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Menopause is a normal part of life ‘€” it is a milestone, just like puberty, and it is not a disease or a condition.

The hormones estrogen and progesterone regulate menstruation. Estrogen regulates menstruation, while progesterone is more involved with preparing the body for pregnancy.

When the ovaries start producing less of these two hormones, the term ‘€œperi-menopause’€ is used to describe symptoms that usually happen three to five years before menopause.

In fact, by the time a woman is in her late 30s, the ovaries start producing less progesterone and estrogen. By the time she is in her 40s, the post-ovulation spike in progesterone becomes less emphasised, signalling a decrease in fertility long time before she may notice any menopausal or peri-menopausal symptoms.

As time passes and the ovaries produce less and less estrogen and progesterone, the ovaries eventually shut down completely and a woman no longer has any more menstrual periods.

The vast majority of females experience a gradual change in menstrual activity, while some abruptly stop producing hormones.

A small group of women may experience premature menopause, or when their ovaries fail earlier thanthey are supposed, usually before the age of 45.

Ovarian failure can occur at any age ‘€” but very rarely ‘€” and often the doctor and patient will not know the reason for this. Some who experience ovarian failure may still have periods and some degree of fertility for a while.

Premature menopause may be caused by enzyme deficiencies, Down’€™s syndrome, Turner’€™s syndrome, Addison’€™s disease, hypothyroidism, removal of the ovaries, radiotherapy to the pelvic area, chemotherapy and hysterectomy surgery.

Some infections, such as mumps and tuberculosis, malaria and varicella, may also be a factor, as well as genetic factors ‘€” and being a twin.

Menopause marks the time in a woman’€™s life when her menstruation stops for one year and she is no longer fertile. In the UK, according to the National Health Service, the average age for menopause is 52.

However in places like India, about one-fifth of women experience menopause much earlier, before 41.

The signs and symptoms of peri-menopause and menopause include irregular periods, usually the first symptom is when menstrual patterns changes. Some women may experience a period every two to three weeks, while others will not have one for months at a time.

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Another symptom is lower fertility. When a woman’€™s estrogen levels drop significantly, this in turn lowers her chances of becoming pregnant.

There may also be vaginal dryness, usually accompanied by itching or discomfort; dyspareunia, or pain during sex; vaginal atrophy, where the vaginal wall thins due to shrinking tissue; as well as decreased lubrication caused by a lack of estrogen.

Approximately 30 percent of women experience vaginal atrophy symptoms early in menopause, while 47 percent do so post menopausally, sometimes up to a decade after their final period. Unfortunately, most post-menopausal women are uncomfortable talking about vaginal dryness or pain and are reluctant to seek medical help.

Another common symptom is hot flashes, or a sudden feeling of heat in the upper body that may spread. The skin on the face, neck or chest may redden and become patchy and the woman typically starts to sweat. The heart rate may suddenly increase ( tachycardia ), or it may become irregular or stronger than usual ( palpitations ). Hot flashes generally occur during the first year after a woman’€™s final period.

There are also night sweats, or when a hot flash happens in bed and disturbed sleep.

A woman might also suffer urinary problems, such as urinary tract infections, more frequent needs to urinate or potentially the start of overactive bladder syndrome; moodiness, which often goes hand-in-hand with sleep disturbances; problems focusing and learning, such as short-term memory problems, difficulty concentrating of difficulties in learning; osteoporosis, or bone loss from calcium loss, due to the lack of estrogen during menopause; fat build-up in the abdomen; hair loss and reduced breast size.

If left untreated, these symptoms will usually taper off gradually over a period of two to five years. However, in a small minority of women, symptoms can persist for much longer.

Only about 10 percent of women seek medical advice regarding menopause. If symptoms adversely affecting a woman’€™s daily life, it is advisable to see a doctor. The kind of treatment depends on your symptoms, medical history and personal preferences.

Available treatments to treat hot flushes include different kinds of medication, and this is best discussed with a specialist.

One of the most well-known treatments is hormone replacement therapy ( HRT ). This is very effective for many of the symptoms that occur during menopause, such as vaginal dryness, vaginal itching and discomfort, urinary problems, bone-density loss, hot flashes and night sweats, as it ‘€œreturns’€ estrogen to women who lack it.

HRT’€™s benefits include treating menopausal symptoms, preventing osteoporosis and lowering colorectal cancer risk. However, there are small but significant risks with HRT, including breast, ovarian and uterine cancer risks, mild and temporary increase in coronary heart disease and stroke upon starting HRT, and a mild increase risk of changes in thinking and memory among women over 65

There are many things that women can do to aid in the transition through menopause, including non-medical options such as exercising regularly; wearing cotton-based clothing and avoiding tight clothing; making sure your bedroom is not hot; reducing stress by learning how to do deep breathing, guided imagery, progressive muscle relaxation therapy and yoga; avoiding spicy food, caffeine, smoking and alcohol; going to bed and rising at the same time; for the sexually active, consider over-the-counter, water-based lubricants or moisturisers; practicing pelvic floor muscle exercises like Kegel exercises; eating a well-balanced diet and try to consume 1,200 to 1,500mg of calcium and 800 IUs of vitamin D a day.

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