Managing Menopause

It can be said that of all those who have a menstrual cycle, a vast majority suffers from some symptoms – if not all – of the premenstrual syndrome. That statement, however, does not stand true for Menopause. That is because not a majority, but every single individual who experiences the beginning of a menstrual journey, must also go through its cessation. In layman’s terms – this is essentially what menopause is.

What is Menopause?

A physiological event which generally occurs in all reproductive women upon reaching mid-life, menopause is defined as the retrospective cessation of a woman’s cyclic menstrual bleeding after twelve continuous months of amenorrhea following the complete loss of ovarian activity. (Nendaz, 2001).

An ancient phenomenon which dates all the way back to ancient Greeks, the concept of menopause dictates the complete end to a woman’s fertile or child bearing years with the cessation of the menstrual cycle. Literally, the word-menopause comes from the words ‘men’ and ‘pausis’, translating to the event where a woman stops experiences her menstrual cycle on a monthly basis. (Milsom, 2005)

Onset of Menopause

Menopause occurs due to the genetically programmed, or natural, loss of follicles or eggs from within the ovary. This is indicative of a natural deficiency of the hormone estrogen.

Menopause is not a condition which occurs suddenly and takes immediate effect. The definitive diagnosis of menopausal onset is only given after 12 complete months of no cyclic menstrual activity. Menopause, although is usually set to occur around the average age of 51 years old, can occur as early as the 40’s or as late as the late 60’s. (Goodman, et al., 2011)

As it is, menopause begins in an average, healthy woman, from her late 40’s where the woman is said to go through the transitional phase of menopause. This transitional phase is called Premenopause and it is said to last approximately for four years before the very last menstrual cycle (Stanford Hospital and Clinics, 2009).

The onset of menopause is affected by dietary and lifestyle considerations such as that chain cigarette smokers are said to experience the menopausal transitional period 2 years earlier as compared to the rest. (Grady, 2006).

Common Signs and Symptoms

There are a number of signs and symptoms that plague women as they go through the menopausal transitional period. These symptoms, which range from mild to severe, are associated with estrogen depletion within the body (NICE - National Institute for Health and Care Excellence, 2015). However, there are a few cardinal symptoms which are considered as the hallmark of menopause. These are the vasomotor symptoms otherwise known as hot flashes accompanied by night sweats. (Stuenkel, et al., 2015)

While all the other signs and symptoms are different for each individual woman, some of the other common signs and symptoms that may aid in the identification of the onset of menopause include (Grady, 2006):

  • Sleep disturbances
  • Vaginal dryness
  • Vaginal burning
  • Vaginal discharge
  • Reduced sexual sensitivity
  • Arthralgia or joint pain
  • Dyspareunia or painful sexual intercourse (which may or may not lead to spotting or bleeding after intercourse)
  • Palpitations
  • Recurrent urinary tract infections
  • Depression
  • Marked irritability
  • Anxiety
  • Significant loss of libido
  • Skin dryness
  • Considerable fatigue and increasing tiredness
  • Mood swings
  • Memory fluctuations
  • Mild incontinence
  • Increased wrinkling
  • Increased abdominal fat
  • Loss of breast fullness
  • Irregular menstrual cycles – either longer or shorter or with an irregularity of flow.
  • A generalized reduction in the Quality of life

Management and Treatment

The treatment and management of menopause is multi-disciplinary. While there is no course of treatment which can completely prevent a woman from experiencing menopause, there are treatment modalities which aid in the management and relief of menopausal symptoms. (Grady, 2006)

These modalities include:

  • Lifestyle modification
  • Dietary adjustments
  • Behavioral Therapy
  • Medications

Lifestyle Modification

According to a number of studies, it has been found that lifestyle changes have a significant impact on the onset of menopause and the premenopausal period on women. As such, there are a few lifestyle modifications recommended by doctors which aid in the smooth transitioning of a woman from her menstrual years to menopause. They include:

  • Regular exercise
  • increased physical activity overall
  • Controlled weight loss and gain
  • Quit smoking
  • Controlled alcohol consumption

Dietary Adjustments

There are also a few dietary adjustments which can help alleviate the symptoms of menopause. These include:

  • The replacement of a fat and carb rich diet with a more protein and fiber-centric diet
  • Regular nutritional supplementation especially of calcium and vitamin D to prevent osteoporosis (one of the complications of menopause)
  • Decreased intake of simple sugars
  • Increased consumption of fresh raw fruits and vegetables
  • Decreased intake of salt to protect the heart health as cardiovascular conditions are another complication of menopause said to affect women during the post-menopausal phase

Behavioral Therapy

The change of hormone levels brought on with the onset of menopause is said to cause a number of psychological symptoms which accompany the physical ones. In order to manage these symptoms such as anxiety, depression, panic attacks, forgetfulness or difficulty in concentration, it is suggested that women seek behavioral therapy and regular counseling to help them navigate through the onslaught of psychological symptoms.


There are a number of different medications and drug therapies which can be prescribed to a menopausal woman to help manage or alleviate the symptoms of menopause. While it is not necessitated for every single individual to seek treatment for menopause, the following are the options available:

  • Over the counter medication such as lubricants for vaginal dryness and other vaginal concerns.
  • Vitamin E supplements to support hot flashes.
  • Prescribed Bisphosphonates (non-hormonal therapy) – to improve bone density and bone mass as well as to protect against Osteoporosis
  • Oral contraceptives to regulate the irregular menstrual cycles before menopause
  • Antidepressants such as SSRI’s to manage the hot flashes and sudden mood swings
  • Testosterone (often combined with Estrogen) to improve the libido and improve mental alertness.
  • Hormone Replacement Therapy or Menopausal Hormone Therapy– the administration of either only Estrogen (known as Estrogen Therapy) or Estrogen in combination with Progesterone (E+P). MHT is available either as a pill, a suppository, a cream, a gel patch, or an implant under the skin.


  • Goodman, N. F. et al., 2011. Medical guidelines for clinical practice for the diagnosis and treatment of menopause. Endocrine Practice, 17(6), pp. 1-25.
  • Grady, D., 2006. Management of Menopausal Symptoms. The New England Journal of Medicine, Issue 22, pp. 2338-2347.
  • Jones, L. M., 2010. Menopause and Menopause Treatments, Rhode Island : U.S Department of Health and Human Services - Office on Women's Health.
  • Milsom, I., 2005. Menopause-Related Symptoms and their treatment. s.l.:s.n.
  • Nendaz, G. G., 2001. Menopause, Perimenopause, Postmenopause, Geneve : Hôpitaux Universitaires de Genève.
  • NICE - National Institute for Health and Care Excellence, 2015. Menopause: Diagnosis and Management, s.l.: NICE.
  • Ried, R. et al., 2014. Managing Menopause. Journal of Obstetrics and Gynaecology Canada, 36(9), pp. 5-15.
  • Stanford Hospital and Clinics, 2009. Menopause , s.l.: Standford Primary Care Clinics.
  • Stuenkel, C. A. et al., 2015. Treatment of symptoms of the Menopause: an endocrine society clinical practice guideline. The Journal of Clinical Endocrinology and Metabolism, 100(11), pp. 3975-4011.

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