Postmenopause

Postmenopause characterizes the extended stage of life where people no longer get monthly periods. It is a natural and inevitable stage in a women’s aging process. It is one of the following three stages of menopause that take place over several years:

• Perimenopause: A transitional stage that refers to the period before menopause, including the 12 months following a person’s last period.
• Menopause: A doctor will diagnose a person as being in menopause 12 months after a person’s final period.
• Postmenopause: The time that follows menopause.

The duration of symptoms during the menopause transition is different for everyone. On average, it lasts for 4.5 years.

Women spend one-third of their life in the postmenopausal stage. It represents a primary ovarian failure where there is a depletion of ovarian follicles, the primary source of estrogen. 2The regularity and length of the menstrual cycle varies across a woman’s reproductive life span, but the age at which natural menopause occurs is generally between 45 and 55 years for women worldwide. Menopause can also be a consequence of surgical or medical procedures. Some women experience menopause earlier (before 40 years of age). This premature menopause may be because of certain chromosomal abnormalities, autoimmune disorders or other unknown causes.

Sign and symptoms of postmenopausal

Postmenopausal symptoms are primarily attributed to the decreased level of circulating estrogen. The hormonal changes associated with menopause can affect physical, emotional, mental and social well-being. The symptoms experienced during and following the menopausal transition vary substantially from person to person. Some have few if any symptoms. For others, symptoms can be severe and affect daily activities and quality of life. Some can experience symptoms for several years.

Symptoms associated with menopause include:

• Hot flushes and night sweats. Hot flushes, refer to a sudden feeling of heat in the face, neck and chest, often accompanied by flushing of the skin, perspiration (sweating), palpitations and acute feelings of physical discomfort which can last several minutes. During the menopausal transition, approximately 50% to 75% of women have hot flashes, night sweats, or both (vasomotor symptoms). For most women, the symptoms last 1–6 years; however, they may persist for 15 years or longer in about 10–15% of women.

• Vaginal dryness, pain during sexual intercourse and incontinence: Urogenital tissues are highly sensitive to estrogen, lack of estrogen causes atrophy, dryness, itching, burning and shortening of the vagina. Decreased estrogen levels affect the urinary tract, including the bladder and urethra, and many develop lower urinary tract symptoms (urinary frequency, urgency, urinary incontinence and recurrent urinary tract infections. During the menopausal transition, more than 50% women have genitourinary symptoms.

•Difficulty sleeping/insomnia: Many people report sleep disturbances throughout the menopause transition, often due to hot flashes, night sweets, an increased urge to urinate and anxiety. Sleep disruption tends to increase as people age. It affects around 35–60% of people postmenopause.

•Changes in mood, depression and anxiety.

•Postmenopausal women express a wide range of psychological symptoms including poor memory and concentration, depression, anxiety, insomnia, fatigue, irritability, and a high level of distress, which may impede coping and decrease quality of life in this group. Both hormone level fluctuations during menopausal transition and biopsychosocial factors during menopause are important in menopause-associated depression.

Both the direct steroid hormone level fluctuations during menpression.

long term impact on health

•The long-term impact of postmenopausal on a person’s health includes positive and negative components. Some of these include:

•Increase risk of osteoporosis:

•Osteoporosis is a condition that indicates low bone mass, where bones are more likely to break or fracture. At menopause the normal bone turnover cycle is impaired by estrogen deficiency. As a result, the amount of bone reabsorbed exceeds the amount deposited, which leads to net loss of bone.

•Research indicates that approximately 20% of bone loss occurs during the menopausal and postmenopausal stages of life. Additionally, osteoporosis affects 1 in 10 females over the age of 60 worldwide. Early menopause may also make some people particularly prone to developing osteoporosis.

•Increase risk of heart disease.

