Forget not the hot flashes

Professor Dr Nazimah Idris, professor of obstetrics and gynaecology and medical director at IMU Healthcare, touches on the topic of menopause and perimenopause.  

Menopause is a phase of life that is frequently veiled in mystery, particularly among younger women who typically do not know what to expect or what to do during this natural occurrence.

According to Nazimah, clinicians should speak to women long before they reach menopause, so that, when it happens, they are more prepared and less anxious about it. “Many women I see wish they had known earlier what they could have done to prepare themselves. As every woman will go through this experience, [they] should enter this life phase empowered with knowledge.”

Start from the beginning

She said the conversation about menopause can begin by explaining that menopause occurs when a woman’s ovaries stop producing eggs and menstruation ceases. Menopause is medically confirmed when a woman has not had menstruation for 1 year. This typically occurs between the ages of 45 and 55. The global average age of menopause is 51.4 years, with 5 percent of women experiencing it early ie, between the ages of 40 and 45.

Before actual menopause happens, women experience a perimenopausal phase that typically lasts 4 to 5 years. During this period, it is normal for women to experience irregular menstruation, which may include heavier bleeding as well as infrequent or missed cycles. This is often accompanied by hot flashes, fluctuating emotional states, difficulty sleeping, and vaginal dryness, and is caused by changes in a woman’s endocrine system that reduce her oestrogen levels. In turn, these factors may also contribute to forgetfulness, low energy levels, and diminished libido which when combined with vaginal dryness, may result in a decreased desire for sex and intimacy. Once menopause has occurred, the symptoms can intensify and last for up to 5 more years.

The entire process from perimenopause to complete menopause can take up to 10 years, which is a long time to deal with symptoms if they are interfering with one’s daily life. Approximately 80 percent of women experience hot flashes, which are far more severe than merely feeling “warmer than usual.” Nazimah explained that hot flashes are severe, with intense surges of heat that worsen at night, disrupt sleep, and cause irritability or difficulty concentrating. She said: “This can be managed with hormone therapy, but only 30 percent [of patients] actually seek treatment, either because they are unaware that treatment exists, or they prefer natural, home remedies.”

Hormone replacement therapy is generally well-tolerated and can be of great assistance in relieving hot flashes and improving sleep quality, vaginal dryness, and urinary incontinence, among other conditions.

Hormone therapy options are available in tablet form to relieve overall symptoms or topical cream to reduce vaginal dryness. Depending on the patient’s family background and medical history, different options exist to cater to each need. Patients with their uterus intact may be prescribed a treatment that has both oestrogen and progesterone, while those who have undergone hysterectomy may be given one that has oestrogen alone. For women prone to osteoporosis, there is also a medication known as tibolone that is similar to oestrogen but has the added benefit of reducing osteoporosis risk.