In Sri Lanka, a woman is believed to reach menopause when her periods cease for more than six months and she is over 40 years of age. Many women are happy when their periods cease. However there are many changes in their body due to the hormonal changes which occur with the change in the [...]

The Sunday Times Sri Lanka

Menopause – Is it a problem?

World Menopause Day was marked on October 18

In Sri Lanka, a woman is believed to reach menopause when her periods cease for more than six months and she is over 40 years of age.
Many women are happy when their periods cease. However there are many changes in their body due to the hormonal changes which occur with the change in the estrogen levels in their body. A reduction of estrogens occurs in the years before and during the onset of menopause. An awareness and knowledge of the changes which occur is helpful for women to understand how best they could overcome the symptoms associated with these changes and carry on a healthy and happy life.

Night sweats: A troublesome and uncomfortable symptom of menopause

The Menopause Society of Sri Lanka aims to spread this knowledge and awareness.
There are many terms associated with menopause:
Premature menopause – Cessation of periods under 35 years which is associated with specific problems: increased incidence of heart disease, osteoporosis, Alzheimer’s disease.
Climacteric: ongoing changes and symptoms from 40 years onwards up to menopause which may last for 15 to 20 years (40 to 60 years)
Late menopause – Menstruation persisting after 55 years of age. Common causes are obesity, and fibroids. This is associated with a slight increase in the risk of uterine and breast cancer.

Early symptoms are experienced when the periods become irregular and erratic. These include hot flushes, night sweats, anxiety, irritability, loss of interest in sex, itchiness of the skin, insomnia, mood changes, loss of memory, loss of confidence and self esteem, headache, dry vagina, genital itching and painful sex.
Intermediate symptoms: These mainly affect the bladder and genitalia and occur after the period stops i.e. late peri menopause. Symptoms during this period include vaginal dryness, pain on intercourse, genital itching, urgency, frequency and burning sensation on passing urine, loss of bladder control, generalized muscle aches and pains, thinning of skin and hair.
Late symptoms:-occur over the age of 60. These include high blood pressure and angina indicating arterial and heart disease and risk of stroke related to atherosclerosis and general aches and pains, backache, joint stiffness and swelling and bone fractures – all related to osteoporosis.
Common symptoms:

Hot flushes
These occur in 85% of women. The degree and frequency varies. During a hot flush, a woman can perspire profusely, her skin temperature will rise, her heart will beat faster and she may experience palpitations. Very occasionally she may faint. Hot flushes can be aggravated by hot weather.

Wear loose clothing and discover ways of cooling down, as well as keep the rooms well ventilated. Limit food and drinks which trigger hot flushes i.e, eat plenty of citrus foods (orange and lime) which contain bioflavonoids. Vitamin E taken with C & B are useful.
Medical therapy with hormone replacement therapy (HRT) is 98% helpful.

Night sweats (Hot flushes in the night)
You may wake up, feeling hot and drenched in perspiration. Keeping the bedroom fairly cool and wearing light night clothes and using light linen may help.
Relaxation is therapeutic as is meditation and yoga. HRT is beneficial.

Vaginal and urinary symptoms

Anatomically the vagina and lower urinary tract (bladder and urethra) lie very close, separated by just a few layers of cells. They both respond to lack of estrogen by becoming thin and dry.

Urinary symptoms typically include discomfort in passing urine, frequent and urgent urination with small amount of urine in the bladder.

Some dribbling due to the sphincter muscle at the bladder neck becoming weak due to lack of estrogen i.e. stress incontinence.

Genital dryness

Vaginal soreness during or after intercourse, because the vagina fails to lubricate, is also common among menopausal and post menopausal women.
Self help

Kegals exercise i.e. stopping the flow of urine midstream when emptying the bladder will help. Draw up the vaginal muscles, hold for a count of five and then relax. Repeat the process 5 times. The whole routine should be done at least 10 times a day.