The risk of cardiovascular disease (CVD) drastically increase after menopause when the level of estrogen is dropping down. As the increased risk of CVD coincides with menopause, studies have shown that female hormones, especially estrogens, are cardio protective and play significant roles in both reproductive and non-reproductive systems. Menopause is associated with a significant increase of blood pressure, body mass index (BMI), obesity, and body fat distribution. Moreover, they can be synthesized in non-reproductive tissues such as the bone, brain, liver, heart, and muscles

In the perimenopause period, changes in the cardiovascular risk usually occur. The occurrence of metabolic syndrome in postmenopausal women is 2–3 times more likely than in premenopausal women. Changes in the lipid profile show a decrease in HDL levels and an increase in the value of triglycerides and LDL cholesterol by about 10–15% in postmenopausal women. An increase in BMI and abdominal obesity in postmenopausal women show about 5 times higher risk of central obesity compared to premenopausal women. CVD is the main cause of morbidity and mortality in both men and women in developed countries. Studies have shown that low estrogen levels correlate with coronary artery disease in men.

Treatment and measures to stay healthy postmenopause

Hormone therapy: It is most effective treatment for hot flashes, night sweats, and vaginal dryness. It improves bone density and decrease your risk of an osteoporotic – related fracture, it improves sleep disturbance, mood and cognitive function associated with menopause. Adverse effect of hormone therapy includes increase breast cancer risk especially with long term use, blood clots risk particularly in women with existing risk factors. Transdermal estrogen options are considered safe than oral estrogen., stroke risk which depend on individual factors, endometrial cancer risk.

•However, hormone therapy is most effective if taken it within 10 years of last menstrual period and younger than 60 years.

•Vaginal estrogen relieves vaginal dryness, discomfort during sex, and some urinary symptoms.

•Calcium and vitamin D supplements aids in strengthening your bones.

•Vaginal lubricants increase comfort during sex.

•Exercise to stimulate heart, bone health and maintain a healthy weight.

•Well- balance diet o help manage heathy weight.

 

Consultation with physician is required before beginning any treatment or supplements, including over the counter and herbal remedies. Keeping up with annual physical exams and scheduling regular preventive screenings, such as mammogram, bone density screening, pap smear and colonoscopy is equally important.

 

References 

1 https://womenshealth.gov/menopause/menopause-symptoms-and-relief

2 https://jamanetwork.com/journals/jama/article-abstract/2801054 3w3aw c

 

3 https://www.ncbi.nlm.nih.gov/books/NBK560840/

4  https://www.medicalnewstoday.com/articles/postmenopause#long-term-impact

4https://www.sciencedirect.com/science/article/abs/pii/S1521693422000426

 

5.https://pmc.ncbi.nlm.nih.gov/articles/PMC10088347/?fbclid=IwY2xjawKE4u1leHRuA2FlbQIxMABicmlkETExeFJyMlBsQWVPMHRlSWFoAR5aSWbUwpaS55wFD7Wk89cYU0x7CDaQKsz3DKrpBdQUGiDPjoeOGTIhbk7AYQ_aem_uFA8yu9GRSd3xlfcRYB2fQ

6  https://pmc.ncbi.nlm.nih.gov/articles/PMC5643776/?fbclid=IwY2xjawKE7ElleHRuA2FlbQIxMABicmlkETExeFJyMlBsQWVPMHRlSWFoAR4H0-Sw3OOsmMmNlOgZC5flYbOWWWtsa9S7c5vCkm_0iCnudJySLrpNEqATWw_aem_fkOAbp9O1FUkCfx1ZxKIHA

7 https://www.medicalnewstoday.com/articles/postmenopause#long-term-impact

8.https://pmc.ncbi.nlm.nih.gov/articles/PMC10074318/?fbclid=IwY2xjawKE6QxleHRuA2FlbQIxMABicmlkETExeFJyMlBsQWVPMHRlSWFoAR4BKUoJ-PifuxYhkiHSLtg7yMIBwcfKxEGtdTZbm324iAm7PVxyrCBqdCZtjg_aem_g-uJIBvFy9veKj0J43IAEA

9.https://www.mdpi.com/1660-4601/17/14/5028#