Though Menopause,  a complete cessation of ovulation and menses, is a natural event in a woman's life, it significantly affects her quality of life. It is often a traumatizing time for women as it involves many other changes that require efficient management, extending far beyond the reach of medical treatment. Unlike most other systemic changes which the human body undergoes as a process of aging, menopause needs much more than just medical treatment.

Certain health conditions become more common after menopause, and it is important for doctors to warn their female patients about diseases that commonly occur after menopause and educate them about ways to protect themselves from these ailments.

Guiding the patients towards a smooth transition to post -menopausal stage and helping them to preserve health after menopause is important.

Here are a few diseases the doctors must discuss in detail with their patients.

• Heart Disease: Before the age of 55, women have a much lower risk of heart disease than men. Estrogen in the system helps keep blood vessels relaxed and open, and helps the body maintain a healthy balance of good and bad cholesterol. After menopause, with a drastically reduced supply of estrogen, cholesterol may start building up on artery walls leading to the heart. By age 70, women have about the same risk for heart disease as men of the same age. Due to this, it is extremely important for them to take precautionary steps after menopause.
• Stroke: This is another condition in which risk drastically increases after menopause. Studies suggest that the risk for stroke for women doubles every decade after age 55. Similar to the causative factors for heart disease, the lower levels of estrogen in women’s body may play a role in cholesterol build-up on artery walls leading to the brain.
• Osteoporosis: Having lower estrogen after menopause causes women to lose bone mass much more quickly than they did before, which puts them at risk for osteoporosis. In such conditions, recommending a diet rich in calcium including milk, nuts, grains, and supplements would help. Along with diet, strength training exercises also help bone mass and it is critical that doctors warn women about such exercises since strength/weight training is not a part of many patients’ workout regimes.

Along with these conditions, doctors can also advise the following for women going through menopause.

• Quitting Smoking & Alcohol: Doctors need to advise their patients regarding quitting smoking. It can be one of the most important steps that women can take to protect their health. Smoking has many ramifications on women’s health, especially after menopause, including being associated with bone damage, heart disease, and as many as 12 types of cancer in women. Women smokers need to be advised to quit immediately and avoid second-hand smoke.
• Physical Activity: Women need to get at least 30 minutes of physical activity on most days of the week. Physical activity is critical for maintaining the health of bones and heart, and even improves mood. A reasonable aim can be to at least get 2 hours and 30 minutes a week of moderate aerobic physical activity or 1 hour and 15 minutes of vigorous aerobic activity or a combination of the two. Along with routine exercises, doctors should advise on muscle building exercises two days a week for maintaining bone density and strength.
• Dietary Supplements: Several research studies advise women to get an adequate amount of micronutrients and vitamins, minerals, fiber, and other essential nutrients in their diet. Some critical advice that doctors need to give to menopausal women are:
• To get 2.4 micrograms of vitamin B12 and 1.5 milligrams of vitamin B6 each day. Doctors should ask women to include it in their diet or have supplements.
• Should recommend 1,200 milligrams of calcium each day. Vitamin D also is important for bone health and doctors should recommend that women 51 to 70 get 600 international units (IU) of vitamin D each day and women who are 71 and older, get 800 IU of vitamin D each day.

Depression

Some women will experience significant depression before menopause. Perimenopause marks the time when women’s bodies begin their transition to menopause.

Because of the intense hormone changes during perimenopause, women are more likely to have menopause-related depression before they reach actual menopause.

Doctors often will need to advise women to seek counseling from a mental health professional during these times. One of the dominant emotions women feel during this time is the realization of the loss of their ability to bear children. Although this is not generalizable, it does happen among some women.

The transition into menopause may be a turbulent time for some women. Rapid changes in hormone levels may influence neurotransmitters in the brain. The drop in estrogen levels during perimenopause and menopause can lead to hot flashes that disturb sleep. This can lead to anxiety, fear, and mood swings.

Depression during perimenopause and menopause is treated in much the same way as depression that strikes at any other time. However, doctors need to be careful and remember that depression is not just a side effect of menopause and needs to be treated as all other cases of depression are treated. Doctors should ideally refer patients to a psychologist if antidepressants and/or counseling are needed.

The family’s role

The family, especially the husband and adult children need to support women through these times. Doctors may need to talk to family members and encourage them to be supportive. The family may need to make special efforts to reduce discomfort for the woman and make the transition easier. Supporting women in any new activities they may take up during this time may be vital.

The family should also keep a watch for signs of clinical depression which may set in during this time. Their role in monitoring the woman is critical.

Most Indian families are unlikely to have a detailed idea of menopause and its implications, and hence may need doctors to brief them about the role they can play in making the transition to menopause easier for women.