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What are Perimenopause and Menopause?

1. Perimenopause and menopause are natural physiological phenomena, which marks the end of the reproductive age of a woman.

2. It has several effects on the physical and mental health- both positive and negative.

3. Menopause is also considered as a public health issue as it gives rise to problems in the entire body, though it is not a disease.

4. It requires treatment and medication based on its degree of severity.

5. This presentation deals with the causes and effects of perimenopause and menopause and considers its good, bad and ugly effects and attempts to explain the underlying reasons of the cause of such effects.

6. It also attempts to explain the reason behind considering it as a major public health concern.

1. The period of occurrence of perimenopause and menopause varies from one person to another.

2. Perimenopause is referred to the time around menopause, that is, the period of transition of a female body from the phase of menstruation to menopause.

3. Menopause is a natural phenomenon which signals decline of reproductive hormones and marks the end of reproductive age of a woman (Honour, 2018).

4. Perimenopause can be considered as the precursor of menopause.

5. If there is no occurrence of menstrual cycle for a period of 12 months, then, she is considered to have begun with the menopausal phase.

6. Generally, perimenopause begins in mid 40s while menopause begins 7 to 8 years after that.

7. During perimenopausal phase, the level of oestrogen, a reproductive hormone, released by ovaries continue to fall and during menopausal phase, oestrogen level falls drastically as the female body stops releasing eggs permanently.

8. This reduces the ability of a female to conceive and get pregnant.

1. The main reasons of occurrence of menopause is the aging ovary and the fluctuating levels of hormones in the female body.

2. On account of aging, the follicles of the ovary do not reach maturation stage. This leads to disinhibition of two reproductive hormones- follicle-stimulating hormone (FSH) and leutenizing hormone (LH), raising their levels. The levels f oestrogen and progesterone declines significantly leading to this change.

3. The risk factors that can cause early menopause in women are obesity, smoking, excessive drinking, autoimmune disorders, enzyme deficiencies and infection (Edwards et al., 2019).

4. Surgeries like ovary-sparing hysterectomy, may reduce the amount of blood flow to the ovaries, inducing menopause.

5. Another possible cause may be that FSH levels may decrease with the abnormal functioning of uterus, resulting into failure of follicle development.

What are the causes of Menopause?

6. Menopause can be induced way before its time by completely removing ovaries surgically or by ablating it with radiation or chemotherapy.

1. Perimenopause can be considered as a primer of menopause, as the transition of female body occurs from irregular bleeding in the perimenopausal phase, to its complete cessation in the menopausal phase.

2. Perimenopause indicates the decline of levels of female reproductive hormones.

3. During this phase, menstrual cycle is unpredictable as it occurs irregularly, but the cycles may be shorter or longer than usual.

4. Ovulation from ovaries continue to occur, though irregularly.

5. The level of FSH, a pituitary hormone, increases significantly during this time. This happens as it stimulates the ovary for releasing an egg.

Several physiological changes that occur during the period of menopause are-

1) Hormonal changes- FSH and LH levels increase significantly due to decreased level of oestrogen.

2) Ovarian follicles- Their size decreases significantly, reducing the level of inhibin.

3) Endometrial lining- Level of progesterone, a reproductive hormone, decreases due to which the endometrial lining breaks down.

4) Vasomotor changes- Increased levels of LH causes problems in controlling temperature of the body.

5) Urogenital changes- The tissues of vagina, urethra and urinary bladder atrophies during this phase.

6) Cardiovascular changes- Oestrogen helps to reduce low density cholesterol and increases high density cholesterol keeping the heart healthy and protecting it from cardiovascular diseases. But during menopause, the risk of such diseases may increase (Newson, 2018).

The good effects are-

1) No side effects of menstrual cycle- Most women are affected by pre-menstrual syndrome (PMS) due to decreased levels of progesterone and oestrogen. Its symptoms are headaches, moodiness and bloating. Menstrual migraines are also severe and painful.

2) No pelvic pain- Pelvic pain, during the reproductive years, may occur due to menstrual cramps, fibroids, cysts and ectopic pregnancy. As the oestrogen level begins to decline during menopause, the uterine fibroids begin to shrink, lowering abdominal pain (Ulin et al., 2020).

3) No pregnancy- As the ovary stops releasing eggs, there is no chance of getting pregnant.

4) Menopausal zest- Some women may feel physically and psychologically energetic after menopause. This may help them to care more for their own selves. Some women also feel empowered after menopause.

The bad effects are-

1) Hot flashes- It causes a sudden rise of temperature of the body resulting in redness of face and flushed cheeks. It occurs at anytime of the day. It is generally accompanied by night sweat when it occurs at night.

Perimenopause: a Primer of Menopause

2) Night sweats- May occur alone or accompanied by hot flashes. It causes excessive perspiration at night.

