After the autumn of youth comes the winter of senility. No matter how much we try to philosophise, ageing is harsh ugly truth we all must come to terms with. For women, the ordeal may seem worse as we try to navigate some uncomfortable symptoms of menopause apart from the loss of youth. Some grapple with memory loss and others with sweating. And then there are the notorious hot flashes.

But menopause is not a sudden phenomenon; the symptoms start years before menopause. And if you think you are too young to be worried about it, you couldn’t be more wrong, says Dr Sangeeta Gomes, Consultant Obstetrician and Gynaecologist, Motherhood Hospitals, Bengaluru.

“Menopause transition or perimenopause usually begins in the 40s when the ovaries start producing less oestrogen. But it can occur as early as in the 30s. The transition phase lasts until the ovaries stop releasing eggs, and menopause happens,” she noted.

The route to menopause is an arduous one. In the perimenopause phase, your oestrogen levels are out of whack; they can rise and fall at will. What follows is a bunch of distressing symptoms.

“Your menstrual cycle may lengthen or shorten. Hot flashes, sleep issues and vaginal dryness are a few symptoms of menopause,” said Dr Gomes.

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1. Irregular periods

The first sign of approaching menopause is irregular periods. The duration between your periods may lengthen or shorten. The flow may get lighter or heavier than usual. And in some cases, you may skip your periods as ovulation becomes more random.

“You may be in early perimenopause if your menstrual cycle length fluctuates by seven days or more regularly. You’re likely in late perimenopausal if the gap between your cycles is 60days or longer.”

Periods can get longer, heavier and more painful. Then just gradually, they stop altogether.

2. Vaginal dryness

When oestrogen levels drop, the vagina becomes drier than usual as it loses its lubrication and firmness. The lining of the vagina is made up of cells filled with water that allows it the flexibility to make sexual intercourse comfortable.

“With the fall in oestrogen levels, the process is reversed, and the tissues become thinner, resulting in dryness. It causes itchiness, pain, and discomfort during sex,” noted the doctor.

3. Bladder changes

Approaching menopause also leaves you susceptible to more UTIs or urinary tract infections. It also leaves you with the urge to urinate more frequently. With menopause, the tissues in the vagina and the urethra lose their elasticity, making it difficult to hold the urine in.

4. Hot flashes and sleep problems

The most infamous symptom of menopause, hot flashes or “power surges” feel like a sudden wave of warmth (not as nice as it sounds) in the upper body. The skin of the face, neck and chest redden. You may also break into a sweat even if the weather is cool.

 

When you are approaching menopause, the instances of hot flashes increase. “Sleep disorders are likely because of hot flashes or night sweats. Sleep can be uncertain without them too,” the doctor informed.

“It’s impossible to sleep,” says R on the condition of anonymity. “Every 30 minutes, you get blasted by this sudden wave of heat. It’s driving me to the point of insanity.”

Sleep is also disturbed by urinary incontinence. You are forced to wake up several times in the night to go to the bathroom.

5. Changes in mood

Women report feeling left drained emotionally, too depressed to even lift a finger. Mood swings can also take an extreme toll on relationships. “I could go from being incredibly angry to crazy to being suddenly calm. My family started walking around eggshells for me,” said T on the condition of anonymity.

“Perimenopause can lead to mood swings, anger, and an increased risk of depression. Sleep disruption associated with hot flashes may be the source of these symptoms. Mood changes can be triggered by a variety of factors other than perimenopause’s hormone fluctuations,” said Dr Gomes.

6. Weaker bones

Oestrogen has a big role to play in maintaining bone health by increasing calcium absorption. So naturally, when the oestrogen levels start falling during perimenopause, the bones suffer.

 

“Calcium in the bones is generally in a condition of equilibrium with calcium leaving and entering the bone at any given time,” said Dr Gomes, “but this equilibrium is broken and calcium outflow from the bone increases.”

The result is osteoporosis.

What causes early menopause?

These days, women as young as 35 are at the risk of facing early menopause. Evidence points to a couple of factors.

Cancer treatments like chemotherapy and radiation, smoking, history of early menopause in the family and hysterectomy are the

“Menopause is not usually caused by a hysterectomy alone.  Your ovaries continue to produce estrogen even if you do not have periods. However, such surgery could delay the onset of menopause. In addition, if one of your ovaries gets removed, the other ovary may stop functioning sooner than predicted.” pointed out Dr Gomes.

How to avoid an early menopause

Maintaining good levels of oestrogen depends on a few lifestyle factors. Leading an all-around healthy lifestyle is the key to it.

Regular exercise, refraining from smoking, sleeping on time, cutting down on alcoholic beverages, maintaining a healthy weight, eating calcium-rich foods and plugging nutritional deficiencies may go a long way in avoiding early menopause in women.