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Understanding Menopause

Menopause is defined as the permanent cessation of menstruation resulting from loss of ovarian follicular activity. (WHO, 1981) The average mean of menopause onset in Indian women ranges from 41.2 to 49.4 years, as opposed to western societies where natural menopause occurs between 45 and 55 years of age. (Ahuja, 2016; Pallikadavath et al., 2016)

Ahuja (2016) explains that the age of onset in menopause is a critical piece of information, not only because it marks the loss of fertility but because it serves as a predictor for many midlife diseases that can be prevented with timely intervention.

Although all women experience menopause differently, the documented physical and psychological effects of menopause along with treatment include (WHO, 1981; Williams et al., 2008; Van Den Akker, 2012; Berk, 2016):

Physical Symptoms

Estrogen levels in women decline and as a result, they experience vasomotor symptoms such as hot flashes due to a rise in skin temperature, increased heart rate which is usually transient. Nervousness, chills, night sweats and irritability are also common. Vaginal and urinary symptoms include pain with sex, decreased lubrication, vaginal infections, and even dryness due to shrinkage of organ size and slow lubrication during arousal.

Decreased estrogen levels imply that the skin is no longer aided in protecting against aging. Women are also at an increased risk of developing osteoporosis, heart disease due to plaque which gets accumulated in arteries.

Psychological Symptoms

Women with a prior history of Depression are more susceptible to elevated symptoms considering menopause is a big life change. The sweating and feeling of heat in the body cause discomfort and subsequent insomnia that leads to fatigue. However, studies using Electroencephalogram have not shown any neurobiological indicators of menopause and decline in sleep.
The meanings women assign to the experience of menopause may be contributive or preventive in terms of psychological effects. For instance, considering menopause signified the end of birth giving; women who have children or don't want to have children may perceive menopause in a better light than women who would have wanted more children.
Some women also feel more liberated to have intercourse without worrying about getting pregnant.

Hormone Therapy

Hormone replacement therapy is prescribed by doctors to alleviate some or all of the symptoms or physical discomfort that arise due to the onset of menopause and decline of estrogen. Hormone therapy is usually of the following subtypes:

  • - Estrogen Replacement Therapy (ERT)
    Characterized by low doses of estrogen alone and is usually prescribed to women who’ve had surgical removal of their uterus.

  • - Hormone Replacement Therapy (HRT)
    A dose of estrogen accompanied by progesterone is prescribed.

    Agarwal et al. (2018) reviewed the need and efficacy, as well as limitations and adverse effects of Hormone Replacement therapy, these include:

    Advantages of Hormone Replacement Therapy

    Hormone Replacement Therapy alleviates many physical symptoms including the risk of cancer. An experimental study concluded that the group that received HRT had reduced symptoms of hot flashes and night sweats as opposed to the control group that received placebo.

Estrogen deficiency causes a condition called vulvovaginal atrophy which causes problems like vaginal dryness, itching and painful intercourse; HRT helps to mitigate this as well. A long cycle of HRT protects from breakthrough bleeding. HRT even helps reduce the incidence of fractures and tackles bone thinning in women.

Disadvantages of Hormone Replacement Therapy

There are certain side effects of Hormone Replacement Therapy that inhibit people from prescribing or taking it for treatment. Long term use of HRT is associated with Alzheimer's disease and other dementias. In addition to neurological disorders, hormone replacement therapy is associated with a risk of blood clots and certain types of cancer.
Venous Thromboembolism is a condition in which blood clot forms in the deep veins of legs and can even cause death; HRT increases the likelihood of developing this condition by two-folds in the first two years of treatment itself.
HRT has also been associated with an increased risk of breast cancer; non-users are at a lesser risk to develop ovarian cancers, and women who start treatment are at risk even after ten years of discontinuation of the treatment.

Although there are many theoretical advantages and disadvantages mentioned, there is a lack of evidence that strongly leans to one side. On one hand, HRT helps to relieve many uncomfortable symptoms of menopause, on the other hand it has risks that are quite severe.

Menopause is a very personal experience that may differ from woman to woman depending on her needs and her body. Therefore, starting any sort of treatment calls for an in-depth medical exam and case history to delineate any contraindications and risk factors before starting on any sort of therapy. Hence, considering that there are no odds favoring one side to treatment, a risk-benefit analysis alongside a skilled physician may prove to be beneficial in the long run.

References:

  1. Agarwal, S., Alzahrani, F., & Ahmed, A. (2018). Hormone Replacement Therapy: Would it be Possible to Replicate a Functional Ovary? ​International Journal of Molecular Sciences,​ ​19(​ 10), 3160. ​https://doi.org/10.3390/ijms19...

  2. Berk, L. E. (2018). Physical and Cognitive Development in Middle Adulthood. In ​Development Through The Lifespan​ (7th ed.). Boston Pearson.

  3. Pallikadavath, S., Ogollah, R., Singh, A., Dean, T., Dewey, A., & Stones, W. (2016). Natural menopause among women below 50 years in India: A population-based study. ​Indian Journal of Medical Research​, ​144​(3), 366. ​https://doi.org/10.4103/0971-5...

  4. Van Den Akker, O. B. A. (2012). Menopause. In ​Reproductive Health Psychology.​ John Wiley & Sons, Ltd. ​https://doi.org/10.1002/978111...

  5. Williams, R. E., Kalilani, L., DiBenedetti, D. B., Zhou, X., Granger, A. L., Fehnel, S. E., Levine, K. B., Jordan, J., & Clark, R. V. (2008). Frequency and severity of vasomotor symptoms among peri- and postmenopausal women in the United States. ​Climacteric,​ ​11(​ 1), 32–43. https://doi.org/10.1080/136971...

  6. World Health Organization. (1981). ​Scientific Group on Research on the Menopause Research on the menopause : report of a WHO scientific group.​ World Health Organization.