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Dec 18

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Toyin Wura Oke

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When it is Time for Hot Flashes - Dr. Shabihul Hassan

Menopause is the end of a woman's menstrual cycle and fertility and is a normal condition that all women experience as they age. It occurs when the ovaries no longer produce estrogen and progesterone, two necessary hormones for a woman's reproductive cycle to function.         Though it naturally occurs with age, menopause may also come on suddenly as a result of a surgical procedure, treatment of a disease, or illness. In these cases it is referred to as induced menopause.                                                                                  

 Photo: shmg

Photo: shmg

The human menstrual cycle, the time from the onset of one menstrual flow to the beginning of the next, is a fascinating cascade of hormonal events. It involves a complex and regular change in female anatomy and physiology over an approximate monthly time period. This cycle commences at puberty (menarche) and ceases at menopause. Within every woman this amazing cycle of life is programmed from the very moment of her conception.                                                                                                                      The programming begins when a baby girl is only one month old in her mother’s womb. At that time, the eggs in her ovaries, which were at their most primitive stage (then called germ cells), begin to multiply, numbering about 7 million by about the 7th month of pregnancy. However, from then on, as they mature to the next stage, they begin to die and only 2-4 million primary oocytes (an immature egg) remain at birth. These oocytes mature to primordial follicles, and by the time a girl has her first period she has 100,000 to 400,000 follicles (each ovarian follicle is a hollow ball of cells with an immature egg in the center). Each follicle ultimately matures into an ovum (egg), which is released at ovulation, joins with a sperm and begins a new life at fertilization. This new human being is then nurtured in the womb. Each menstrual cycle is a race because at its beginning, several follicles begin to mature but usually only one makes it to ovulation.                                                                    

The ovaries are glands which are part of the female reproductive system. The ovaries are about the size and shape of an almond and sit just above the fallopian tubes -- one ovary on each side of the uterus. Every month during ovulation, either the right or left ovary produces a single mature egg for fertilization.                                                

On the first day of menstrual flow, the brain receives the signal to begin another cycle. It sends its own signal to the ovary and the follicles in that race begin to produce estrogen. This hormone goes to the lining of the womb, which begins to lay the building blocks to house the expected new guest. The battle belongs to the strong and thus one follicle produces much more estrogen than the rest, leading to the death of the others. This dominant follicle when close to ovulation begins to produce another hormone – progesterone. Progesterone goes to the womb and acts like the cement between the laid-down blocks, making it strong. When the follicle reaches full maturation its ovum is released during ovulation.                                                              

This egg travels down the fallopian tube, hoping to be fertilized. Meanwhile the remnant of the follicle becomes filled with fat and is called a corpus luteum, which continues to make progesterone to maintain the lining of the womb. If fertilization does not occur, then both the corpus luteum and egg disintegrate. Things having fallen apart, the center cannot hold and the lining of the womb breaks down and flows out through the opening of the womb (cervix) and vagina as blood.               

The blossoming or maturity of female characteristics and attributes usually lasts around thirty years, after which menopause or the cessation of menstruation occurs. The anterior hypothalamic nucleus in a cyclic fashion induces the pituitary gland to secrete the hormones FSH (follicle stimulating hormone) and LH (leutenizing hormone) which act on the ovaries and cause the secretion of estrogen and progesterone.

These in turn, induce changes in the uterus, causing menstruation, as well as affecting the other genital organs and the breasts. These changes regulate the aspect, and function of a woman’s hormonal cycle. As the estrogen production in the ovary progressively disappears, the menstrual function also disappears, thus providing an important definitive sign of menopause.                                        The lack of estrogen may lead to an involution of the female genital tract : the regression of the vagina and vulva formations, as well as its dryness and fragility, may make intercourse painful and even impossible. In order to avoid this problem and to preserve their youth, some women resort to estrogens. This is an arguable practice, it may even be dangerous and, it is only advisable under strict medical supervision.                                                                                                 The menopause occurs earlier in single woman than in widows, and earlier in widows than in women who have a normal, regular sex life. The immediate and total stopping of menstruation is only observed in less than one quarter of women which sometimes leads them to think they might be pregnant.

In general the menopause appears as abnormal menstrual cycles, either in their frequency or in their amount: if they are heavy and irregular, this may cause some alarm and it is advisable to see the doctor in order to rule out other pathological causes                                                             

When menopause occurs naturally, it tends to take place anywhere between the ages of 40 and 58, with an average age of 51. But for some women it can occur as early as the late 30s, or as late as their 60s. When menopause occurs before 35, it is considered premature menopause, but just as menarche is genetically predetermined, so is menopause.                                                   

For many women who enter menopause, their menstrual cycle becomes irregular and then stops and they don't have any other symptoms. But, for others, the decreasing levels of estrogen associated with menopause may cause more distressing symptoms including mood swings, decreased sex drive, hot flashes ,sweating ,racing heart (palpitations) ,headaches ,vaginal dryness and soreness, trouble with sleeping, and bone thinning (osteoporosis) .    

