Perimenopause

The transition in to menopause is usually somewhat gradual. The years leading up to it are called perimenopause. Perimenopause typically starts in a woman's thirties or forties. During this period, estrogen levels start to fall. Perimenopause on average lasts for 4 years but its term varies widely ranging from a few months to a decade.

Perimenopause lasts right up until menopause. In the last couple of years of perimenopause, estrogen levels fall dramatically and one may start experiencing the symptoms of menopause.

Symptoms of menopause

Menopause is diagnosed when a post puberty woman has gone through 12 months without a menstrual period. The symptoms of menopause begin towards the end of perimenopause, and most of them continue past menopause for an average of four years but could continue on for a lot longer.

Towards the end of perimenopause, periods become irregular and women may also experience irregular episodes of vaginal bleeding. Other symptoms of menopause include:

• hot flashes

• night sweats

• vaginal dryness, irritation or itching

• painful intercourse

• worsening of acne

• weight gain

• mood changes

• stress

• fatigue

• sleep disturbances

• forgetfulness

• nausea

• loss of bone density

• low sex drive

• breast tenderness

Wow! I got tired just typing that list. Now imagine going through it. The only saving grace is, that not all women experience all the symptoms and degrees of severity too vary. So I sincerely hope we are all spared a significant fraction of the symptoms at least.

Early menopause

If menopause is reached before the age of 40, it is called premature or early menopause. Some of the risk factors of early menopause include chemotherapy, family history of early menopause, autoimmune diseases like lupus, hypothyroidism or Grave's disease. According to this article early menopause in India is on the rise, although it does not give specific numbers to support the claim. The reason it states, is increased survival rate among people with childhood cancers and smoking. Chemotherapy and radiotherapy increases the risk of premature menopause, and smoking contributes to ovarian failure.

The ovaries are also sometimes removed during a hysterectomy, which is an operation performed to remove the uterus in case of a medical problem like thickening of the uterus, endometriosis, uterine fibroids, uterine prolapse, chronic pelvic pain, etc. In such a case early menopause sets in. If only the uterus is removed, and not the ovaries, then menopause may not occur.

Menopause treatment

Though menopause is inevitable, its symptoms can be treated if they are significantly affecting quality of life. Hormone replacement therapy (HRT) can help with symptoms like hot flashes and night sweats. This link also suggests medicines that help with some of the other symptoms.

Treatments for early menopause also include HRT as well as menopausal hormone therapy. Early menopause cannot be reversed, but treatment can help slow it down and manage the symptoms.

According to this article it is even possible to conceive with premature menopause, using donor eggs and IVF.

Menopause taboos

In spite of the long list of symptoms of menopause and the intense discomfort they cause, menopause is rarely discussed. Since it is natural and not considered a health condition, the discomfort is not taken seriously, even though women have to endure these symptoms for several years. Women who find the courage to broach the subject, find that people are often dismissive.

The Padman movie has made it more acceptable to talk about menstruation. So now how about we start talking openly about menopause too?

Menopause is not all bad news, and some people are opening up about it, at least in the west. Few people want to think of post menopausal women having sex, but it is the first time women can have sex without having worrying about pregnancy, though note that sexually transmitted diseases are still a risk of unprotected sex. And menopause does not necessarily imply a decrease in sex drive, in fact it can go up too. Here is an informative article, that discusses sex after menopause and this article reasons that sex can actually be better after menopause.

Long life, social skills, intelligence and grandmas

One baffling question that remains is, why do women live so long past menopause? What could be the evolutionary explanation for it?

One theory called the grandmother hypothesis suggests that post menopausal women have historically helped look after their grandchildren by foraging food and providing care freeing up their daughters to have more children. So long lived women, who have helped look after grandchildren, have had many more well cared for grandchildren with a better chance at survival, than those with short lived grandmas, thus resulting in a propagation of long lived genes.

According to this article in The Atlantic the theory, though controversial, further suggests that the grandmother style of upbringing with its emphasis on social dependence gave rise to new social skills, like teaching and co-operation. The article also suggests that grandmothering freed up time for the pursuit of intellectual activities. Hawkes, one of the key proponents of the grandmother hypothesis, has developed convincing mathematical models to defend her theory against various criticisms. According to these models grandmothering results in a doubling of lifespan through evolution over 60000 years.

Whether or not the grandmother hypothesis holds up to rigorous scrutiny in future, it certainly is an interesting theory.

I am thrilled to be participating of the A to Z blogging challenge 2018.