Menopause is a natural phase of a womans life and is marked by the complete cessation of periods for one whole year. The average age at which Indian women undergo menopause is approximately 46 years. The main physiological change is that the ovaries stop producing the female reproductive hormone- estrogen.The years prior to menopause are called pre-menopause and they involve many changes such as irregular periods, vasomotor symptoms such as hot flashes(feeling hot suddenly for a few seconds to minutes especially in the face), cold sweats(i.e., sweating for no reason), mood disturbances including irritability, emotional lability and bouts of anger and crying etc. Other changes include urogenital symptoms such as urinary leakage, urgency and vaginal dryness and irritation; skin changes such as thinning, dryness, itching etc and loss and thinning of scalp hair. These symptoms can be variable in presentation and severity. About 80% women experience symptoms like hot flashes, which is the most common symptom.The health risks revolve around the effects of lack of estrogen such as bone loss leading to osteoporosis and associated fragility fractures, heart disease such as atherosclerosis, myocardial infarction, dementia, psychological disorders, certain cancers like breast, colon cancer etc.Being well-informed is the first step towards self-care. It is important that women in their premenopausal years undergo certain baseline tests to determine if there are any underlying diseases. Common disorders that may be pre-existing or new-onset are anaemia, hypocalcemia, vitamin D deficiency, osteoporosis, diabetes mellitus, hypertension and hypothyroidism, hypercholesterolemia and depression and anxiety. Also a baseline cancer screening is important and involves tests like Pap smear for cervical cancer, clinical breast examination and mammography and an ultrasound scan of the abdomen and pelvis.Lifestyle modification forms the fundamental preventive strategy at this age. Consistent moderate exercises such as weight bearing exercises, strength and balance exercises, yoga asanas and surya namaskar, regular walking or jogging go a long way in maintaining physical and emotional health. Nutrition at this stage is also important and should aim to get enough calcium, iron and other micronutrients along with soya based protein which is rich in phytoestrogens (plant based estrogen). Calcium supplements and vitamin D supplementation may be required to prevent weakening of bones. About one fifth of menopausal women may have severe symptoms for which various medications may need to be initiated. Menopausal hormone therapy can be given in selected individuals after a thorough evaluation, and helps alleviate symptoms substantially. Although, fertility rates drop substantially in perimenopause, women must use effective contraception until menopause is complete i.e., a year has passed since the last period.Regular follow up with physician, gynaecologist, urologist, psychiatrist, orthopaedician, ophthalmologist etc is vital to maintain health over the long term. Annual or more frequent health checks would help in identifying diseases earlier.Being fit at forty, strong at sixty and independent at eighty should be the motto for us women.May 25th 2020By Dr. Aruna Muralidhar, senior consultant obstetrician and gynaecologist, Fortis La Femme, Richmond Town, Bengaluru

Disclaimer: The views and opinions expressed by the doctors are their independent professional judgment and we do not take any responsibility for the accuracy of their views. This should not be considered as a substitute for physician's advice. Please consult your treating physician for more details.

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Menopause: How to prepare your body for it - Times of India

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