3) Frequent urination- It may occur due to more frequently due to declining levels of oestrogen in the body.

4) Weight gain- It may occur as the body can store more fat due to changing hormonal levels (Kozakowski et al., 2017), (Koo et al., 2017).

5) Insomnia- Oestrogen has an impact on regulating sleep cycle. Its declining levels have a severe impact on sleep. Night sweats, hot flashes and frequent urge to urinate disrupts sleep.

6) Problem sleeping- Problems may arise with the continuance of daily activities. Hormonal changes can disbalance the entire physiological functions (Lee et al., 2019).

7) Fluctuating moods- Mood swings or mood fluctuations may lead a woman from instant happiness to severe depression.

8) Irritability- It is one of the common effects found in women during menopausal phase.

9) Lowered libido- Lack of vaginal lubrication and added discomforts may lead to painful events of sexual intercourse. This decreases the level of libido in women.

10) Changes in breasts- It may enlarge in size causing pain.

The ugly effects or complications that might occur are-

1) Vaginal dryness- As menopause marks the beginning of unreproductive stage in a woman’s life, hence, the vagina produces less lubricants leading to its dryness. This causes discomfort and requires application of lubricant or vagina creams.

2) Decrease in bone density- Lower levels of oestrogen may decrease bone density causing osteoporosis. This puts a woman at risk of bone fracture (Karlamangla, Burnett-Bowie & Crandall, 2018).

3) No ovulation- There are no chances of getting pregnant, once a female enters this phase.

4) Vulvar itching- Sensation of burning and an urge of itching occurs during this phase.

5) Infections of urinary tract- Lower hormonal levels may increase the susceptibility of vagina and the urinary tract to infections. Antibiotics may be needed to take the situation under control.

6) Vaginal atrophy- Decline in oestrogen levels may cause thinning of vaginal walls. This, in association with vaginal dryness, makes sex painful.

7) Cardiovascular diseases- Oestrogen helps in keeping the heart healthy by preventing the blood vessels and arteries from stiffness. Hence, decline in the level of this hormone increases the risk of heart diseases in menopausal females. Women may even require postmenopausal hormone therapy to deal with this complication and cardiovascular disease prevention.

8) Effects on skin and hair- Loss of oestrogen makes skin thinner and drier. Hair loss may occur due to dryness and brittleness.

Conclusion

1. Perimenopause and menopause are normal phenomena occurring in a woman, where perimenopause can be considered as precursor or primer of menopause.

2. Perimenopause refers to the transition phase from reproductive age of a woman to her non-reproductive age.

3. Menopause brings with it several physical and psychological changes due to increase and decrease of several reproductive hormones.

4. From the discussion in this entire presentation, it can be concluded that the ill effects outweighs the good, hence, this phenomena, though not a disease, can be considered as an important public health concern.

References

    Kozakowski, J., Gietka-Czernel, M., Leszczy?ska, D., & Majos, A. (2017). Obesity in menopause–our negligence or an unfortunate inevitability?. Przeglad menopauzalny= Menopause review, 16(2), 61. doi: 10.5114/pm.2017.68594

    Edwards, H., Duchesne, A., Au, A. S., & Einstein, G. (2019). The many menopauses: searching the cognitive research literature for menopause types. Menopause (New York, NY), 26(1), 45. DOI: 10.1097/GME.0000000000001171

    Honour, J. W. (2018). Biochemistry of the menopause. Annals of clinical biochemistry, 55(1), 18-33.

    https://doi.org/10.1177/0004563217739930

    Ulin, M., Ali, M., Chaudhry, Z. T., Al-Hendy, A., & Yang, Q. (2020). Uterine fibroids in menopause and perimenopause. Menopause (New York, NY), 27(2), 238. doi: 10.1097/GME.0000000000001438

    Koo, S., Ahn, Y., Lim, J. Y., Cho, J., & Park, H. Y. (2017). Obesity associates with vasomotor symptoms in postmenopause but with physical symptoms in perimenopause: a cross-sectional study. BMC women's health, 17(1), 1-8.

    https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-017-0487-7

    Karlamangla, A. S., Burnett-Bowie, S. A. M., & Crandall, C. J. (2018). Bone health during the menopause transition and beyond. Obstetrics and Gynecology Clinics, 45(4), 695-708. https://doi.org/10.1016/j.ogc.2018.07.012

    Newson, L. (2018). Menopause and cardiovascular disease. Post reproductive health, 24(1), 44-49.

    https://doi.org/10.1177/2053369117749675

    Lee, J., Han, Y., Cho, H. H., & Kim, M. R. (2019). Sleep disorders and menopause. Journal of Menopausal Medicine, 25(2), 83-87. DOI: https://doi.org/10.6118/jmm.19192

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