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Some cycles could have heavy menstrual discharge but sometimes

menstrual periods are completely skipped.

These changes occur over a period of five to eight years, called

perimenopause, and finally end in menopause.

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7. What are the Risk Factors for Menopause?

Menopause is a normal biological process. Yet, there are certain

factors that could affect the onset of menopause.


If you have a family history of premature menopause, you stand a

greater risk of having it too. Premature menopause is where you

enter menopause before the age of forty.

Medical Treatments

If you are treated for any ailment where you undergo radiation and

chemotherapy treatments, this may cause you to enter menopause



If you undergo surgical removal of the ovaries as in total

hysterectomy and bilateral oophorectomy, you will enter menopause

early. A hysterectomy removes only your uterus and not your

ovaries. Such an operation may not cause menopause, as your

ovaries continue to produce estrogen and progesterone hormones.


Nicotine levels in your body may help to induce early menopause, as

they are believed to restrict free production of hormones. This could

disrupt your regular menstrual cycle and you may enter

perimenopause and menopause earlier.

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Specific medications that reduce estrogen levels in your body could

cause early onset of menopause.

Autoimmune diseases

Certain autoimmune diseases disrupt normal physiological

functioning of your body and some may be involved in the early

onset of menopause.

Premature Ovarian Failure

This is a very rare condition where your ovaries could stop

functioning well before the age of forty due to specific genetic or

other medical conditions. This may causes menopause to start


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8. Myths and Misconceptions about Menopause

Menopause marks the start of a new phase in your life. Many

women treat menopause as something unwanted or uncalled for but

menopause is a normal biological process and you cannot run away

from it.

There are numerous myths and misconceptions about menopause.

Myth: Menopause causes weight gain

Your metabolic rate normally decreases with age. There could be a

little gain in weight during menopause but it not be due to

menopause alone.

Eating the right type of foods and exercising for thirty to forty-five

minutes every day can help you maintain your weight.

Myth: Menopause marks the end of sexual life

Menopause causes vaginal dryness and lowered libido. However,

reduction of hormone levels does not mark the end of your sexual

life. You can maintain normal sexual relations with your partner.

Myth: Menopause denotes you have become old

Menopause is a normal process and every woman has to experience

it. Some women experience severe symptoms while some encounter

few or no symptoms.

Menopause usually starts in your forties and fifties when you have

completed almost half your lifespan. Although you are aging by

then, you can learn to age gracefully.

It is the second innings of your life. Learn to relax and enjoy it.

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Myth: Menopause causes memory problems.

Menopause may not be the sole or even the main cause for your

memory problems. Various nervous diseases or stress about life

issues such as retirement, familial problems etc., cause problems in

retaining facts.

Menopause causes hormonal changes. Some of these changes may

contribute in part to problems in concentration.

Myth: Menopause is a disease

Menopause is not an illness or ailment. It happens to every woman.

Develop and maintain a positive attitude towards a different chapter

in your life.

Learn to accept life as it comes and you will be able to sail through

your menopause smoothly.

Myth: Menopause is natural, so it does

not have major consequences

Menopause is a natural process. But, it could be a factor in the

occurrence of various ailments like osteoporosis, colon cancer,

vaginal and urethral atrophy, diabetes, heart disease, Alzheimer’s

disease, and impaired vision.

Low estrogen levels may make you more vulnerable to these


However, there is no need to panic. Proper management of

symptoms and prompt medical care can help you overcome almost

all possible ailments.

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Myth: Hormone replacement therapy is bad

Hormone replacement therapy may have serious side-effects with

some individuals. But, it is not always a bad option.

Hormone replacement therapy is a conservative option.

Doctors advise such therapy treatment to women in dire need of it.

It can bring huge relief from most menopausal symptoms like hot

flashes, night sweats and vaginal dryness.

Myth: Menopause causes depression

Depression is risk factor among women with a family history of

depression and a common ailment among women in their late

forties and fifties.

Menopause can aggravate depression symptoms in women with a

prior history of depression but this does not mean that menopause

causes depression.

Depression can be an after-effect of various other ailments like

heart disease.

Myth: Menopause could mean the end of an active life.

This is an unfortunate myth.

Menopause is a part of your life.

You can continue with your active life schedule. Regular exercise,

good and nutritious food, adequate rest and remaining connected

with different issues can help you continue with your active life

without much disturbance.

Regular visits to your doctor and regular checkups can help you lead

a healthy life for many years after menopause.

