It is the time when a women’s period stops. Women allover the world interpret menopause differently, their fears and concerns about menopause vary by culture. Some women fear a loss of their spouses’ sexual interest when they can no longer have children or due to increased complaints from sexual act due to vaginal soreness and dryness others worry about their mental health and fear losing control of their emotions. Too many women have been victims of cultures and societies that have not taken their symptoms seriously. Medicine has found solutions to help women passing though this interval.

Menopause happens between 45 – 55 years old. It is due to depletion of her eggs. During her reproductive life, the eggs are responsible for releasing Estrogen and other hormones which have many good effects on her body. The decreased hormones level and especially estrogen leads to  Vaginal dryness and thinning of the vaginal lining which can reduce arousal during sex and increase friction which in turn may produce burning or irritation , The woman becomes more vulnerable to urinary infections , Breasts may lose some of their bulk , Skin may become a little less elastic , Hot flushes, Psychological symptoms such as mood swings and insomnia, Sweating attacks ,Heart diseases are increased due to increased LDL (Bad cholesterol) , A decrease in testosterone levels thus decreasing sex libido , loosing bone density rapidly, increasing your risk of osteoporosis and fractures , frequent and sudden urge to urinate followed by an involuntary loss of urine or the loss of urine with coughing, laughing or lifting.

However, a lot of women move through menopause with little or no symptoms.

Menopause Checkup

Menopause is confirmed by elevated FSH levels and declining estrogen levels. Regular annual checkup at the doctor is done by:

  • Bone densometry using DEXA machines or sometimes using ultrasound measuring of the bones of the heel as a screening method.
  • Breast mammogram is an x-ray test that produces an image of the inner breast tissue on film. It shows normal and abnormal structures in the breasts.
  • Breast self-examination on a monthly basis and regular examination by a doctor.
  • Blood cholesterol and lipid profile for fear of heart diseases.
  • Heart checkup and blood pressure.
  • Pap smear is a medical procedure in which a sample of cells from a woman’s cervix is collected and examined under a microscope to look for pre-malignant (before-cancer) or malignant (cancer) changes.

Possible treatments for menopause

  • Hormone replacement therapy consists of estrogens or a combination of estrogens and progesterone. It is used to control the symptoms of menopause but unfortunately it has side effects so the decision about hormone therapy is very individual in which the patient and doctor must take into account the inherent risks and benefits of the treatment. It is currently recommended that if hormone therapy is used, it should be used at the smallest effective dose for the shortest possible time.
  • Alternatives to Hormone Replacement
    • For hot flashes: Several drugs offer limited relief: synthetic progesterone and androgen, methyldopa.
    • For painful intercourse due to vaginal dryness: Applying a vaginal cream or vaginal tablets with estrogen once or twice a week can be of help.
    • Bone loss: Bisphosphonates, Raloxifene, Calcitonin, Vitamin D, estrogen, calcium.
    • Psychological Depression: Counseling and low dose anti depressants.
  • Lifestyle and home remedies Fortunately, many of the signs and symptoms associated with menopause are temporary. Take these steps to help reduce or prevent their effects:
    • Heart diseases: Stop smoking, regular aerobic exercise, and eat a diet low in saturated fats and plenty whole grains, fruits and vegetables.
    • Hot flashes: regular exercise, dress in layers and try to pinpoint what triggers your hot flashes. For many women, triggers may include hot beverages, spicy foods, alcohol, hot weather and even a warm room. Other options of treatment include aromatherapy, homeopathy, acupuncture, herbal medicines and massage.
    • Decrease vaginal discomforts: Use vaginal lubricants or moisturizers. Staying sexually active also helps. Other options include the consumption of phytoestrogens, found in soy-based foods.
    • Optimize your sleep. Avoid caffeine and plan to exercise during the day, learn relaxation techniques.
    • Urinary tract infections: Drinking plenty of fluids and urinating as frequently and completely as possible.
    • Strengthen your pelvic floor muscles by Kegel exercises.
    • Eat well:  Eat a well balanced diet and increase your calcium and vitamin D intake.
    • Don’t smoke.
    • Exercise regularly.
    • Schedule regular checkups with your doctor.

Pros of Menopause

  • You no longer have to deal with monthly menstrual cycles, which are often accompanied with cramping and bloating.
  • You can have sex safely because you no longer worry about getting pregnant.
  • Relationships get stronger because women communicate more with their partner.
  • Reaching menopause is a sign that you are physically and emotionally mature enough to handle all the tuff stuff that life has to dish out with grace and elegance.

Urinary Incontinence

Urinary incontinence is the unintentional loss of urine. It can be Stress incontinence when the bladder can’t handle the increased compression during exercise, coughing. It can also be Urge incontinence if caused by a sudden, involuntary bladder contraction. Overflow incontinence in which the bladder becomes too full because it can’t be fully emptied, is a rarer type of the disorder.

