During midlife, women will experience physical changes. Hormonal changes duringperimenopause (pre-menopause) gradually lead up to menopause. But because these changes occur gradually, one may not beaware of them. No two women will experience these changes in the same way.
During the reproductive years, every woman has a distinctive menstrual pattern. At perimenopause, some women just simply have one last period and none after that. However, most women experience changes or irregularity in their periods over a period of time during perimenopause. This is due to the decreased frequency of the release of eggs (ovulation) with consequent irregular secretion of the ovarian hormones.
The initial changes may not be noticeable. The menstrual cycle usually shortens with periods occurring more frequently than monthly. The bleeding may last more or less than previously and the flow may be lighter, heavier or just spotty.
Later, as menopause approaches, it is not uncommon for women to skip periods. Some women may have no periods for several months and then menstruate regularly again.
Although irregular periods are common during menopause, it cannot be assumed that all changes are due to the body's hormonal changes.
Other conditions may cause abnormal uterine bleeding. A doctor should be consulted if any of the following occur:
Abnormal uterine bleeding could be due to hormonal imbalance; pregnancy; reaction to contraceptive pills, depot contraceptives or intra-uterine contraceptive devices; fibroids; non-cancerous (benign) uterine polyps; cancers of the cervix, uterus or vagina; and conditions that interfere with blood clotting.
The doctor may perform one or more of the following procedures to establish the cause of any abnormal uterine bleeding:
The treatment of abnormal uterine bleeding depends on the cause. They include:
It is advisable to consult the doctor immediately should any bleeding occur 12 months after the last menstrual period.
Some women who are taking hormone replacement therapy (HRT) may have bleeding. Unless the bleeding is the typical pattern caused by hormone treatment, all post-menopausal bleeding requires investigation to rule out cancer.
A woman's fertility declines from the late 30s. This is due to the ageing of the eggs in the ovaries. The risk of spontaneous miscarriage is increased so much so that by the age of 45 , the rate is about 50%. At the same time, the risk of congenital abnormality in the foetus increases from the age of 37 so much so that by the age of 45 , the risk is about one in 40.
Although assisted reproduction technologies are available for perimenopausal women, they are expensive, have some risks and have low success rates.
There is also an increased risk of pregnancy complications like hypertension and diabetes in the mother, the need for Caesarean section and stillbirth.
Despite reduced fertility, a woman is not free from an unplanned pregnancy until a year after the last menstrual period. Even if there are other signs like hot flushes, it does not mean that one cannot get pregnant. About 75% of pregnancies in women over the age of 40 years are not planned.
If pregnancy is not desired, an effective contraceptive method is necessary.
It is usual practice for doctors to advise using a contraceptive for another year when the menopause occurs at age 50 or more, and for another two years when the menopause occurs before 50 years of age.
It is advisable to stop the combined oral contraceptive pill at about 50 and change to an alternative contraceptive method until the menopause status can be determined.
Fertility awareness techniques may the only method available for couples because of religious or cultural reasons. However, it can be difficult for women with erratic cycles. The alternative methods can be used until the age of 55 when the loss of natural fertility can be assumed.
HRT cannot be relied upon as a contraceptive as ovulation may still occur. It is also difficult to assess the timing of the natural menopause in women on HRT.
Some perimenopausal women experience hot flushes (also known as hot flashes). It is more common in Caucasian than Asian women and is due to sudden changes in the body's temperature regulation.
The brain, which mistakenly senses that one is too warm, initiates events to cool down. Blood vessels near the surface of the skin increase in diameter. The increased blood produces the red, blushed appearance of the face and upper body. One may also start to sweat. A hot flush occurs suddenly and may last a few seconds to several minutes or more. A few women may experience a cold chill after the flush.
Hot flushes may occur with increased sweating during sleep. The night sweats and hot flushes may interfere with sleep, although it may not wake the affected individual.
Hot flushes usually have a consistent pattern and can occur several times in a day or a few times a month. Some women will get hot flushes for a few months, some for a few years and others do not get them at all. There is no way of knowing when they will stop. However, hot flushes are not harmful.
Most women can identify certain factors that start their hot flushes e.g. hot drinks, hot or spicy food, caffeine, alcohol, stress, emotions, and external heat. Certain medicines like tamoxifen used for chemotherapy and raloxifene for prevention and treatment of osteoporosis can trigger hot flushes.
If one has hot flushes, one can take steps to improve one's comfort, to the extent that the hot flushes can sometimes be eliminated altogether:
Dr Milton Lum is Chairperson of the Commonwealth Medical Trust. This article provides general information only and is not intended to replace, dictate or define evaluation by a qualified doctor. The views expressed do not represent that of any organisation that the writer is associated with.
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