Menopause.
When women are asked what they know about menopause, hot flashes are often the first, and sometimes the only, symptoms that come to their mind. But hot flashes are not the only symptom of menopause and the menopausal transition may begin in various, and far less obvious, ways.
As the menopausal transition begins, ovarian function becomes increasingly variable, leading to lower levels of progesterone and fluctuations in oestrogen. These hormonal changes can affect multiple systems in the body-from head to toe, causing varied symptoms affecting multiple bodily systems.
The effect of the hormonal changes in the brain can lead to mood swings-anger, irritability, feelings of sadness, being overwhelmed, or anxious. The brain effects also lead to âbrain fog', which includes difficulty finding words, remembering details or staying focused. The hot flashes and night sweats are an effect of the hormonal changes on the temperature regulation centre in the brain. As the night sweats tend to disturb an already fragile sleep, the poor sleep, in turn, can affect mood, energy levels and concentration.
The hair and skin show effects like dryness, skin pigmentation, or hair loss. The effect on the bones, muscles and joints, collectively called the musculoskeletal syndrome of menopause, come with joint aches and pains, muscle pains and delayed recovery from exercise. For some, perimenopause also comes along with changes in their menstrual cycle with periods becoming heavier, lighter, more frequent or less predictable.
The changes in the vaginal and urinary tissues, together called the genitourinary syndrome of menopause, comes with changes in sexual desire, vaginal dryness and urinary symptoms like urgency, leakage and recurrent urinary tract infections.
And just as the woman is grappling with these symptoms, her metabolism is changing with decreased bone density and muscle mass, increased insulin resistance, increased LDL cholesterol even though her diet and activity remain the same, leading to changes in body composition, including increasing abdominal fat.
Very often, connecting the dots and recognising a possible common hormonal connection between these varied symptoms becomes difficult. Many women attribute these changes to work pressure, family responsibilities or simply getting older.
While it is equally important to not to blame every new symptom on hormones, with thyroid disorders, anaemia, sleep disorders, nutritional deficiencies and other medical conditions which can also cause similar symptoms, a thorough medical assessment with an eye open for menopause can help distinguish between these possibilities. The diagnosis also becomes challenging because perimenopause does not have a single hormone test for diagnosis due to the fluctuations in hormone levels. The diagnosis is primarily clinical, based on age and symptoms.
Perimenopause is not an illness, but neither should its symptoms be dismissed. Simply because the older generations "managed" this issue, the same should not be expected of women who are now learning to take care of themselves. Recognising the many faces of this transition is the first step towards seeking timely care while improving the woman's health and quality of life.
So remember ladies. You do NOT have to suffer. Understanding what is happening to your body can be the beginning of feeling like yourself again.