What are causes of UI?

Women are most likely to develop incontinence either during pregnancy and childbirth, or after the hormonal changes of menopause, because of weakened pelvic muscles. Pelvic trauma, spinal cord damage, caffeine, or medications, including cold preparations and diet drugs that are available over-the-counter, can also cause episodes of UI. Diseases which affect the nerves that control the bladder, such as multiple sclerosis, can be associated with UI.

Other factors that contribute to bladder incontinence include decreased mobility or impaired thinking (such as forgetfulness, confusion, or senility), particularly in combination with drugs such as sedatives, sleeping pills, and alcohol.

What treatments are recommended for UI?

Treatment for UI depends on the type of incontinence, its causes, and the capabilities of the patient. Here are commonly recommended treatments:

  • Pelvic muscle rehabilitation – to improve pelvic muscle tone and prevent leakage by :
    • Regular pelvic Kegel exercises.
    • Biofeedback in conjugation with Kegel exercises help people in awareness and control of their pelvic muscles.
  • Pelvic floor electrical stimulation. Mild electrical pulses stimulate muscle contractions. Should be done in conjunction with Kegel exercises.
  • Behavioral therapies – to help people regain control of their bladder.
    • Bladder training teaches people to resist the urge to void
    • Toileting assistance uses routine or scheduled toileting, habit training schedules, and prompted voiding to empty the bladder regularly to prevent leaking.
  • Pharmacologic therapies – to improve incontinence medically.
  • Surgical therapies – to treat specific anatomical problems.
    • Sling procedures, bulking injections (such as collagen) and other surgical procedures support or move the bladder to improve continence.
Urinary Incontience
Urinary Incontience

Genital prolapse

Pelvic organ prolapse is the descend into or outside of the vaginal canal or anus of any of the pelvic floor organs. You may hear them referred to in these ways:

  • Cystocele: A prolapse of the bladder into the vagina, is the most common condition
  • Urethrocele: A prolapse of the urethra (urine-carrying tube)
  • Uterine prolapse
  • Vaginal vault prolapse: prolapse of the vagina
  • Enterocele: Small bowel prolapse
  • Rectocele: Rectum prolapse

What Causes genital prolapse?

Anything that increases pressure in the abdomen can lead to prolapse. Common causes include: Pregnancy, labor, Obesity, chronic cough and constipation.

What are the symptoms?

Some women notice nothing at all, but others report these symptoms:

  • A feeling of pressure or fullness in the pelvic area
  • A backache low in the back if it is the uterus
  • Painful intercourse due to drop of rectum or uterus
  • A feeling that something is falling out of the vagina if it the uterus
  • Urinary problems such as leaking of urine if it is the bladder
  • Constipation if it is the rectum.

How can genital prolapse be prevented?

  • Do Kegel exercises daily to maintain good muscle strength in your pelvic area
  • Maintain a healthy weight
  • Avoid constipation
  • Do not smoke

How is genital prolapse treated?

Treatment depends on how severe the symptoms are. Treatment can include:

  • Behavioral treatments, such as doing Kegel exercises designed to strengthen the pelvic floor muscles.
  • Mechanical treatments, such as inserting a small plastic pessary into the vagina to provide support for the drooping organs.
  • Surgical treatment, either to repair the affected tissue or organ or to remove the organ (such as removal of the uterus by hysterectomy).
Genital Prolapse
Genital Prolapse

Pelvic Pain

Pelvic pain is a common complaint among women. It is categorized as either acute (sudden and severe), or chronic (lasting over a period of months or longer). Pelvic pain may originate in genital or extra genital organs in and around the pelvis, or it may be psychological (pain sensation and no physical problem is present).

What causes pelvic pain?

Pelvic pain may have multiple causes, including:

  • inflammation or direct irritation of nerves caused by acute or chronic trauma, fibrosis, pressure, or intraperitoneal inflammation
  • muscular contractions or cramps of both smooth and skeletal muscles
  • psychogenic factors, which can cause or aggravate pain
  • causes of acute pelvic pain may include: Ectopic pregnancy, pelvic inflammatory disease, twisted or ruptured ovarian cyst, miscarriage or threatened miscarriage, urinary tract infection, appendicitis, ruptured fallopian tube
  • causes of chronic pelvic pain may include: Menstrual cramps, endometriosis, uterine fibroids, adhesions or scar tissue between the internal organs in the pelvic cavity, endometrial polyps and cancers of the reproductive tract

How is pelvic pain diagnosed?

Diagnosis includes a good medical history (which includes the character of the pain) and physical exam. In addition some diagnostic procedures may include the following:  Blood tests, pregnancy test, urinalysis, culture of cells from the cervix. Non invasive imaging techniques like an ultrasound, MRI. Laparoscopy to see the whole pelvic area. X-ray to produce images of bones and internal organs.

