“I notice body changes…my mood is going up and down….I have hot flushes and night sweats… is the menopause on its way?” These are a few examples of questions asked by women in their 40s.

Technically menopause is the last menstrual flow of a woman’s life and the climactic period of time preceding and following this event. In general usage, menopause refers to the whole process. For most women, menopause occurs between the ages of 40 and 60 and takes place over a period from 6 months to three years.

Changes in Periods
Irregular menstrual periods, one of the most common and predictable signs of menopause, most often occur because of the erratic levels of estrogen and progesterone and less-frequent ovulation. “Irregular” refers to periods when menstrual bleeding is lighter or heavier than usual, periods that are unusually close together, bleeding for fewer or more days than usual, or periods that are skipped altogether.

Why see your gynaecologist? It may be menopause, but it could be the symptoms of a hormone imbalance, thyroid disease, uterine fibroids, uterine polyps, or even cervical or uterine cancer. All of these can cause menstrual irregularities, which is why it’s important that you see your gynaecologist if your periods start to change.

Some menstrual changes that could be considered abnormal include:
- Periods which are very heavy and gushing, or bleeding with clots.
- Periods which last more than 7 days.
- Periods that last 2 or more days longer than usual.
- Spotting between periods.
- Bleeding after intercourse.
- Fewer than 21 days between periods.

Hot Flushes and Night Sweats
Hot flushes are the second most frequent symptom associated with menopause.

Hot flushes are the body’s way of cooling itself down. Abrupt changes in the body’s “thermostat” in the brain can cause it to mistakenly sense that you’re too warm. This causes blood vessels to dilate, and blood to rush to the surface of the skin to cool the body. That’s why you get the red, flushed look on your face and neck. Sweating, which sometimes accompanies a hot flush, also cools the body as the perspiration evaporates.

Why see your doctor? It may be menopause, but it could be hyperthyroidism. That’s because the symptoms of an overactive thyroid (a large gland in the neck which produces hormones regulating growth and development) – which can include flushing, sweating, heat intolerance, heart palpitations, and sleeplessness – can easily be confused with those of menopause. If left untreated, an overactive thyroid can cause a loss of bone mineral density, which, over time, can lead to osteoporosis (a medical condition in which the bones become brittle and fragile).

Infectious Diseases
If you’re feeling sick in addition to experiencing hot flushes and sweating, you could have an infectious disease such as tuberculosis, lyme disease or AIDS. When you’re having menopausal hot flushes, you may feel tired because you haven’t had a good night’s sleep, but you shouldn’t feel sick.

Cancer
Sweating along with a fever could also be caused by cancers, such as leukaemia or lymphoma. A rare tumour to the adrenal gland called a pheochromocytoma and one that usually occurs in the intestine called a carcinoid tumour, can cause flushing and feelings of warmth too, which could be mistaken for menopause symptoms.

If you’re losing weight but not dieting, your heart frequently beats rapidly, you’re always hot even when people around you are cold, you feel generally unwell, or you have a fever, don’t ignore it. A blood test called a TSH (thyroid-stimulating hormone) test can tell your doctor if the culprit is hyperthyroidism, and other tests can be run to rule out infection or cancer.

Depression
We know from studies that giving oestrogen to women during peri-menopause (the transition to menopause) helps reduce their depression. Other studies have suggested that oestrogen improves mood in post-menopausal women who feel depressed.

Depression may also be triggered by the loss of sleep that hot flushes and night sweats that menopause can cause. Sleep problems can leave you feeling irritable, which may result in the loss of your overall sense of well-being.

Why see your doctor? It may be menopause, but again it could be hyperthyroidism.

Palpitations
Palpitations can feel as though your heart is beating erratically or fast, skipping a beat, or as if there are butterflies in your chest. Usually they occur with hot flushes and night sweats, but they can appear on their own.

Oestrogen levels, during peri-menopause, alternate between very high and very low. This causes a destabilisation of the cardiac rhythm, which can lead to palpitations. If it turns out that your palpitations are related to menopause, they can usually be relieved with oestrogen replacement therapy.

Why see your doctor? It may be menopause, but it could be hyperthyroidism. A revved-up thyroid can increase the effects of adrenaline, a stress hormone in the body, which can cause a rapid heart rhythm or arrhythmia. It’s diagnosed with a TSH test.

The next ‘Vital Points’ will contain more information about menstruation, alternatives for handling menstrual flow, and myths and believes in Myanmar and throughout the world about menstrual flow and menopause remedies.