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Part-III: Diagnosis and Clinical Aspects

9. When to Seek Medical Advice

Menopause normally starts between the ages of 45 and 55. It

could start with irregular periods.

Visiting your doctor and seeking medical advice can tell you if you

are pregnant or in the perimenopause stage.

Women in their perimenopause and menopause stages should

undergo a thorough annual medical check-up that includes

mammogram, pelvic examination and breast examination.

The perimenopause stage could bring different changes in your

body. Seeking medical advice helps you to understand those body

changes and what, if any, treatments may be necessary to reduce

the possibility or effects of major symptoms.

Menopause and perimenopause are transitional stages and your

body needs sufficient time to adjust to these changes.

Your doctor can give you advice about what to expect and how to

deal with these changes.

Menopause signifies low estrogen levels in your body. You may be

at a greater risk for different ailments like heart disease and cancer.

Professional advices from your doctor can help you make suitable

dietary and lifestyle changes as a preventive measure.

Menopause could cause irregular periods due to low estrogen levels.

Yet, you can still become pregnant. Doctors sometimes advise birth

control pills with low estrogen levels to prevent pregnancy and get

some relief from hot flashes, a common symptom of menopause.

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Seeking medical advice at all stages of perimenopause and

menopause is essential to maintain good health.

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10. How Is the Menopause Diagnosed?

There are many tests and examinations that help in determining


Most of these tests involve drawing a little blood from your veins

and arteries. You could feel slight pain and discomfort as a result.

In some cases, it could cause excessive bleeding. Infection is

possible. Sometimes, though rarely, you could experience dizziness

or could lose consciousness for some time.

But, doctors take all necessary precautions before undertaking any

of these tests.

Diagnosis of menopause includes reviewing your medical history,

present symptoms and ruling out other possible causes for your


Irregular periods are a common menopausal symptom, although it

does not necessarily indicate menopause.

Other Tests to Diagnose Menopause

Urine test: Doctors advise a specific urine test to detect hormone

levels because high hormone levels in urine could indicate


Blood Test: A blood test to determine the amount of follicle-

stimulating hormone (FSH) can indicate if symptoms pertain to

menopause. This test is specifically for women who have had a

hysterectomy operation without removal of ovaries. The result is

that the ovaries of these women continue to produce estrogen and


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Pituitary glands produce FSH and stimulate ovaries to produce

estrogen. However, in women over the age of forty, estrogen

production declines although their FSH level may increase.

Excess FSH then enters your blood.

Sometimes, a single FSH test is not enough for diagnosis of


Further, some doctors may advise that you should not be taking

birth control pills when you are tested as hormones present in those

pills could affect test results.

Your FSH levels can help to identify symptoms of menopause if you

are in this group.

Bone Tests: Menopause may lower the density of your bones,

sometimes leading to osteoporosis.

Bone tests detect and calculate bone density levels and compare it

with normal levels.

This involves taking an x-ray of hipbones and those in the lower

parts of your spine. Before this, simple screening of bones through

ultrasound machines can detect bone density. However, this simple

screening is insufficient to detect actual levels necessary to

determine menopause.

If levels are between 1 and 2.5 standard deviations below the

average value, it may indicate osteoporosis.

Heart Tests: Menopause could place you at risk of heart ailments.

Doctors prescribe normal blood tests to determine cholesterol

levels. High cholesterol may indicate the possible existence of heart


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Pregnancy Test: Doctors conduct pregnancy tests to determine if

you are pregnant or in menopause if you miss your regular

menstrual periods.

Thyroid Test: Thyroid problems in women often show the same

symptoms as those of menopause. Therefore, doctors recommend a

thyroid-stimulating hormone test to check if irregular periods are

due to thyroid problems or due to menopause.

Urine test: There is a specific urine test that determines hormonal

levels in urine. High hormone levels may indicate menopause.

Transvaginal ultrasound test: This test detects abnormalities in

uterus or any extra growth around uterus that could be responsible

for excessive and abnormal bleeding during or in-between

menstrual periods.

Menopause may induce such irregular periods with excessive

bleeding. This test can help doctors determine if the bleeding is due

to menopause or other problems associated with the uterus.

Endometrial biopsy: This test detects the functioning of the

uterine lining. Normally, progesterone and estrogen form a thick

lining around uterus to house a fertilized egg. If there is no

fertilization, this lining comes off as menstrual bleeding. This biopsy

can therefore detect if such uterine lining takes place and thereby

can give some indication if you are into menopause or not.