How to treat pelvic pain?

Specific treatment will be determined based on your age, overall health, and medical history, cause of the disease, type and severity of the symptoms and your tolerance for specific medications. Generally treatment usually includes antibiotics, anti inflammatory and pain medication. In cases of severe infection, hospitalization may be required to administer intravenous antibiotics. Occasionally, surgery is necessary. If a physical cause cannot be found, psychotherapy is recommended. Relaxation exercises or physical therapy is always recommended.

Pelvic Pain
Pelvic Pain

Abnormal vaginal bleeding

Abnormal vaginal bleeding is a flow of blood from the vagina that occurs either at the wrong time or in inappropriate amounts. Normal ovulation is necessary for regular menstrual periods.

What conditions cause abnormal vaginal bleeding in women who are ovulating regularly?

  • Excessively heavy menstrual period
    • Non-cancerous causes: uterine fibroids or polyps, intrauterine devices, blood clotting disorders and certain medications, especially those that interfere with blood clotting.
    • Cancerous Causes: It can be a sign of endometrial cancer or the precancerous endometrial hyperplasia (thickened endometrial lining), it is more common above the age of 40.
  • Menstrual periods that is too frequent
    • Pelvic inflammatory disease or Endometriosis. Sometimes, the cause is unclear and the woman is said to have dysfunctional uterine bleeding.
  • Menstrual periods at irregular intervals
    • benign growths in the cervix, such as cervical polyps, infections of the uterus and use of birth control pills. Perimenopause (the time period approaching the menopausal transition) is often characterized by irregular menstrual cycles
  • Spotting between menstrual periods
    • Women who are ovulating normally can experience spotting between menstrual periods. Hormonal birth control methods as well as IUD may sometimes lead to spotting between periods.
    • Psychological stress, certain medications such as anticoagulant drugs, and fluctuations in hormone levels may all be causes of light bleeding between periods.

What conditions cause abnormal vaginal bleeding in women who are NOT ovulating?

Anything interfering with normal ovulation can cause abnormal vaginal bleeding, examples are chronic medical illness or severe medical or emotional stress, malfunction of a part of the brain-hypothalamus, Anorexia nervosa(an eating disorder associated with excessive thinness) or Polycystic ovarian syndrome(hormonal problem) may cause anovulation and irregular periods.

What conditions cause abnormal vaginal bleeding after menopause?

Any vaginal bleeding is considered abnormal and doctor’s consultation should be immediate to rule out the serious causes like endometrial cancer or the precancerous endometrial hyperplasia (thickening of the uterine lining).

What causes vaginal bleeding during or after sexual intercourse?

Injuries to the vaginal wall or vaginal opening during intercourse.  Infections or Lowered estrogen levels in peri-menopausal or postmenopausal women may cause the lining of the vagina to become thinned and easily inflamed or infected. Anatomical lesions, such as tumors or polyps on the cervix or vaginal wall may lead to vaginal bleeding during or after intercourse.

What diagnostic tests are used to evaluate abnormal vaginal bleeding?

Diagnosis includes a medical history and physical exam. During the pelvic examination, the physician attempts to detect cervical polyps or any unusual masses in the uterus or ovaries.  In addition some diagnostic procedures may include the following:  Tests should be performed to know the hormonal status of the woman, pregnancy test as routine if the woman is pre menopausal. Pap test to rule out cervical cancer, culture of cervical and vaginal discharges to rule out infections. Blood tests to evaluate thyroid function, liver function, or kidney function abnormalities. A pelvic ultrasound is also performed. An endometrial biopsy is also beneficial.

How is abnormal vaginal bleeding treated?

Treatment for irregular vaginal bleeding depends on the underlying cause.

  • If the cause of the bleeding is lack of ovulation, doctors may prescribe either progesterone to be taken at regular intervals, or an oral contraceptive, which contains progesterone, to achieve a proper hormonal balance
  • If the cause of irregular vaginal bleeding is a precancerous change in the lining of the uterus, progesterone medications may be prescribed to reduce the buildup of precancerous uterine lining tissues in an attempt to avoid surgery.
  • When a woman has been without menses for less than six months and is bleeding irregularly, the cause may be menopausal transition. During this transition, a woman is sometimes offered an oral contraceptive to establish a more regular bleeding pattern, to provide contraception until she completes menopause, and to relieve hot flashes.
  • Benign growths are removed surgically to control bleeding.
  • If the cause of bleeding is infection, antibiotics are necessary.
  • If bleeding is excessive and cannot be controlled by medication, a surgical procedure called dilation and curettage (D&C) may be necessary.
  • Occasionally, a hysterectomy is necessary when hormonal medications cannot control excessive bleeding. However, unless the cause is pre-cancerous or cancerous, this surgery should only be an option after other solutions have been tried.