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A rite of passage : Menopause

For the longest time, people talked about menopause in hushed tones and tiptoed around the subject. Women did not know how to cope with the uncomfortable, and sometimes, debilitating symptoms. They felt that they were losing their femininity and youth. It was, in no uncertain terms, thought to signal the beginning of the end of a woman’s life.

Now, with better medical and social understanding of menopause, we are able to accept that it is just another phase in a woman’s adulthood and that there is more to look forward to in the next two or three decades. Just like with puberty, menopause is a rite of passage for every woman. It can be fraught with challenges but it can also be a celebration of wisdom and experience.

Age is not a bad word

Unfortunately, there is the perception that menopause is a disease, and therefore, women must suffer. However, if we turn that thinking on its head and look at menopause as just another phase in life, we can learn to face it differently. When we reach the age of 50, we have already accumulated so many valuable life experiences and lessons. We have truly come to discover ourselves, including our capabilities and strengths.

We should stop thinking of age as the enemy. Menopause has had a bad reputation because we think that women are useless once they turn wrinkly and unnattractive. But who says beauty has to be defined by youth? At this stage of life, we should embrace everything that life has to offer and more. If we turn away from menopause in fear, it would be akin to saying that we reject everything that we have gained so far and everything that is yet to come.

Instead, we should think of menopause as a rite of passage. Just like other milestones in our life, for instance puberty, coming of age, marriage or graduation, menopause celebrates the achievements of a woman and hails her arrival into the next stage of adulthood.   This is bound to bring physical and emotional changes, which are now recognised as menopause symptoms. The experience is not the same for every woman, as some may be more affected than others.

The changes of menopause

Menopause is not something that happens at a fixed time with the exact same symptoms in every woman. It is not something that can be switched on and off. However, being prepared for it can help a woman to face it with less stress. First, it helps to know that once you reach your 40s, you should expect to begin the transition towards menopause. This transition phase, known as perimenopause, is marked by changes in the hormone levels, leading to irregular ovulation. Eventually, the body will produce less oestrogen and progesterone, and the woman’s ovaries will stop producing eggs and menstruation will become less frequent.

Women usually experience menopause between the ages of 45 and 55. Once a woman has not had a period for a year, she enters the post-menopausal phase and can no longer become pregnant. The ups and downs of the hormone levels may lead to some women experiencing changes in their bodies. It can be quite drastic for some women, such as pounding or racing heartbeat, hot flashes, night sweats, flushed skin or insomnia.

Other women may experience some, but not all, of these changes: decreased interest in sex, forgetfulness, headaches, irregular menstrual periods, mood swings including irritability, depression, and anxiety, urine leakage, vaginal dryness and painful sexual intercourse, vaginal infections, joint aches and pains, or palpitations. The biggest concern is the change that occurs in the bones. Decreasing levels of oestrogen cause bone loss and could increase a woman’s risk of osteoporosis.

It is believed that about 15% of women do not have any problems when their periods stop, but 70% of women experience some form of menopausal symptoms. While we encourage women to accept menopause as a phase of life, we should also acknowledge that some of the changes they go through can be quite severe and cause an upheaval to life. We should not deny women proper support – from their partner, family and doctor.

HRT – is it for you?

Every woman’s experience of this phase is different, so there is no universal approach to addressing menopause. Not every woman needs medical therapy. Some women are not too bothered by the changes they go through, while others only need some short-term medications or support therapy that does not involve drugs. Dietary changes, regular exercise and stress management can help many women feel better during this period.

Hormone replacement therapy (HRT) is one of many options that women can explore to help them get through the menopausal changes. Women have to understand that HRT is not a “one size fits all” approach. There are many types of HRT available for women to choose from, depending on her health status, her medical history and her needs. In recent years, bio-identical hormones have emerged as an option for women considering HRT. Bio-identical hormones (BHRT) are made from a plant source, such as yams and soybeans, and are exactly identical to the hormones produced by the body’s ovaries.

Some BHRT formulations are made in special pharmacies called compounding pharmacies, which produces custom-made medications – however, these compounded BHRT formulations are not approved by drug regulatory agencies. Some women are now very excited about BHRT, heralding it as a completely safe and wonderful therapy because it is “natural”. However, I always advise caution – any type of therapy, including HRT and BHRT, carry risks and have to be assessed to ensure it is safe for every individual.

For some women, the benefits may outweigh its risks, but it should still be prescribed carefully and at the lowest possible dose. HRT or BHRT are not to be given to every woman who experiences the symptoms of menopause. Its purpose is to relieve symptoms and improve the quality of life in women who find it difficult to function normally or enjoy life due to menopausal changes. If a woman does not find her life to be disrupted by menopause, then she may not need HRT.

Doctors should advise every woman based on her individual situation and needs. Every woman should sit down with her doctor and ask “What’s right for me?” If a woman decides to go on HRT or BHRT, she should have an annual checkup with her doctor to look at her situation and whether her treatment should be reviewed. HRT also has to come hand-in-hand with lifestyle changes involving the diet, physical activity, as well as mental and emotional health. What is important is that every woman ages healthily and is able to enjoy the years to come, which could be another 20 or 30 years.

The Star Newspaper, Mar 27, 2011
By Dr Nor Ashikin Mokhtar