Mrs Bolanle is a 53-year-old shop owner who has increasingly become moody and irritable. Sometimes, she would be happy and suddenly switch and may start crying for no clear-cut reason. She also feels more tired than usual and has been sleeping poorly.
She went to the clinic for checks as she was convinced that she was unwell. The doctor took a careful history, conducted a physical examination, and then requested for some tests. He subsequently reassured her that there was nothing wrong with her per se, as the symptoms she was experiencing were due to menopause. Mrs Bolanle did not really understand and the following conversation ensued:
Mrs Bolanle: Thank you Doc. But what does this really mean? I have vaguely heard about menopause previously, but I don’t really understand.
Doctor: Okay, let me start with some explanations. First, there are chemicals which control how our brain works and how we feel – whether we are happy or sad or experience a pleasure. These feel-good chemicals are very essential to our day to day functioning. They serve as the messengers that give instructions to control our body’s physical and chemical functioning.
Second, hormones are specific examples of these chemical messengers. And the female body has some special types of hormones called estrogen and progesterone which control menstruation and fertility in women. The ovaries of the woman produce these hormones, which also exert some effects on mood.
This explains why some females from adolescence may have noticed that preceding the period of their menses, they are transiently moody, irritable and may experience other mood changes that are referred to as premenstrual syndrome (PMS).
Lastly, these hormones control the menstrual cycle from puberty till midlife when the menses become erratic, and then eventually stop in their 40s and 50s as the production of estrogen gradually reduces over time.
Thus, menopause is said to have set in, when a woman in this age range has not experienced her menses for up to 12 months. Perimenopause describes the five to 10 years leading up to eventual menopause, over which the estrogen levels begin to gradually drop.
Mrs Bolanle: Okay, so how do all these explain how I have been feeling lately?
Doctor: Very good, remember I said I was starting with general explanations of the changes that occur in woman’s body as a result of chemicals, such as hormones. Do you remember the names of these hormones?
Mrs Bolanle: Of course, I remember: estrogen and progesterone, which reduce until the levels are so low that menses eventually stop. And when the menses have stopped for up to a year, then menopause has occurred.
Doctor: Excellent. So, the next step is to understand that these changes in estrogen levels and other chemicals affect our brain and our body in different ways. These may include a) physical symptoms such as feelings of internal heat (hot flashes), tiredness, poor sleep, uncomfortable night sweats, and forgetfulness; b) emotional symptoms such as mood swings including tearfulness, feelings of sadness, irritability, difficulties with concentration and lack of motivation.
So, you can clearly see that all the symptoms you complained about when you first came in are all within the physical and emotional symptoms of menopause.
Mrs Bolanle: Thank you Doc, but my best friend, Mrs Taiwo is already 55 years and she is not having these problems. She stopped menstruating almost five years ago and she is very fine. Why is mine different?
Doctor: Okay, menopause occurs with minimal and barely noticeable symptoms for the majority of women. And every woman will have her own uniquely different experience of menopause. It is only when the symptoms are causing significant discomfort that it becomes a focus of medical intervention.
Indeed, many women, once they understand what is going on, feel reassured and become comfortable with it – without needing any medical intervention.
Mrs Bolanle: Thanks a lot for these explanations. I already feel reassured now. Is there anything else I should know?
Doctor: I am glad to hear that you feel reassured. Please, keep in mind that this age period is often characterised by several life changes that are also stressful.
Children grow and leave home, parents are ageing and dying, marital difficulties/divorce may be occurring, financial worries, concerns about retirement etc all exacerbate the feelings of stress; when added on top of the menopausal symptoms.
Mrs Bolanle: So, what should I do now?
Doctor: There are simple measures that can help. These include regular physical exercise, paying attention to general physical health and medical conditions, adequate rest and sleep. However, if symptoms are very uncomfortable, you may need to see a gynaecologist who may consider the use of hormonal replacement therapy.
Serious emotional symptoms such as anxiety and depression may also require the use of anti-depressant medications and psychotherapy.
Mrs Bolanle: Thank you so much Doc. I feel better now.
Doctor: You are very welcome Ma’am.