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Menopause is the physiological phenomenon of stoppage of menstruation. It occurs in all of the women in between 40 and 50 years of age and signifies the end of fertility. Common understanding is that the menopause signifies cessation of all functions of the uterus like stoppage of uterine bleeding however biologically menopause means end of primary ovarian functions namely ripening of ova per cycle, production of hormones which leads to the changes in the inner linings of the uterus (proliferative changes) and shedding of the linings (secretory changes).
Menopause does not occur abruptly rather it is a gradual change which occurs over years. Sometimes certain bothersome symptoms like hot flashes, mood swings, irritability, depression, excessive crying etc may occur. In some women the symptoms become so much bothersome that there is interruption of normal routine. Contrary to common belief menopause does not mean end of sexual life however one can still remain healthy and sexually active.
The gradual transition to menopause is known as perimenopause. Usually it may take years before one attains menopause. The common symptoms of menopause include irregular menstrual blood loss in a woman with previously regular period, dryness of vagina, hot flashes, excessive perspiration at night time (night sweat), disturbed sleep, mood swings, increase in body weight, slowing of metabolism, thinning of hair, loss of natural tightness and lustre of skin, sagging of breasts etc
Although in most of the women only few of the above mentioned symptoms appear and most common irregularity of period occurs. Irregularity of periods usually start about one to two years before the actual menopause sets in however despite irregularity of periods ovulation occurs and hence there is increased chance of accidental pregnancy.
Following menopause there is increased chance of suffering from certain health conditions like heart diseases due to fall in estrogen level, osteoporosis characterized by thinning and weakening of bones and fracture with minimal or no trauma, leakage of urine (urinary incontinence) as there is loss of elasticity, loss of libido due to dryness of vagina and loss of elastic tissue, inappropriate weight gain etc.
Menopause is a natural inevitable biological phenomenon.Usually once a woman reach late 30’s there is decrease in production of estrogen and progesterone although the period remains more or less regular, during the 40’s the periods become longer or shorter with heavy or scanty blood loss but still regular to some extent but in the early part of the 50’s the ovaries stop egg (ovum) production and complete stoppage of menstrual blood loss.
Menopause can occur prematurely under certain circumstances; these are
1. Following surgical removal of uterus (hysterectomy): in case of complete hysterectomy which include removal of both the ovaries and the tubes along with the uterus menopause occurs immediately. However in partial hysterectomy cases where there is only removal of uterus but not of the ovaries although the bleeding stops but the ovaries continue to produce ova and the female sex hormones. In these cases biologically menopause has not occurred.
2. Following chemotherapy and radiotherapy there is increased chance of menopause and loss of fertility although not always permanently.
3. Primary ovarian insufficiency: in these cases the ovaries stop producing ova and hormones before the affected woman reach 40 years of age leading to premature menopause. Although the exact cause is not known genetic factors and autoimmune diseases (where the immune system of the body mistakenly attack own body cells instead of foreign infective organisms) are the two known causes. Hormone replacement therapy is essential in these women until the usual age of menopause in order to protect the bones, brain and heart. About one woman out of 100 women suffers from this condition.
There is no way to prevent menopause however the bothersome symptoms of menopause can be managed successfully. Common options include
1. Hormone replacement therapy
2. Local application (vaginal) of estrogen
3. Antidepressants
4. Drugs to correct osteoporosis like bisphosphonates, calcium, vitamin D, parathormone, calcitonin etc.

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