Menopause

Leena is 45. She’s excited to be starting a new phase of her life as her children leave home and she has more time for her other interests. She’s looking forward to traveling and taking a computer class.

………….But recent health changes have been getting in the way of her plans. Leena has been having irregular periods for the past few months. Now, she’s getting hot flashes and having trouble sleeping. The hot flashes, which cause her body and face to heat up quickly and uncomfortably, are waking her up several times a night. She is tired and irritable from lack of sleep and fed up with the hot flashes. 

Menopause – derived from the Greek word, Root which essentially means month! But im sure to most women who have gone through this or going through this, menopause in layman terms means that time of life where a woman doesn’t know if she is coming or going, on fire or freezing, happy or sad, wants to diet or eat everything in sight. Some common phrases used during this time include, hot flash, mood swings and brain fog!  

As if pregnancy, labour, delivery, breastfeeding, stretch marks, cellulite wasn’t enough, women do have to also go through the ordeal of Menopause! But that’s perhaps because god knew, we men aren’t strong enough to handle all of this! Iv been a gynaecologist for 20 years now, and I know what it takes to be a woman! A big Salute to all you women out there!

What is Menopause and this menopausal transition.

Women are born with a finite number of eggs. They recruit few eggs from this pool every month. Once the egg numbers start to dwindle, fertility goes down and when this pool of eggs is almost finished, menopause sets in. menopause essentially means stopping of periods. Periods need to stop for 12 months for us to diagnose a state of menopause. The phase lasting from 6 months to 10 years before this final cessation of periods is called peri menopause or menopausal transition. During this time women may face various symptoms. Let us understand these symptoms and those of menopause in little more details

…………….Irregular periods: in the months or years preceding menopause, as the number and quality of eggs starts to go down, the cycle length tends to get shorter and the flow during periods reduces. With ovulation becoming less frequent, cycles become less frequent and women start to get their periods after delays and then start to skip months leading finally to the menopausal state wherein, they don’t have periods for a year. Thus, Menopause by definition is cessation of periods for a year. 

About 8 out of 10 women will have additional symptoms before and after their periods stop:

  • hot flushes – short, sudden feelings of heat, usually in the face, neck and chest, which can make your skin red and sweaty. You could be sitting in a room full of people and while everyone is comfortable with the temperature you practically could be having smoke coming out of your ears. This can last from a few secs to a minute and can keep recurring through the day. 
  • night sweats – hot flushes that occur at night
  • difficulty sleeping – this may make you feel tired and irritable during the day. 
  • Irritability: sometimes this and reduced sleep may the only symptoms initially. You may get into unnecessary arguments with your spouse or children or the staff at home. There may be other mood changes like depression or anxiety. 

The reduced oestrogen levels may additionally cause:

  • a reduced sex drive (libido)
  • problems with memory and concentration and 
  • vaginal dryness and pain, itching or discomfort during sex

There can also be other problems like:

  • joint stiffness, aches and pains
  • reduced muscle mass
  • recurrent urinary tract infections (UTIs)

As I said before, most women will experience one or the other of these symptoms. That doesn’t mean majority of them need to have the more disturbing symptoms like hot flushes or night sweats or irritability etc. ……………………..The symptoms are sudden and more severe in those who undergo surgeries for their ovary removal, usually along with the uterus, because this causes a sudden loss of oestrogen hormone and thus does not allow the body to gradually adapt to the falling levels of the hormone. 

How does one know that menopause has arrived?

As I said before, periods need to stop for a year for us doctors to arrive at the diagnosis of menopause. 

Are there tests available?

Yes, there are. We can do tests like AMH which will be extremely low and FSH which will be extremely high, but these tests can point towards menopause but cannot prove that your periods have stopped or that they will conclusively stop within the next few months. A vaginal ultrasound done may show small shrunken ovaries.

……………………Besides the symptoms and problems that I have mentioned, are there any complications that you should worry about? Yes, there are ….

Osteoporosis: The bone structure is dynamic with calcium deposition and calcium loss happening all through life. The deposition starts to reduce after age 30 and this loss is accelerated after age 45 and become more severe after menopause. This can lead to bone thinning and osteoporosis related fractures.

  • Osteoporosis results in one fracture every sec
  • 61% of these fractures occur in women
  • 1 out of every 3 women above age 50 will experience osteoporosis related fracture
  • Even in women above age 45 years of age, osteoporosis accounts for more days spent in hospital than many other diseases including diabetes, heart attack and breast cancer. 
  • The forearm, arm, hip and spine consecutively are most affected in that order.

Heart Disease
One important thing to know is that the risk of heart disease increases after menopause, so post-menopausal women are even more likely than men to have a heart attack. The sharp decline in oestrogen levels has also been linked to irregular heartbeat or palpitations.

Urinary Problems
Urinary incontinence (the occasional and involuntary release of urine) is common in aging women, particularly after menopause. The decline in oestrogen causes the vaginal tissues and lining of the urethra (a tube that connects the bladder to the outside of the body) to thin out and lose elasticity. As a result, you may experience an uncontrollable urine leakage. This often occurs during sudden movements, such as laughing or coughing……………….. The loss of elasticity might just be superimposed upon the weakness that the muscle might have undergone due to repeated vaginal deliveries or because of the damage suffered during forceps or vacuum delivery of the baby. 

