All women usually go through menopause between the ages of 40 to 55, but can occur as early as 35 or as late as 60. Women may experience perimenopause (early menopause) symptoms first, such as irregular or heavy menstrual cycles, hot flashes, night sweats, mood swings, insomnia, unexplained fatigue, short-term memory loss, and vaginal dryness. During this stage, the body is undergoing some hormonal changes. The ovaries gradually make less of the hormone estrogen, while another hormone called FSH (follicle stimulating hormone) increases. FSH function is to regulate the growth and the development of an egg by stimulating the ovaries to release estrogen and progesterone. Once the egg matures, the function of FSH is finished. FSH production decreases and will repeat the same process at the start of a new menstrual cycle. Natural menopause occurs when the ovaries stop producing the hormones estrogen and progesterone and the menstrual cycle is absent for one year.

Symptoms experienced by perimenopausal/menopausal women:

Are the symptoms related to hormonal changes?

Yes, the symptoms are related to hormonal changes during perimenopause. During a woman’s reproductive age, the hypothalamus (it is located in our brain) releases a hormone called gonadotropin-releasing hormone (GnRH). GnRH stimulates the pituitary gland (it is located at the base of the brain) to produce luteinizing hormone (LH) and follicle-stimulating hormone (FSH). Both LH and FSH can stimulate maturation of follicles and release of eggs. With the maturation of follicles that occur each month, there is an increase in production of estrogen and progesterone. Both estrogen and progesterone can increase the thickness of the uterine lining which is important for fertilization. If fertilization does not occur, the uterine lining will be shed off and menstrual flow will start. However as women ages, her ovaries begin to shrink which can increase rate of follicle disappearance. Ultimately, age related changes to the ovaries will result in hormonal fluctuations.

How about vaginal dryness?

Vaginal dryness is related to the hormone, estrogen. As woman ages, the level of estrogen production decreases, this can lead to vaginal dryness and decreased mucus production. As a result, some women will experience painful intercourse.

Can I get pregnant during Peri-Menopause?

The answer is yes. It is because during perimenopause, the ovaries are still releasing follicles and eggs. However, it should be noted that the pattern of menstrual cycle is irregular and therefore it may be more difficult for a woman to detect if she is pregnant. It is recommended that those who do not wish to become pregnant to continue to use contraception at this time.

Is there anything I can do to alleviate the symptoms?

What other types of medical condition one should pay attention to after menopause?

Osteoporosis and cardiovascular disease

What is osteoporosis?

Osteoporosis is defined as a loss in bony tissue resulting in bones that are brittle and liable to fracture.

How does it happen?

Bones are continually breaking down and building up. As we age, the rate of break down is faster than the rate of build up. As a result, bone density will decrease and some bones can become too weak to support the whole body.

Is there any way women can prevent osteoporosis?

• Get calcium and vitamin D supplements

• Increase the consumption of calcium rich foods
• Have a bone scan performed
• Engage in regular weight bearing exercise

What is cardiovascular disease?

Cardiovascular diseases involve the heart and blood vessel in our body. It includes high blood pressure, angina (chest pain), heart attacks, strokes and atherosclerosis (hardening and narrowing of arteries).

How should we deal with these problems?

• Do not smoke
• Follow a diet with high fiber, vitamin, and unsaturated fatty acids
• Choose low-fat foods
• Exercise