatment. However, those women who have severe symptoms affecting the quality of their life may be offered the following treatments by their doctor.

1. Hormone replacement therapy: In case of menopausal hot flashes, estrogen therapy is the most effective treatment. Your doctor may prescribe estrogen at the lowest dose and for the shortest time to give symptom relief.
2. Estrogen for vaginal dryness: Estrogen can be applied directly to the vaginal canal in the form of a cream, pill, or ring to reduce vaginal dryness. Only a small amount of estrogen is released and absorbed by the vaginal tissues.
3. Antidepressants at low doses: Antidepressants such as selective serotonin reuptake inhibitors (SSRIs) have been found to reduce menopausal hot flashes.

Prevention of symptoms or complications following menopause

1. Get plenty of rest. You should avoid coffee, as it can make it difficult to fall asleep, and excessive alcohol consumption, which can also disrupt sleep.
2. Work on your relaxation skills. Deep breathing, timed breathing, guided visualization, massage, and gradual muscle relaxation are among techniques that can aid with menopausal symptoms.
3. Work on your pelvic floor strength. Exercises which strengthen the pelvic floor muscles can help with urinary incontinence.
4. Consume a well-balanced diet. Include a wide range of fruits, vegetables, and whole grains in your diet. Saturated fats, oils, and sweets should all be avoided.
5. You should avoid smoking, which raises your chances of developing heart disease, stroke, osteoporosis, cancer, and a variety of other illnesses. It may also cause hot flashes and hasten the onset of menopause.

Maintaining testosterone levels in the cases of male menopause or andropause:

1. Getting enough sleep (7-9 hours) per night is recommended.
2. Eating a well-balanced diet rich in healthy fats, proteins, and carbohydrates.
3. Avoiding alcoholic beverages
4. Working out, especially strength training
5. Reducing stress
6. Boosting vitamin D, magnesium, and zinc levels
7. Weight loss

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