Estradiol test: Estradiol is an important form of estrogen secreted

in the ovaries, adrenal cortex and placenta. This test detects

estradiol levels in blood. This hormone promotes growth and

development of uterus, breasts, vagina and fallopian tubes. It also

promotes distribution of body fat.

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You should not take birth control pills or be on estrogen therapy

while taking this test. This test can check functioning of ovaries,

adrenal glands and placenta. It also detects any abnormal growth

around ovaries or placenta.

This helps doctors analyze if you are going through menopause or

having other problems related to your ovaries like ovarian cancer, a

tumor or any other problem.

LH (Luteinizing Hormone) Blood Test: This test detects levels of

the luteinizing hormone or LH. Your anterior pituitary gland

releases a special protein hormone, LH. Increase in LH levels during

mid-cycles of menstruation causes ovulation.

Doctors conduct this test on a specific day of your menstrual cycle.

Doctors detect such levels through blood test. If levels of LH

hormones in your blood test are very high, it may indicates


But, these levels also could be high if you have ovarian cancer, a

tumor or possibly the formation of cysts around the uterus.

Doctors analyze these test results with regard to your other

menopause-linked symptoms to detect if you are into menopause or


You should refrain from using any birth control pills or hormone

replacement therapy while undergoing this test.

Pelvic Examination: Doctors conduct a thorough pelvic

examination to detect any abnormalities in your pelvic region and

around the uterus. Excess growth, pain or discomfort could prompt

doctors to go into deeper examinations to detect the actual cause of

your problem.

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Normally, women into menopause have fat deposits in the pelvic

region that may result in some weight gain. This test can detect

changes in vaginal lining that take place during menopause.

Breast examination or mammography: Breast examination can

detect abnormalities or pain around or in the breasts. Menopause

induces a tender feeling in the breasts while making them softer.

Mammography can detect any such abnormalities for doctors to

diagnose the root cause of your problem.

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12. Self-Testing for Menopause

You can use a self-testing method to detect if you are in

menopause or not.

Some of the home tests are said to be similar to those used by

doctors. However, doctors have greater knowledge and are better

able to analyze test results in conjunction with your other symptoms

to come to the most reliable conclusions.

Even if your self-testing gives a positive response, you cannot be

sure that you are into menopause and therefore stop using any


Getting your doctor’s confirmation and opinion is essential.

Similarly, do not assume that a negative result indicates you are not

yet into menopause. There could be other reasons that cause such a


A simple home-testing kit measures follicle stimulating hormone

(FSH) levels in your urine. Your pituitary gland produces FSH and

these levels every month increase to stimulate your ovaries to

ovulate. During menopause, your ovaries stop ovulating and the

FSH levels increase in your urine.

This self-testing involves checking your first morning urine. After

putting a few drops of urine on the test device, dip it into a cup of

urine. Chemicals in the device react and produce a specific color,

which indicates current FSH levels.

Although this test may deliver good results most of the time, your

results also depend on other factors like:

• the amount of water you had before the test,

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• if it is the first morning urine,

• if you are on any contraceptives, estrogen supplements

• if you are on any estrogen supplements or

• if you have undergone hormone replacement therapy.

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13. Medical History for Menopause Diagnosis

Your medical history assumes great importance in your menopause

diagnosis. Doctors need to know if you suffer from any chronic

illnesses like arthritis, hypertension, diabetes, thyroid disease, or

urinary tract infections. You should give all details of therapies,

medications, and allergies.

Menopause diagnosis requires information about the start of your

menstruation cycles, length of cycles and bleeding during cycles.

Information about pregnancies, abortions, fibroids, pelvic surgeries,

contraceptives in use and sexually transmitted diseases is also


Doctors would also inquire about your lifestyle and dietary habits.

Family related details like your mother’s and sister’s age at

menopause, fertility problems and any genetic disorders inherent in

your family also play a part in your menopause diagnosis.

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14. Is It Possible to Delay the Menopause?

Menopause is a natural biological process and you cannot delay it.

However, a very recent news item offers an alternative prospect.

Robert Winston, professor of fertility studies at Imperial College,

declared that researchers found a new protein that may be able to

delay the onset of menopause.

Professor Winston stressed that risks with use of this pill or injection

might be fewer than with some other treatments.

Some researchers suggest that, as they believe that many women

today are much healthier than fifteen years back, menopause might

be delayed without much risk.

