Expert Talk on Women’s Health

Are you in your 40’s or early 50’s and at the final years of menstruation? If so, then you have reached the menopause phase. Many people wonder what exactly menopause is. Simply put, menopause is when the menstrual cycles permanently end due to the natural depletion of ovation oocytes. The average age for menopause is 51 years, but some women experience it in their 30s or as late as their 60s.

Some of the factors that lead to menopause are the natural decline of reproductive hormones, hysterectomy, radiation and chemotherapy, and primary ovarian insufficiency. In the natural decline of reproductive hormones, your ovaries begin to produce less estrogen and progesterone (the two hormones that are responsible for menstruation); hence your fertility decreases. Once you turn 40, your menstrual cycles will become irregular and the flow may be lighter or heavier. By the age of 50, your periods will completely end, as your ovaries will stop producing eggs. Surgical hysterectomy, in which both the uterus and ovaries are removed, also leads to menopause. Primary ovarian insufficiency is faced by fewer women, where they experience menopause at the age of 40. In this condition, the ovaries do not produce normal levels of reproductive hormones because of factors such as autoimmune disorders or genetics.

This week, we got in touch with a gold medallist in obstetrics and an experienced gynaecology laparoscopy surgeon, Dr Lakshmi Rathna. Currently the Head of Department of obstetrics and gynaecology at Nice Hospital, she is also a senior consultant at Apollo Cradle. We spoke with her about menopause, its symptoms, and any special diet or exercise that is recommended for women who are going through menopause.

What are the most common symptoms of menopause? Are there any medications to control them?
Some of the common symptoms that women experience during menopause are: no menstrual periods for 12 months, vasomotor symptoms or hot flashes, cold sweats, night sweats, mood changes, depression, difficulty in falling asleep, urinary problems, vaginal dryness, loss of libido, weight gain, and slowing of the metabolism. This is a transition stage wherein women move from a reproductive phase to a non-reproductive phase. It sets the stage for ageing and in turn accelerates the process of non-communicable diseases.

What is perimenopause, and how is it different from menopause?
Perimenopause, also referred to as the menopause transitional phase, is the stage just before menopause. Perimenopause begins several years before menopause. It is the time when the ovaries begin to make less estrogen. It usually begins when women are in their 40s; however, it can start even earlier, while they are still in their 30s. During this phase, there will be an erratic, irregular flow, and also reduced fertility. It lasts until menopause. On the other hand, menopause is when your periods completely stop as the ovaries produce the least amount of estrogen; hence they no longer release the eggs.

Is there any special diet that women should follow during menopause?
There is no special diet as such, but it is very essential to eat balanced, healthy, and nutritious food. The daily caloric requirement is around 2,000 calories for sedentary workout, 2,230 for moderate workout, and 2,800 for heavy workout. A healthy diet must contain about 50-60% complex carbohydrates and high fibre. The fat content should not be more than 30% and saturated fats should be less than 10%. As far as proteins are concerned, they should be around 15%. Make sure your diet includes citric fruits and vegetables, limit your intake of coffee or tea to three cups a day, and consume around 500-600 ml of low-fat milk or curd. More precautions that one must take during menopause are: limit consumption of sugar, use a mixture of two cooking oils such as Omega-3 rich oils and soybean or mustard oil. Whole gains and lentils, nuts (2-4), and fish (1-3 serving) are also very healthy during this stage. Most importantly, women must consume up to eight glasses of water per day.

Can workouts make the symptoms worse or better? Are there any specific exercises that women should do during menopause?
Exercising is an integral part of healthy living, especially during menopause. Women during this phase should exercise at least five days a week for about 30 minutes each day. Exercising helps in maintaining body weight and reduces cardiac risk. It also strengthens the body, building muscle mass and bone density. Pelvic floor exercises are very helpful as they aid in maintaining urogenital health.

What are the hormonal changes that women face during menopause? Can you suggest some effective treatments that help with hormonal imbalance?
Some hormonal changes that women experience are the increase in levels of follicular stimulating hormones and a decrease in anti-mullerian hormones; estrogen is also decreased. Hormonal therapy is an effective treatment, but it should only be done when there is an indication, and under the supervision of a gynaecologist.          - Akhila