Menopause: A gift of time

--Brig. Gen. Dr. Suraiya Rahman (Retd)

9. Surraya

Menopause is a natural change occurring in a woman’s life over years of longevity. It brings about physiological changes, affecting both physic and psyche. It comes cyclically like the high and low tide in a river or a sea. Life does not stop with these changes, it may falter for a while only.  Truely, to enjoy this gift of time, one need some physical and mental preparation well ahead in time.

What is Menopause?

It is only a phase in a woman’s life like menarche and motherhood. ‘Meno’ means ‘month’ and pause is to ‘stop; It is a state of permanent cessation of menstrual cycle resulting from loss of ovarian function. Diagnosis is retrospective, after menstruation stops for atleast 12 months.

Time span of menopause:

Premenopause: Few (4-5) years before menopause, the fluctuation of pituitary and gonadal hormones cause much distressing symptoms. It may start from age 40+-mid 40’s. Menopause occurs as a progressive event by the age 48-50years. Average age is considered to be52years in this country. This age may vary in countries and races, so does the symptoms.

Why are we concerned about ‘menopause’ today, when the topic was a ‘taboo’ till the other day?

In 1990, 467 million women world wide were postmenopausal; of these, 40% were living in developed countries. By the year 2030, this number will be more than double and 75% of postmenopausal women will be living in developing countries like ours. Average life span of women in Bangladesh today is 69 years.

The increase in the number of postmenopausal women is going to affect the socio-economic background of our country in a negative way. It is going to be a public health of great concern.

Health Risks

It is important to consider the health risks of these women for better understanding and planning management in an organized manner. During reproductive period, ovarian steroid is the transcriptor regulator of gene which maintain haemostatic regulation of bone calcium, blood lipids, immune system and so on. Health risks may be targeted in two broad categories:

Immediate ones are manifested as hot flushes and night sweats, fatigue, palpitations, insomnia, urinary and sexual problems, mood disorders etc.

Late changes may involve CV problem, osteoporosis, urogenital problems, skin atrophy and cognition.

Most important factor is that these risks may overlap each other. Modern methods advocate risk factor assessment by molecular and genetic diagnostics, so that directed therapy may be given.

With decline in estrogen production, ‘onset of menopause related complaints’ take place as follows:

These symptoms have been differently perceived among urban and rural women.

It is important to mention here that for better understanding and management, staging of menopause have been devised like other physiological event such as normal labour.

Most practical clinical staging is designed by late Dr. Behram Anklelsaria, an eminent gynecologist and ex president of Indian Menopause Society.


Apart from physical and physiological changes, the social and psychological stress have a great impact on the elderly population. Loss of power and position, children growing up to get apart, relationship with husband getting distant, seclusion from main stream society, create a, state of ‘Emptyness Syndrome’ affecting many of them.

As we already know that these menopause related complains continue for month to years to decades. There is this ‘grace period’ during which prevention way be targeted. Prevention is from the sufferings of menopause related complaints and further consequances of aging life. So, how can we plan it? If premenopausal symptoms appear around mid 40S or before, prevention may be targeted in the following ways:

Diet: should be well balanced with plenty of vegetables, fruits, some dairy products and adequate vitamins and minerals, but low in calory, easy digestable

Excercise: Walk-ing, jogging, Swimming, moderate weight bearing exercise, aerobic, yoga, freehand exercise

Alcohol and  Smoking: Should be abundoned.

Stress and strains: Relieve with meditation, yoga, hobby cultivation, gardening, socializing

Therapeutic / other alternative: If necessary after consulting doctor.

If this program is started earlier in life from age 30+, then a better benefit is awarded. In India, Club plus -35 has become quite popular in this context.

Hormone therapy

One of the most important armamentarium, which is scientifically established. It is considered quite safe if prescribed intelligently in a professional manner. All queries regarding HT should be addressed clearly and knowledge regarding this may be disseminated through awareness, educational programs and media.

Screening for early detection of diseases as well as age related co-existent medical problems like DM, HTN, dyslipidaemia, thyroid disorders and chest diseases need early detection and treatment.

Healthy Aging

As clinicians, with interest in the health of women at midlife and beyond, we recognize that what we are dealing with is “healthy aging” WHO defines health as a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity. Burnside consider health of older women from four perspective of fitness:

1) Intellectual

2) Physical

3) Social &

4) Purposive

Health in older people is best measured in functional degree of fitness rather than extent of pathology.

Etiology and consequences of Health risks

It becomes very difficult to distinguish between health risks and disease etiology related to estrogen deficiency associated with menopause VS natural process of aging. These may overlap each other. Such distinction actually does not matter, for with increasing skepticism regarding medicalization of menopause, our role is to encourage our clients to the healthiest path that midlife can offer:

–           Life style changes

–           Disease prevention (pharmacological or not)

Hormone therapy should be part of an overall strategy including life style recommendation regarding diet, exercise, smoking and alcohol, for maintenance of health during peri and post-menopause.

Conclusion: The significance of midlife and menopause is consistent with their being in the prime of life and staying healthy., Menopause is not viewd as a medical event, but does create an opportunity for women to evaluate their health. Services to enhance health promotion and disease prevention should be available to all for the benefit of the entire society. Healthy aging in 21st century should take into account dimensions of biology, psycho-sociology, geography, culture-community, mind and nature. Let us try to avail the opportunity of enjoying the phase of menopause with positive attitude as a’ gift of time’.