If further research and controlled testing bears out this theory, you

might be able to prolong your fertile years. This could enable

women to have healthy pregnancies and smooth deliveries even in

their forties.

But, the risk factors remain.

Women who smoke may have menopause two to three years

earlier. Drug addiction may cause premature menopause. Alcohol

abuse and high caffeine consumption may cause menopause to set

in earlier by two to three years.

Maintaining good health through adequate nutrition and a sensible

lifestyle and dietary changes may help to protect you from major

diseases like cancer.

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15. Life after Menopause

When there has been complete cessation of menstrual periods for

over twelve months, you enter the post-menopause period.

Women undergoing surgical removal of ovaries, chemotherapy

treatments, or hormone replacement therapy enter menopause

much early in life. Although they stop having periods during such

treatments, some start their menstrual periods once again after

completion of therapy. Hence, they may experience menopausal

symptoms during the intervening period and also later in life.

The post-menopause period is not the same for all women.

Menopausal symptoms like hot flashes and night sweats could also

occur in your sixties and seventies.

Life after Menopause

Post menopause is a new life and often, there is more publicity

about the supposed negatives of this period than its positives.

This period has these positives for most women:

9 allows you to be free of worries like unexpected


9 absence of hot flashes and night sweats,

9 better sexual life,

9 gives you a sense of a special type of freedom.

This second beginning offers many women the chance to perhaps

take up a different vocation that may relate to your hobby or other


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Often, you can spend more time on yourself, as your children are

grown-up and independent.

You can revive your personal passions and undertake new journeys

to rediscover yourself.

Menopause is a transition period.

The fall in estrogen levels during this period is the main cause for

most menopausal symptoms. After that, it takes some time for your

body to accept and adjust to the low hormonal levels.

Once you are able to attain this equilibrium, you can be more at

peace and ease with your body. You may no longer suffer from

depression or other psychological ailments.

Sex life in the post menopause period is more carefree and

interesting. Although vaginal dryness could pose some problems,

medications like creams help you over these problems. You may no

longer have to take contraceptives or use other birth control


The risks of osteoporosis and heart disease increase during post

menopause due to low estrogen levels. However, seeking medical

help early and adhering to a few restrictions may help you to

overcome these.

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Part-IV: Menopause and Other Conditions

16. Complications of Menopause and Other Conditions

Menopause could signal the start of various chronic medical

conditions. You are better able to combat them if you are well-


You might start following preventive measures from an early age to

reduce the chance that you could experience severe menopausal

symptoms later in life.


Osteoporosis causes serious loss of bone density, making your

bones weak and brittle. Loss of bone density may increase faster

during and after menopause.

You have a higher risk of fractures, especially of the spine, wrist,

and hips.

In consultation with your doctor, include calcium-rich foods in your

diet and increase your intake of vitamin D. Have more milk, cheese,

yogurt and, maybe, calcium supplements.

Regular exercise, like jogging and walking, may help you to keep

your bones strong and healthy during and long after menopause.

Cardiovascular disease

Low estrogen levels may increase your risk of cardiovascular

diseases. You can lower your chances of developing heart ailments

by adhering to a simple diet rich in whole grains, vegetables and


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Abstain from diets rich in saturated fats, stop smoking, and keep

alcohol consumption, if any, low.

Take steps to control your blood pressure and protect you from

possible heart diseases.

Regular aerobic exercises are very useful.

Increase in body weight

Menopause may encourage women to develop greater fat deposits

around their hips and abdomen.

Although you cannot avoid it totally, you can restrict weight gain

considerably. You might want to start on a low-calorie diet and

make exercises a part of your daily routine.

This helps to keep your metabolism rate at a healthy level and

maintain a good and normal body weight.

Urinary incontinence

Estrogen is responsible for maintaining urinary tract functions.

Estrogen levels fall drastically during menopause and consequently,

your urinary system may suffer. Your bladder muscles and sphincter

have less flexibility.

Your vagina and urethra lose some of their elasticity.

Some women experience frequent urinations, urinary incontinence

and urine leakage when laughing, coughing or lifting weights.

Pelvic exercises may prove very helpful in combating these

incontinence problems. If you have been practicing these exercises

since your youth, you could largely escape suffering these problems

during menopause.

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17. Menopause and Your Emotions

Menopause bring along many emotional problems. These are due

to hormonal changes which are taking place in your body.