Weight Gain
Many women experience weight gain as they reach their 40s and 50s. However, this may be due to the natural process of aging—and not solely from menopause. With age, it’s harder to maintain muscle mass. Lower muscle mass slows down your metabolism, so it’s easier to gain weight.

The reducing oestrogen coupled with the unbalanced increasing male hormone level also tends to cause weight gain especially around the hips and tummy. 

The increase in abdominal fat is particularly dangerous, as it ups the risk for heart disease

I have also been asked quite frequently if one needs to see a doctor when going through menopause.

My answer as always is that there is a need for regular health check-ups every year as part of disease prevention and early detection. This should start around age 30 and be done every 2 years. After age 40 it should be every year. If one has been doing this and menopause is not causing any major problems then one doesn’t need to see her doctor specifically for this as all advise and treatment related to bone health, multivitamin supplementation and early cancer detection have already been given. 

Of course, if one is facing any of the problems, I have mentioned in the podcast then for sure you need to see your gynaecologist. 

How do we deal with the problems associated with menopause? Is there treatment available?

Managing menopause starts young, from the teens. 

Childhood and adolescence are particularly valuable times to improve bone mass through exercise. Higher levels of leisure time, sports activity and household chores and fewer hours of sitting daily were associated with significantly reduced fracture rates. Good nutrition with adequate fruits and vegetables and calcium and vitamin D supplementation help as does reducing smoking and drinking. High protein diet of course in consultation with a nutritionist goes a long way in preventing muscle wasting. 

Coming to specific problems and treatment:

  • Hot flushes and night sweats:
    • Wear light clothing
    • Keep your bedroom cool at night
    • Take cool showers, avoid hot drinks
    • Reduce stress levels
    • Avoid potential triggers such as spicy food, caffeine, smoking and alcohol
    • Hormone replacement therapy or some medicines that reduce heart rate and certain anti-depressants work brilliantly if all the above fail
  • Mood changes
    • Exercise helps a lot. There are a lot of studies which say Yoga and Tai chi have shown very promising benefits
    • Psychologists are of great help especially if one is a little lonely and depressed.
    • Anti-depressants are of course there above all else.
  • Reduced sexual desire
    • Hormone replacement therapy helps and if that is not good enough then testosterone or male hormone supplementation can be done. Funnily that helps.
  • Vaginal dryness and discomfort
    • The treatment starts with elimination of any local infection which might be present followed by use of local lubricant creams and gels
    • If that doesn’t help oestrogen creams applied locally help rejuvenate and lubricate the area. 
  • Last but most important Weak bones and osteoporosis
    • Exercising regularly esp. weight bearing and resistance exercises
    • Eating a healthy diet including plenty of fruits, vegetables and sources of calcium
    • Lactose intolerance has been shown to associated with increased risk of fractures
    • Get some sunlight to naturally manufacture vitamin D
    • Stop smoking and cut down on alcohol
    • Take calcium and vitamin D supplements

A discussion on menopause can’t end without a discussion on hormone replacement therapy and the huge fear that it had bad side effects and that taking it means getting cancer later. I have 3 points to mention in this regard:

  1. The studies on which this whole assumption of hugely increased cancer risk was based were found to be faulty on closer scrutiny. The women included in the study were older than age 60 and they were given HRT for more than 5 years. ………The women who usually need this are around age 50 and are only given the HRT for maybe 6 months to a year. Both of which are extremely safe practices.
  2. Secondly statistics can sometimes be misleading. Yes, there is a small increase in risk with long term HRT usage. No doubt. If I were to ask you how many people betrayed Jesus Christ, you would say 1 I would say 8% since 1 out of 12 is 8%. They both are the same but don’t convey the same meaning to the listener. 
  3. Lastly and most important, trust your doctor, he or she knows best. We doctors have spent years training, reading and honing our skills to be where we are. To treat without causing harm will always be our primary goal and if HRT can cure dismal and life stressing symptoms or save lives by reducing osteoporosis or can return normal sexual life to someone facing distressing problems, why walk away from it. HRT is a gun that saves lives in trained hands, you need not fear it. 

………….As someone rightly said, there is no more creative force in the world that a menopausal woman with zest! On that note, to all you lovely ladies hearing this podcast, just three words, You are Strong! I’m fortunate that my career allows me to be a part of your journey!



This brings me to the end of yet another discussion. This discussion is also available as a podcast – check out here.

This podcast is available on Apple and Google podcast as well as Spotify. Do subscribe and leave your comments and suggestions on the Apple podcast app. That’s the only way we can make this better. 😊 Looking forward to great interactions…. keep listening.

If you get a chance do look up my website www.drrajeevagarwal.co.in and YouTube channel in my name.

Do email me on fertilitywithoutborders@gmail.com if you have any queries or if you want me to create a podcast on any topic of your choice. 




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