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That uncomfortable `pause' that eves dread
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Menopausal symptoms are not exactly a subject of drawing room conversations, but anything on it interests both men and women, if given in black and white. MINU ITTYIPE does some research on the subject and comes up with some interesting information.
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IF WOMEN could take menopause and put it an unlabelled bottle and throw it in the darkest corner of their store rooms, they would. But the fact remains that that wouldn't take menopause away. Menopause has such distressing connotations that most women don't want to think about it, talk about it and least of all address it. And when finally menopause is upon them they are unaware that body changes are very often inextricably linked to their behaviour and over all well-being.
Though not all women experience menopausal symptoms, many have their lives dictated by these symptoms and find this phase totally unendurable and unmanageable.
Dr.Ramani Philip, Gynaecologist at Sree Sudheendhra Medical Mission, elucidates "Menopause happens in the twilight years of a woman's life when the hormones produced by the woman's ovaries are slowly petering out. This is not a quick event but it takes several months or even a few years. It is a period in a woman's life when her menstruation gradually stops and the way it stops will vary from person to person. This phase could last from the age of 45 to 60 or could even commence earlier from the age of 40. Menopause can either occur naturally or can be brought on surgically with the removal of her uterus and ovaries (together)." During this phase the woman's ovaries stop responding to the Follicle Stimulating Hormone and as a direct fallout of this the ovaries and uterus produce less of the hormones estrogen and progesterone respectively. This drop in hormone levels brings an end to ovulation and menstruation. During this time women are prone to symptoms like mood swings, hot flushes, low libido, insomnia, skin involutions, uro- vaginal atrophy, osteoporosis, increased risk of cardio-vascular diseases, colon cancer and Alzheimer's disease.
Dr.Ramani Philip points out "50 per cent of women don't complain about any kind of menopausal symptoms. In India, women think it is their lot and try to cope with it in the best possible way. It has been noticed that the educated women who have devoted the major part of their life to their family, suddenly find they have nothing much to do when the children have flown the nest and when menopause occurs simultaneously these women go through major depression. While the women in the lower income category are so busy that they have little time to think of anything else and probably the discomfort goes unnoticed."
Dr.T.K. Shantakumari, Gynaecologist at Vijaya Hospital says, "30 -35 per cent of the women have menopausal symptoms and 35 per cent of the women who surgically remove the uterus and ovaries together have these symptoms. However, the women who undergo hysterectomy but without the removal of the ovaries do not experience these symptoms immediately because the ovaries continue to produce the estrogens but this too slowly declines." Though the women may not be aware of their own behavioural changes their husbands have of late been more vocal and often confide in the doctors.
Says Dr.Jeevan Raj, Director of Vijaya Hospital, "The husbands very often tell me that their spouses have become short tempered, depressed and are disinterested in sex. The vast amount of reading material available about menopause also makes the men aware and more often now than ever before, they are willing to discuss the problems the women are facing."
To affirm this,Seena*, a working woman at the age of 47, who is waiting for the menopausal symptoms, says, "I don't have any such symptoms but my husband is all set to deal with me when it comes. He has heard that women become short tempered and have mood swings and he is waiting for it to happen to me."
Dr. Ramani Philip says that often men say that their wives are absolutely disinterested in themselves during this phase. They don't change out of their nightdress or comb their hair or look good. "It is a time when women don't feel attractive, and they feel nobody needs them anymore and they become depressed." And when it comes to sex many women with menopausal symptoms put it on hold like how the appellation itself spells, `Men - O- Pause', for during this time women often have low libido and do not like men coming anywhere near them.
While the behavioural changes may be more conspicuous Dr.Jeevan Raj points out that there are other underlying problems associated with menopause. " The decreased estrogen levels may also bring about other complications like cardiac problems and osteoporosis. Studies show that estrogen appears to protect the heart from diseases and it also enhances calcium absorption. Without estrogen the risks of cardiac problems and osteoporosis seem higher. So when women come with menopausal symptoms we routinely put them on Hormone Replacement Therapy (HRT) but before they start on HRT it is pertinent that they undergo a complete check up to ascertain if they already have any of these problems."
However, many women are wary of Hormone Replacement Therapy because studies have shown high levels of estrogen are linked to breast cancer and endometrial cancer. Says Aruna*, "The onset of menopause for me was characterised by continuous menstruation for two months and both my ovaries and uterus had to be removed. I was put on Hormone Replacement Therapy for two years and I experienced severe cramps in my joints so I switched over to Homeopathy. The Homeopath advised me to stop using estrogens completely and started alternative treatment and encouraged me to eat phytoestrogens, but my pains have not subsided."
Dr. Ramani Philip says, " The risk of women getting cancer from HRT is only minimally higher, just 0.01 per cent higher and to counter the side effects of estrogen women are given other drugs in combination. Today in the market the drug called Tibilone is available, which is expensive but it is both breast friendly and endometrium friendly."
She adds, "Many women are conscious about what medicines they take and would like to take natural sources of hormones instead of synthetic drug preparations. The estrogens found in plants are called phytoestrogens and vegetables like yam, soyabeans and curry leaves are rich sources of phytoestrogens. Today these phytoestrogens are also available in tablet forms. However when a woman comes with unbearable hot flushes and night sweats we don't advise her to take phytoestrogens because this may not have any effect on the patient and it is pertinent that she be put on synthetic hormones for immediate relief."
Dr. Jeevan Raj affirms this."Phytoestrogens should become a part of a woman's diet when she enters her late 30's and this should not be perceived as a cure once the woman experiences the menopausal symptoms for it may not help at all. Phytoestrogens compounds are weaker than naturally occuring estrogens. Where as HRT immediately makes the woman feel comfortable and she can lead a normal life without the discomforts." Menopause is a delicate period in a woman's years when she needs the support of her spouse, relatives and friends.
Many a time one would have noticed women in this age reduced to tears for the silliest of reasons much to the dismay of everyone around them. If the family is around to lend support to these women then it would be a time for women to rediscover themselves. Instead of the head in the sand syndrome where women pooh pooh menopausal symptoms as old wives tales, it would be wise if they recognise the body changes happening to them and address the situation from the start.
(* Names have been changed to protect their identity)
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