These symptoms can last from a few months to up to 10 years.        Menopause is a gradual process. The events preceding and following menopause amount to a huge change for women both physically and socially. Physically, this process has four stages: The premenopause in which their periods have just started to get irregular, but they do not yet experience any classic menopausal symptoms such as hot flashes or vaginal dryness. A woman in premenopause is usually in her mid-to-late 40s. If your doctor tells you that you're premenopausal, you might want to ask him or her how he or she is using this term.                         

The perimenopause refers to women who are in the thick of menopause. Their cycles may be erratic, and they may begin to experience hot flashes and vaginal dryness. On average, women are about 47 when they hit the perimenopause stage.

The menopause technically refers to the final menstrual period. You will not be able to pinpoint your final period until you've been completely free from periods for one year. Then, you count back to the last period you charted, and that date is the date of your menopause. After more than one year of no menstrual periods due to menopause, any vaginal bleeding is considered abnormal.                                                                                                    This term Postmenopausal refers to the last third of most women's lives, ranging from women who have been free of menstrual periods for at least one year to women celebrating their 100th birthday and beyond. In other words, once you're past menopause, you'll be referred to as postmenopausal for the rest of your life.                                                    

 Photo: Prima

Photo: Prima

Hot flashes are the most frequent symptoms of menopause and perimenopause.  A hot flash is a momentary sensation of heat that may be accompanied by a red, flushed face and sweating. The cause of hot flashes is not known, but may be related to changes in circulation. 

Hot flashes occur when the blood vessels near the skin's surface dilate to cool. This produces the red, flushed look to the face. A woman may also perspire to cool down the body. In addition, some women experience a rapid heart rate or chills.                                         

Hot flashes accompanied with sweating can also occur at night. These are called night sweats and may interfere with sleep. The severity and duration of hot flashes varies among women going through menopause. Some women have hot flashes for a very short time during menopause. Other women may have hot flashes over many years.

Generally, hot flashes become less severe as time passes.                       While it may be impossible to completely avoid hot flashes during menopause, there are certain triggers that may bring them on more frequently or cause them to be more severe. To prevent hot flashes, avoid these triggers: stress, caffeine, alcohol, spicy foods, tight clothing, heat and cigarette smoke.                                                                                                         Other things you can do to keep hot flashes at bay include: Staying cool (Keep your bedroom cool at night. Use fans during the day. Wear light layers of clothes with natural fibers such as cotton), trying deep, slow abdominal breathing (six to eight breaths per minute). Practice deep breathing for 15 minutes in the morning, 15 minutes in the evening and at the onset of hot flashes. Walking, swimming, and bicycling are all helpful.                                                                

Talk to your doctor about taking short-term hormone replacement therapy, or HRT if your symptoms are very severe. This treatment prevents hot flashes in many women. In addition, it can help other symptoms of menopause, including vaginal dryness and mood disorders. However, even short-term hormone therapy carries some risks, including blood clots and gallbladder inflammation. If HRT is not right for you, there are other treatments that may offer relief. These include both over-the-counter and prescription therapies. It is important to clear any new drugs (including over-the-counter) or supplements with your doctor before taking them.                                                                                                                                         The treatment of Menopause includes a proper understanding of what is going on in your body and medications to control the symptoms if required. Regular consultation with your family doctor is very helpful because all symptoms can be easily managed, with and sometimes without medications.                                                                              

The intense feeling of heat often accompanied with a rise in body temperature is often mistaken for a febrile illness, and it is not uncommon for women to continue visiting hospitals frequently and assuming that they have malaria, typhoid or some other illness. It is also not uncommon for many unnecessary laboratory tests to be conducted.                                                      

It is extremely important for family doctors to counsel their patients about the menopause, especially between the age of 45 and 55.                                                                                                 Many women arrive at their menopause years without knowing anything about what they might expect, or when or how the process might happen, and how long it might take. Very often a woman has not been informed in any way about this stage of life. It may often be the case that she has received no information from her physician, or from her older female family members, or from her social group. In many societies there appears to be a lingering taboo which hangs over this subject. As a result, a woman who happens to undergo a strong perimenopause with a large number of different effects may become confused and anxious, fearing that something abnormal is happening to her. There is a strong need for more information and more education on this subject.                                                                                       It is extremely important that husbands, children and other family members remain conscious of the fact that every women will go through this phase of life and that there may be mood swings, irritability, sudden hot flashes, intense sweating, insomnia, bouts of severe anxiety and depression. Their support at this stage in her life is the best part of her treatment.                    

Within biomedicine, the dominant understanding of menopause may be that of a hormone deficiency, but women going through menopause do not necessarily have to see it that way. They should see it as yet another life event like puberty, adolescence and pregnancy. It is yet another phase of their lives that they should know they will emerge through — with a bit of wear and tear, but with a sense of renewal, a sense of looking forward to the rest of their lives without the immense responsibilities of child bearing and rearing.

 

 

 

 

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