Wear loose cotton underwear to prevent irritation of urogenital tract. Avoid using perfumed additives in your bath.

Medical treatment
Hormone replacement therapy is the final answer. In 25% of cases systemic HRT is not sufficient and vaginal creams / vaginal tablets are needed.
Muscle and joint symptoms

Collagen is the protein that provides the scaffolding for every tissue in the body. When collagen disintegrates at menopause, muscles lose their bulk, strength and coordination, and joints become stiff.

Muscles become more prone to soreness and stiffness after exercise, and joints may swell so that their mobility becomes restricted.

Carpel tunnel syndrome occurs due to fluid retention in the wrist pressing on the nerve to the hand and fingers.

Osteoporosis causes aches and pains all over the body especially upper back due to the thinning of the vertebral bones.
General fatigue may be common. Besides under-used muscles and joints, other causes of chronic fatigue includes low blood sugar, anaemia, and underactive thyroid.
Maintain muscle tone through aerobics, stretching, weight-bearing, and yoga. Complementary treatment may include HRT.
Skin, hair and nails

Estrogen deficiency causes disintegration of collagen and weakening of the protein elastin which gives connective tissue its strength and suppleness. Lack of collagen leads to a decrease in skin thickness and suppleness, dry hair, brittle nails, sore eyes, mouth dryness, gum shrinkage and increase in joint stiffness.

Reduction in the blood flow in the skin and subcutaneous tissues contributes to the loss of skin firmness, as does shrinkage of underlying muscles.

Deterioration of the nerve endings in ageing skin can lead to itchiness and a condition called formication. Formication is common in 20% of women within 12 to 34 months after menopause. It eventually disappears but the mechanism not known.

Moisturizing the skin is important. Avoid soaps that will strip the natural oils and use special cleansing oils and lotions. Guard your skin from the sun. A multivitamin/mineral complex is useful. The ultimate treatment is hormone replacement therapy.


  • Lack of sleep is common if you are depressed, anxious, or suffering from night sweats.
  • Women who have normal levels of estrogen, or who take HRT fall asleep faster than women who don’t.
  • Without estrogen, we can sleep for a whole night but still feel tired on waking.

A walk or exercise before bed may help
Breast symptoms –
Mastalgia (Breast pain and discomfort)

Breast pain (Mastalgia) is common in 70% of women at some stage in life over the age of 40 before menopause. Breasts become hard, tender and extremely painful, especially the nipple. The commonest reason is abnormal sensitivity of breast tissue to the fluctuation of the female hormone estrogen at the menopause.Women with pain tend to have lower levels of unsaturated fatty acid and high levels of saturated fatty acids in their blood.

Wearing a good supporting bra and cutting down on the fat consumed may help. If there is no improvement, medical help should be sought.
Weight gain i
This is common after menopause, Exercise is thus extremely important as is a healthy diet with plenty of fruits, vegetables and less starch and fats.

Measure the waist at its narrowest point when one stands relaxed.
Measure the hips at the widest point.
Divide the waist measurement by the hip measurement to obtain the waist-hip ratio. A ratio above 0.8 in a woman is associated with a greater risk of diabetes, heart disease, high BP, osteoporosis, and arthiritis.

By eating healthy food and exercising regularly, one can control weight gain.
Emotional changes
Mood changes, anxiety and irritability are common. Treatment includes yoga, exercise and hormone therapy.
Intellectual symptoms
Forgetfulness- you may forget where you put something, miss appointments, and things that used to be easy to remember can suddenly require enormous effort.
Ability to concentrate also becomes diminished, making it hard to carry out work that involves complex assessments and major decision-making.

Even minor decisions can sometimes be quite paralyzing.
Any sort of work or study will go a long way to preserve your intellectual ability. It’s never too late to get a job. Many universities provide employment retraining. Vitamin B complex, calcium and potassium taken together will help.

Most intellectual skills improve with HRT. You will feel more confident about making decisions, be more assertive and better able to concentrate.

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