Prof. Chris Aimakhu is a consultant obstetrician and gynaecologist at the University College Hospital (UCH), Ibadan. In this interview with SADE OGUNTOLA, he speaks on menopause and why women need not suffer in silence but speak up when the symptoms are severe.
MENOPAUSE generally occurs in Nigerian women at around 51 years of age. Is that the situation in every woman?
In menopause, generally, we talk about a natural decline. in normal hormones of women that make them a woman, so to speak. In Nigeria, studies have shown that menopause occurs between the ages of 48 and 54. It tends to come earlier in Nigerian and Ghanaian women. The average natural menopause in most societies is between ages 50 and 52. Different reasons were adduced for menopause happening early. In these African women, people talk about culture and diet as part of this. But usually, by the time a woman reaches her late 40s and early 50s, she tends to have menopause.
Are the common symptoms of menopause in Nigerian women different from those in women in other climes?
They are similar; menopause is the cessation of periods; it happens when there’s a reduction in the oestrogen levels of a woman. It usually starts with the climacteric, about 12 months, and the women’s periods become irregular. Maybe they start seeing their period once in two months and once in three months. Then over time, it disappears. There are other symptoms, including loss of libido, hot flushes, vaginal dryness, and palpitations because of the withdrawal effect of the oestrogen. Usually, the sudden hot and sweaty impact on the upper part of the body is the first thing they feel apart from the reduction in periods. Some also experience pains in their joints and pathological fractures because they easily break their legs, arms and fingers. Also, there are sleep disturbances that actually might lead to depression.
There is a claim that once a woman is menopausal, she becomes more sexually active because her libido is better. How true is this?
Menopause tends to reduce libido because there’s vaginal dryness, and sex becomes very painful, and so women become withdrawn in terms of their sexual drive. But then we still have some older women who still have the drive to have sexual intercourse. Their sexual drive is slightly higher than others.
What are the cultural and societal factors that impact menopause in Nigerian women?
There’s that depression; there’s that being withdrawn; they want to know why. Some compare themselves to others to say, Okay, “Why is it that my period has stopped, and my mother’s period did not stop till she was 60?” Another thing that has contributed to it is women who continue to take ovulatory drugs. They take these ovulatory drugs because they want to get pregnant; the more a woman uses these ovulatory drugs, the higher the tendency for them to stop ovulating early. Of course, menstruation then stops early. Recently, we’ve noticed in Nigerian women a reduction in menarche, which may also be diet-related. Before, women were seeing their first period at ages 17 and 18. Now, we’re seeing girls getting their periods as early as age 11. When menarche starts early, there is also a chance that menopause will start early.
Does the use of contraceptive pills or the number of children a woman gives birth to have anything to do with when she attains menopause?
The more children you have, the fewer menstrual cycles you have. Women who have more children are likely to get to menopause later than women who don’t have children. This is because women who don’t have children are continuously menstruating.
Some Nigerian women also rely on traditional remedies and herbal concoctions to manage menopausal-related symptoms. Would you advise that?
I would not advise that because we don’t know the constituents and effectiveness of these herbal medications. Nigerian women use herbal medications for everything now because Western medications are expensive. Even the drugs that would help menopause are expensive. However, regarding menopausal symptoms, if women start having hot flushes, they tend to think they have malaria. And they use drugs that they presume will lower their body temperatures. And those who want to increase their sexual drive also resort to traditional remedies. People generally will look at menopause as the fact that they can’t have children anymore or they can’t be sexually active anymore. Nigerian women tend to look at what their husbands are doing; their husbands keep relationships outside because they look at them as older women. So some Nigerian women tend to do things to help them cope with menopause.
Are they not supposed to do anything about those symptoms of menopause?
Generally, it’s just general symptomatic relief unless they want to make their periods regular. You rarely will see women who want to keep having regular periods. So they will rather want to take care of the symptoms. For those women who want to keep having regular periods, you can put them. These are hormone replacement therapies because the hormonal levels have been reduced. But it is expensive. However, not all women can benefit from hormone replacement. therapies in managing their menopausal symptoms, particularly hot flushes. It makes them bear the symptoms better. Hot flushes could be very severe in some women. They will feel like pulling off their clothes even when they are outside. I saw a woman who keeps on having fractures and pains in her joints because of menopause. However, hormone replacement therapy is not for all women; particularly those with reproductive tract malignancies like ovarian and endometrial cancers. It doesn’t cause the tumour to spread to other parts of the body.
