Q1. What is menopause?

Menopause is a natural phenomenon that occurs in all women when the ovaries stop functioning. As a result the female hormone levels fall and periods become irregular and eventually stop. The menopausal transition stage (peri-menopause) usually begins when women are in their mid-to-late 40s. The average age of menopause in Indian women is around 48 years.

Q2. What are the symptoms of menopause?

3-6 in 10 women will experience physical and/or emotional symptoms during this period. The main symptoms are:

• Hot flushes and night sweats-these all hallmark symptoms. They affect the face, head, chest and neck and last for a few minutes.
• Sleep disturbances
• Mood swings
• Tiredness, forgetfulness and lack of concentration
• Vaginal dryness, urinary symptoms

Q3. Do I need any investigations for diagnosis of menopause?

Menopause is a clinical diagnosis. You must undergo a preventive health check-up including a clinical breast examination, pap smear, mammography and pelvic ultrasound.

Q4. When do I need to see a gynecologist?

a.Preventive Health Check-Up: This check-up must include pap smear, pelvic ultrasound, mammography and screening for cardiovascular disease, lipid abnormalities and osteoporosis (bone loss).

b.Menopausal symptoms affecting quality of life: Hormonal and non-hormonal treatments

c.Postmenopausal bleeding: Any vaginal bleeding after menopause needs immediate attention. Your gynecologist will advise a pelvic ultrasound. If the lining of the uterus is thickened on scan, you will be offered hysteroscopic guided endometrial biopsy to rule out any malignancy.

Q5. What are the various treatment options for menopausal symptoms?

a.Lifestyle modification:

b. Non Hormonal Treatment:

There are various options available. Some of these include:

• Plant and Herbal supplements- Phytoestrogens like isoflavones.
• Foods such as soy beans, nuts, wholegrain cereals and oilseeds, are rich in
• Vaginal moisturizers and lubricants
• Medical treatment- Drugs like tibolone for specific symptoms.

There is no good evidence that alternative treatments are effective. The quality, purity and constituents of herbal treatments may be unknown. Hence they must be taken after a detailed discussion.

c. HRT (Hormone Replacement Therapy)

HRT is medical treatment for menopausal women in which low dose hormones (estrogen, progesterone) are given. If lifestyle modifications and non-hormonal treatments don’t work, HRT might be offered. It is available as tablets, skin patches and vaginal creams. It is very effective to treat menopausal symptoms like hot flushes, night sweats, mood swings, vaginal and urinary symptoms. HRT must always be taken under medical supervision and its risks and benefits must be discussed.