Menopause does not cause a complete cessation of hormone

production. Your ovaries continue to produce estrogen and

progesterone. However, the amount produced is lower and the

levels may vary.

These variations in the amount produced can cause you to

experience serious emotional changes. Sometimes you feel sad,

unhappy, and low while you are happy and contented at other

times. Women often experience irritability, anxiety, concentration

problems, tension, mood changes, poor motivation, sadness,

aggressiveness, and overall fatigue during menopause.

Combating the emotional swings during menopause is essential to

maintain your equilibrium.

You can get the help of trained psychological professionals.

But, remember that some simple things can help to de-stress your

life, such as:

9 You can talk out your emotions with your family

members and friends.

9 Talking about pleasant things in life can help change

your mood and raise your emotions to better levels.

9 Physical and mental relaxation is very important to

overcome any emotional upsets during menopause.

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9 Regular exercise can help you feel satisfied and happy.

Taking part in physical activities like swimming,

jogging, and walking can make your body strong and

fit. This makes you feel better and you probably will

have a better emotional outlook in general.

9 Yoga and meditation can bring extensive mental


9 Join support groups with members from the same

background or who are experiencing similar emotional

problems. Talking with each other about your

emotional problems will help all members that

constructively participate.

9 If the group members are not supportive, then either

they or you should seek a different group.

Other simple tactics to overcome emotional problems include;

9 avoiding alcohol intake and sedatives.

9 Eating a healthy diet helps you stay fit and mentally


9 Engage in varied social and group activities,

9 go out with your friends, and

9 engage your mind in healthy activities.

9 This gives you less time to brood or go into emotional


9 Friends help you laugh which boosts your spirits and

improves your mood easily.

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18. Menopause and Depression

Depression is a common problem associated with menopause.

Emotional upheavals are common during menopause due to low

estrogen levels.

Also, physical symptoms like lack of adequate sleep, hot flushes,

and night sweats tend to make you irritable. The combination of

physical and psychological symptoms can induce depression during


Depression during menopause can take many different forms:

Lack of appetite causing you to be overindulgent at

times and make you only nibble at other times.

Changes in your sleep patterns. You sometimes lay

awake the whole night and you oversleep at other


Hard to retain interest in hobbies or other activities you

really liked before.

Low sex drive.

Concentration and memory problems.

Some people even develop suicidal tendencies.

Although there are various depression symptoms that may occur

during menopause, few women experience all the symptoms. It

seems to be related to the estrogen levels in your body.

Combating depression during menopause is important. You can get

the help of trained professionals to overcome your depression.

There is nothing to be gained by keeping the information to

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yourself. Feel free to discuss all your problems with your medical

practitioner and follow their directions. You could experience

extensive relief.

Depression can cause problems in doing your normal routine.

Talk to your family members and friends to support you and help

you overcome any days when you have especially deep depression.

Exercise can make you feel better, as physical exercise causes your

brain to release special feel-good hormones that will help you to

overcome your low feelings.

Maintain a regular exercise schedule. Spend time in doing yoga,

meditation, deep breathing or other mental relaxation exercises.

Maintain a regular sleep pattern by going to bed and waking up at

the same time each day. Get adequate rest.

Relax by reading a book, listening to soothing music or having a

warm bath.

Eat a healthy and well-balanced diet.

Reduce or eliminate your alcohol consumption and smoking.

Go for friendly outings and spend time indulging yourself - keep

yourself happy.

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19. Menopause and Bladder Function

Menopause causes low estrogen levels in your body. Estrogen

affects many important body functions. Low estrogen levels may

adversely affect your bladder function and urinary system.

Menopause might increase your chances of contracting urinary tract

infections which could make your bladder weaker.

Estrogen helps control your urinary system by keeping bladder

muscles toned and strong. The sphincter at the bottom of the

bladder also remains taut.

The bladder muscles and sphincter jointly control urine leakage. Low

estrogen levels can cause these muscles and sphincter to function

poorly and this results in some degree of incontinence with some


Although your incontinence problem may not be apparent, urine

leakage could occur if you sneeze hard or laugh loudly.

Hormone replacement therapy might also aggravate the situation.

You can try some measures to try to overcome or manage the


Simple surgery can help improve sphincter taught and control


Another option is to have collagen injections. This can tone up

bladder muscles and sphincter.

Pelvic floor exercises can provide relief. If you do regular pelvic

exercises from your youth, incontinence in menopause is likely to be

less of a problem.

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