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What Is Menopause or Midlife Crisis?

The menopause is the time in life when a women stops having periods. The periods stop because the ovaries stop producing the normal amounts of estrogen and progesterone hormones. Across most ethnic population, the menopause occurs around fifty-one years old. For many people, the menopause is uneventful and they do not suffer adverse symptoms. Nevertheless, some of you will experience a series of different symptoms at the time of the menopause that initiate you to seek help and treatment.

Menopausal Symptoms & Complaints

In Caucasian women, hot flushes and night sweats are very common and characteristic of the menopause. But local Asian women do not complain much of these, possibly due to climatic adjustment. Instead, Asian women tend to speak of non-specific joint aches and body aches that become progressively disturbing. You may have disrupted or poor quality sleep, that eventually contributes to tiredness and chronic exhaustion; mood swings and irritability, poor concentration, reduced short-term memory, and in few of you, episodic heart palpitations and panic attacks. With time, some of you will deep into depression. In addition, you will notice body changes like drying and itching of skin, thinning of hair and cracking of nails, and the vaginal skin also become thin and dry. Women often describe a decrease in libido (sex drive) as well.

A few years into the menopause, you may notice changes in your urinary habits. The pelvic floor becomes weaker and the pelvic organs may begin to slide downward, giving rise to uncomfortable sensation. Osteoporosis is the commonest long term complication of the menopause. As the amount of estrogen decreases, increasing amount of calcium dissolves out of the cortical bone. This process of accelerated bone loss is osteoporosis, and it continues to the end of life. As you age, the “soften” bone becomes prone to fracture. Severe osteoporosis of the spine leads to loss of vertical height and the back becomes hunched. When your long bones are severely osteoporotic, you may have hip or wrist fractures with minimal trauma. For many years, it is known that estrogen is cardio-protective; which is the reason why there are less coronary heart disease and strokes in women before the age of the menopause. When the menopause sets in, your risk for coronary heart disease increases significantly.

Diagnosing Menopause

Diagnosing menopause when you are in the late forties is straight forward. However, when it happens in the mid thirties, then certain blood investigations have to be organized. Other causes of period cessation have to be excluded.

Hormone Replacement Therapy -
Is It Advisable?

When estrogen level declines with the menopause, supplementing it with extraneous hormones is a appropriate concept. HRT has been a very popular through the eighties and nineties. Many women have benefited from the replacement treatment. Yet, at the turn of the Millennium, several large plunged HRT into disrepute. The bad press has continued to turn women away from HRT. The clinical effect of the estrogen replacement at the menopause is about fifty to hundred times less potent that the estrogen effect in the combine oral contraceptive pill. As a result, the side effect profile of HRT is far less, especially with venous thromboembolism. What is true is that HRT is used in women in their fifties and sixties, as compared to the younger women with the pill.

If you suffer from the symptoms of going through “the change”, and they are making your life unbearably miserable, the use of estrogen replacement is the most apt treatment. No other medication or plant products measure up to it. Your quality of life improves soon after and you will be in a better position to engage the mid-life. Hormone replacement is also prescribed, albeit less frequently nowadays, to prevent the long term effect of the menopause. This is especially important if you belong to the high risk group who are prone to osteoporosis, coronary heart disease and strokes.

It is wisdom to say that anything and everything when used in excess has undesirable outcomes. There is no medication that does not come with a host of potential complications. The science of medicine determines what possible effect can arise and what is the risk involved. The art of medicine applies the data in each individual to use it appropriately in order to minimize the risk. We are in the position to advice, but we cannot make the decision for you. Unfortunately everyone is concern about side effects, and the bad media publicity does not make it easier to have an informed understanding.

Side Effects of Hormone Replacement Therapy

There is evidence since the 1970s that prolonged use of combined estrogen and progestogen replacement therapy increases the risk of breast cancer by a small amount, estimated at 2 per 10000 per year (after 5 years of use) above the baseline risk. This increase is nullified when estrogen is used on its own. The risk is not high, and it is certainly advisable to have regular breast surveillance if you are using hormone replacement. There is no evidence to suggest that HRT increases the risk of cervical or ovarian cancer. In fact, users of HRT are found to have reduced risk for colorectal cancer.

Among those women who is unfit to use hormonal preparation, severe vaginal dryness may be effectively cured by vagial laser therapy, such as the Monalisa Touch.


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