Are there benefits from having hormone replacement therapy? Are there risks with managing menopausal symptoms?
It’s just general symptomatic relief of the symptoms. Hormone replacement therapy also makes people not age much. They can tolerate sex better because they don’t have pain during sex. They don’t have vaginal dryness; they don’t feel too old so quickly. For instance, Caucasians want to keep on looking young, so they tend to use it. They also don’t have hair loss. Apart from the fact that they still menstruate, psychologically they are better, and then, of course, it reduces depression. Depression is a big problem in women due to the reduction in the oestrogen levels of a woman. Studies have shown about 15 to 20 per cent of women who go through menopause go through depression. And in about 10 per cent, they need psychological treatment.
Hormone replacement therapy is expensive, so what other options do the women have for their menopausal symptoms?
It does not mean that hormone replacement therapies are beyond the reach of all women, some women can afford them. Primapak and Premarin are the commonly available drugs and they have both oestrogen and progesterone in them; they merely need to take one tablet daily for as long as they want to experience those premenopausal effects on their body. However, Primapak and Premarin are scarce in Nigeria, so people want to get them from foreign countries. Other things can help. These include light exercises to keep active; changing their appearance by wearing wigs and makeup. So if a woman feels old inside, they can do a lot with their appearance. They also need to psychologically believe in themselves.
What are some wrong perceptions individuals have about menopause?
These include things like “menopause makes women feel as if they are old.”. Nobody wants to feel so old so quickly. You can combat things like hair loss when it comes to keeping that physical femininity. Menopause is an ageing process; women who attain menopause early will age faster than those who are older before getting to menopause. There are a lot of symptoms that women with menopause do have; people can still think of night sweats, visual disturbances, and things like that. People will think they have malaria, typhoid fever, and other things. Generally, fibroids should reduce with age because oestrogen, which is one of the things associated with fibroids, actually reduces as the woman gets older. Women who have fibroids generally should have the size of the fibroids reduced as they approach menopause. But funny enough, a few of them continue to have fibroids. And then, because they are losing weight, they tend to look at their abdomen as being big, and it gets to trouble them. I saw a patient some days ago who is 52 and says she wants to take out her fibroids now. Now she finds out that it’s disturbing her appearance. So as people get older, of course, they become more aware of how they look. So they tend to say, Okay, I want to take out my womb.
Early onset of natural menopause among Nigerian women in Zaria is strongly associated with parity and inversely associated with body mass index and diastolic blood pressure. What is the link between all these?
Generally, hypertension comes with age. Of course, menopause itself, diabetes, hypertensive heart disease, and a whole lot of other things come with age. A lot of women who are overweight may have menstrual issues too. Also, the more children you have, the higher the risk of you reaching menopause early. Similarly, with increasing BMI, the chances of reaching menopause early also increase, too. Likewise, women with low body weight to menopause early too. They also have problems with their hormonal profiles. Meanwhile, a woman who keeps having children for so many years keeps on ovulating and this also will make menopause come early.
Can sexual intercourse cause sickness for menopausal women?
No, they may feel like they don’t have that sex drive anymore. So it may disturb them. But then there are various things depending on their partners that they may find helpful. Of course, the man may find out that the wife’s libido is low and then want to keep away. And then don’t forget, these women are also rearing children that are taking up their time. Some have gone higher in their jobs, and so sex to them is like, “Why do I want to disturb myself? I don’t want to have children anymore.”. A low drive for sex is a behavioural thing. As you get older, you tend to have a reduction in the need for sex for women. It is an age thing; the hormonal reduction that happens in menopausal women also reduces their sexual drive.
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Since menopause is a physiological ageing event, are women therefore not supposed to seek an expert’s help to cope?
Those who are bothered should seek expert management. Those who are not so bothered probably have experienced people around them to tell them how to cope. However, it has only recently been that more women are particular about it. They think they are ill, so they want solutions to these problems. They may be referred to a doctor, a gynaecologist, or somebody who understands the symptoms. Most times treatment is just about counselling them. It’s not necessarily drugs. If the heat flush is a problem, she can have a cold shower, wash her face, or put on the fan or air conditioner when the heat is unbearable. Wearing light fabric is also helpful. Analgesics can be taken for joint aches. For palpitations, it is important to rule out hypertension. There are drugs that people do take for sexual problems, although I advised against them. Many individuals are not aware that they are hypertensive or borderline hypertensive. For these individuals, these drugs can cause them to have a stroke or ischaemic heart disease.
and then