Let’s talk about it: Embracing the Big "M" - Menopause

Firstly, menopause is not a disease; it is simply a natural transition from one phase to another. Just as puberty marks the beginning of your reproductive self, menopause can be seen as the end of that reproductive journey. 

Do men go through menopause?

While women experience menopause, men experience a gradual decline in testosterone from the age of 30 - 40, which is sometimes referred to as andropause. 

“Unlike menopause in women, which marks the definitive end of reproductive abilities, andropause does not result in a complete cessation of reproduction in men,” Dr Mpumie Zenda aka Dr Gyae, an Obstetrician - Gynaecologist and Sexologist, explains. “This is due to the continuous production of new sperm every 60 days, allowing for the possibility of reproduction well into their 60s, especially when coupled with a healthy lifestyle.” 

Men experiencing andropause may encounter various symptoms such as a decreased sex drive, erectile dysfunction, mood swings, irritability, increased fat accumulation in the abdomen and breast area (gynecomastia), as well as a loss of energy and enthusiasm. These symptoms may be attributed to late-onset testosterone deficiency (late-onset hypogonadism), as well as lifestyle and psychological factors. A comprehensive assessment, including hormonal blood tests, is necessary for diagnosis, and hormone replacement therapy (specifically testosterone) is available for cases where a deficiency is identified.

What is the difference between menopause and perimenopause?

Menopause is the permanent cessation of menstrual periods, confirmed 12 months after the final menstrual period. Perimenopause refers to the transition period leading up to menopause, during which the body undergoes changes, and marks the end of the reproductive years. 

“It is a process rather than a single event and varies from woman to woman,” says Dr Zenda. “Oestrogen levels gradually decline from the mid-thirties, and menstrual changes typically begin in the early forties. The duration of perimenopause can vary, with cycles initially being mostly regular and later becoming more interrupted, leading to longer periods of missed periods until the final menstrual period (FMP) is reached. Post-menopause follows when no menstrual periods have occurred for 12 consecutive months.”

Menopause typically occurs between the ages of 48 and 52, with an average age of 51. The exact timing can vary among women and may be influenced by familial factors. Menopause is officially diagnosed 12 months after the final menstrual period.

Menopause occurs because women are born with a finite number of eggs stored in the ovaries. The ovaries produce hormones, such as oestrogen and progesterone, which regulate the menstrual cycle and ovulation. When the ovaries no longer release eggs and oestrogen levels decline, menstrual periods cease.

What are the symptoms of menopause?

Menopausal symptoms can vary among women, and the approach to treatment should be tailored to each individual's needs and preferences. Symptoms typically begin around 2 years before the final menstrual period, peak in the year following it, and then some will gradually subside.

Symptoms may include:

- Vasomotor symptoms: Hot flushes or flashes.

- Sleep disturbances: Insomnia and sleep apnoea are common, but experiencing interruptions in sleep patterns can also occur.

- Psychological symptoms: Some women may experience depressive symptoms, anxiety, mood swings, and temporary cognitive changes commonly referred to as "brain fog."

- Genitourinary syndrome (GSM) symptoms: Vaginal thinning, dryness, inflammation, and pain and discomfort during sexual intercourse. Pelvic organ prolapse with urinary retention and/or urinary incontinence may also occur. “GSM can contribute to more frequent vaginal and urinary tract infections due to an increase in vaginal pH and changes in the vaginal microflora. The underlying connective tissue also thins and is more susceptible to inflammation or infection,” says Dr Zenda.

- Sexual function effects: Approximately 15 percent of women aged 45 to 64 years’ experience some form of sexual distress. During the menopausal transition and postmenopausal, there are significant decreases in sexual interest (low libido), frequency, and arousal along with increased pain during sex (dyspareunia). 

During menopause, the decline in oestrogen levels increases the risk of certain health conditions, including:

- Osteoporosis: Weaker and brittle bones due to decreased bone density.

- Cardiovascular disease: Higher risk of heart attacks and strokes.

- Dementia and Alzheimer's: Possible increased risk of cognitive decline.

- Type 2 diabetes: Increased likelihood of developing diabetes.

- Metabolic syndrome: Higher chances of developing conditions like high blood pressure and abnormal cholesterol levels.

How are menopause symptoms treated?

“Treatment for menopause symptoms includes hormone replacement therapy (HRT), which is recommended for symptomatic women who meet certain criteria,” Dr Zenda says. “HRT involves taking oestrogen and, if necessary, progestin to prevent endometrial cancer. Other non-hormonal prescription therapies and complementary and alternative therapies, such as certain medications and natural products, can also be considered.”

In addition to medical treatments, maintaining a healthy lifestyle is important during menopause. This includes following a balanced diet, getting regular exercise, and attending routine health check-ups to detect any potential problems early.

“Managing hot flashes during menopause can involve various approaches. Making lifestyle changes can be helpful, such as dressing in layers, carrying a fan, and consuming cool liquids. Avoid triggers like alcohol, caffeine, and smoking. Losing weight, if needed, may provide additional relief,” Dr Zenda recommends.

Meditation and relaxation techniques can assist some women in coping with hot flashes. Hormone therapy, specifically taking oestrogen, has been proven to be the most effective treatment for alleviating hot flashes and night sweats. Certain medications may also be prescribed to help manage these symptoms. It's important to consult with your gynaecologist to determine the most suitable options for your specific needs.

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