The ovaries produce the female hormones, oestrogen and progesterone, which exert their effects on the reproductive tract by playing a significant role in ovulation, implantation, maintenance of pregnancy, childbirth and breast feeding.
Oestrogen also plays important physiological roles in the urinary tract, cardiovascular system, central nervous system, immune system and bones. Its biological effects are found in cells that express oestrogen receptors which are found in many parts of the body like the reproductive and urinary tracts, breast, heart, brain, and skin. At menopause, the ovary stops producing female hormones. So there are effects felt in many parts of the body because of the ubiquitous effects of the hormones.
Skin and hair changes
There is a loss of skin collagen and elasticity with menopause. This results in dry skin, sagging and wrinkle formation. The skin is also more prone to damage from sunlight. Individuals who have smoked for a long time are prone to greater skin damage.
Drinking plenty of water and applying skin creams will help keep the skin moist. Avoidance of tobacco smoke will reduce considerably skin damage. The use of an effective sunscreen is helpful in protecting the skin from the sun’s harmful ultraviolet rays.
If there is any dark mole or if there are changes in one, a doctor should be consulted.
With ageing, the hair becomes grey and more brittle. There may be increased hair growth in areas where the hair follicles are more androgen sensitive i.e. upper lip, chin, and cheeks. The hair may also thin especially after menopause.
Taking a nutritious diet and avoiding chemicals and sunlight that dry the hair will keep it healthy. If there is severe hair loss, a skin specialist (dermatologist) should be consulted.
During the reproductive years, most women become accustomed to their own hormonal rhythm but this changes during the perimenopause. The hormonal fluctuations can contribute to mood swings.
The onset of the perimenopausal changes may also coincide with new demands, changes in routine, other stresses like relationship problems with spouse and/or children, separation, divorce or widowhood, concerns and care of ageing parents, career issues, body changes, etc.
A woman’s body image and self-esteem may also be affected by today’s youth-orientated society.
It is not uncommon for perimenopausal women to report difficulty in concentrating and memory lapses. This frightens some women who may think they have Alzheimer’s disease, but this is rarely the case. They may be more related to stress and ageing than to the perimenopause.
Everyone experiences anxiety, which is an agitated sense of anticipation, fear or dread, at some time in his or her lives. Perimenopausal women may have more anxiety because of physical and psychological changes as well as various stress-provoking factors. Most anxiety usually resolves without need for treatment. However, if it occurs frequently, consult your doctor.
Depression is associated with a chemical imbalance in the brain.
Maintaining emotional health during the perimenopause requires recognition of problems, understanding their causes and developing coping mechanisms. Coping skills can be learnt to empower a woman to meet life’s challenges.
The following may be helpful:
Some women may feel uncomfortable about discussing their psychological problems. If there are unsteady emotions or memory or mental lapses, a consultation with the doctor will be helpful.
Sometimes, knowing just what is not right can bring relief. At other times, there are treatments that can help.
Some women may have sleep problems which are often due to night sweats that disrupt sleep. It may also be due to mood or sleep disorders. There may be difficulty falling asleep or one may wake up before the usual time.
Some women do not get enough REM (rapid eye movement) sleep during which dreams occur and the brain is rested. Without REM sleep one will feel tired. When sleep rhythms are disrupted, health, mood and the ability to cope with problems may be affected. There may be problems of concentration or even depression.
If there are sleep problems, the following may be helpful:
Should the above measures fail to address the sleep problems, consult the doctor, who will rule out conditions like thyroid disorders, anaemia, breathing problems and allergies. The doctor may then prescribe a hypnotic and/or an oestrogen, which has been shown to improve sleep in women by alleviating night sweats.
Women in their 40s and 50s often gain weight. They sometimes attribute this to the menopause or hormone replacement therapy. This is not supported by scientific evidence. In fact, the weight gain is related to their lifestyle and the ageing process itself. Studies have revealed that:
There are some studies, which suggest that hormonal fluctuations may play a role in headaches. The women who have these headaches are usually those who have had a history of headaches at the same time each month when they were still having their periods. It is important to remember there are non-hormonal causes of headaches e.g. dental or sinus problems, and infection.
Most headaches are minor and do not require treatment or can be treated with non-prescription pain medicines.
However, if the headaches are persistent or severe, it would be prudent to consult your doctor to determine the cause.
There is an increase in tooth loss with menopause. Good dental care and regular check ups by the dentist are important.
Eye changes occur with ageing. There will be an increasing need to wear corrective lenses as well as an increased incidence of eye conditions like cataracts. The eyes may feel dry, scratchy or burn. The use of eye moisturizers may be helpful. If it persists or if there are any eye problems, an eye specialist (ophthalmologist) should be consulted.
There is no evidence that links menopause to palpitations. However, an increase in heart rate may occur during a hot flush, anxiety, mood changes or thyroid disease and this may be felt as palpitations. It is unlikely that the palpitations experienced at these times are related to heart disease. However, an evaluation by your doctor will be helpful to rule out any serious illness.
There is no evidence that link the menopause to joint pain. However, the risk of osteoarthritis increases with ageing.
Dr Milton Lum is Chairperson of the Commonwealth Medical Trust. This article provides general information 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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