Times of India
19 October 2010
By Umesh Isalkar
Pune, India

Menopause in late 40s ups health risks
Nation–Wide Study Claims Estrogen Effect Lasting Longer In Urban Women Than Before
Anjali (45) would have hot flushes (sudden perspiration) and she grew anxious about trivial matters, lost hair, complained of headaches and increased irritability. Her menstrual period grew short and occurred after long intervals all signs that she was approaching menopause.

It is the period when a woman’s life undergoes a transition from the reproductive to the non–reproductive stage. This is when the menstrual cycle stops for over 12 months and there is a drop in the levels of the two most important hormones estrogen and progesterone. October 18 is world menopause day.

Experts say that the average menopause age in urban women is rising. The data of a multi–centric study conducted by the Indian Menopause Society (IMS) across the country shows that the menopausal age among urban women is now between 47 and 52 years as against the previous 40–45 years. Lifestyle changes, improvement in nutrition and increasing obesity are the reasons, say experts.

According to epidemiological studies, the incidence of heart attacks among women increases drastically with the onset of menopause, a phase that is characterised by the reduction of estrogen production in the body.

Of the 80,000 new cases of breast cancer reported every year in Maharashtra, a majority are menopausal and post–menopausal women. A mammogram conducted at regular intervals and regular self–examinations are needed to facilitate early detection of breast cancer.

"The mean age of menopause in India is 44.3 years. However, sedentary lifestyles and a diet rich in nutrition and fat has pushed the age of menopause among urban women. It is a new trend that has been substantiated by our study," gyanecologist Jyothi Unni, vice–president of the national body of IMS, told TOI on Monday.

Since a large number of Indian women experience menopause in their forties, they have a longer period of estrogen deprivation and its consequences. The IMS has conducted a study across the country and the data showed that the age of menopause is about 47 years and women attaining premature menopause (before the age of 40) is about 7 per cent, said Unni.

Gynaecologist Parag Biniwale said sedentary lifestyles and a diet rich in carbohydrates and fats were largely responsible for obesity. "Obese women continue to produce estrogen which is responsible for a delay in menopause," he said. Other studies have linked late menopause to increased risks of ovarian, breast and uterine cancer.

The use of contraceptives or pills is also responsible for the delay, he added. "Some women use contraceptive pills often and for a long time. This can contribute to a delay in menopause. There are certain advantages of delayed menopause. Circulatory estrogen prevents heart attacks to a certain extent. It also protects bones, reducing chances of osteoporosis."

"However, when menopause is delayed, the woman should go for regular health check–ups because circulatory estrogen is responsible for some forms of endometrial cancer or breast cancer," said Biniwale. He is the joint secretary of the Pune chapter of IMS.

The most consistent psychological symptoms reported by menopausal women are irritability, headaches, dizziness, mood swings, anxiety, and feeling blue and decreased concentration. In a multi–centric observational cross–sectional data of the IMS study of 1,661 post–menopausal patients, 47. 26 per cent of the respondents reported hot flush, followed by depression and anxiety (47.97%). It was found that no single symptom was present. There was a cluster of symptoms with hot flushes and depression being the most common.

"Diet, exercise and dietary supplements are a must to prepare the body to cope with this increased vulnerability. Women must look at it as a natural transition and understand that they will come out of it. Besides, there is always help available. The family must also be supportive and understanding," said Unni.

How To Deal With It
Menopause marks the end of a woman's fertile, reproductive years. But if women experience late menopause, they may become pregnant in their 50s or 60s. and such pregnancies are risky for both the baby and the mother.

Late menopause has been linked to increased risks of ovarian cancer, breast and uterine cancer as a result of the body's continued exposure to estrogen Several benefits are linked to late menopause including improved bone thickness, improved cardiovascular performance, enhanced mood and increased longevity of life

Managing psychological symptoms

• Maintain a positive attitude
• Stick to a healthy diet, never skip meals
• Exercise regularly
• Opt for deep breathing, pray and meditate
• Focus on hobbies, mental activities

What are hot flushes
Hot flushes are a sudden feeling of intense heat over your face and upper body, which is sometimes accompanied by reddening of the skin and sweating. At menopause, when the estrogen is not forthcoming, areas of your brain that regulate your body temperature by controlling the dilation and constriction of blood vessels go haywire. The result are hot flushes. They occur more often late in the day, after you eat or drink something hot, in hot weather, or at any time of the day when one is tense.

To reduce an attack, do this

• Avoid spicy food, coffee, tea, alcohol
• Eat lentils, soy products
• Wear loose cotton clothes
• Avoid a hot water bath before sleeping
• Look for medical treatment

Eat right, exercise, soak in sun

• Eat food high in calcium like milk, yogurt, nuts, and green leafy vegetables.
• Take calcium supplements every day like calcium citrate, calcium carbonate, and calcium phosphate. Up to 1,200–1,500 mg of calcium supplements per day is generally recommended.
• Take vitamin D supplements between 400 and 800 IU every day to absorb calcium.
• Exercise regularly. Walking strengthens bones. Exercise for 30 minutes, three to four times a week
• Do a bone density test and ask your doctor about medicines to help prevent or treat osteoporosis
• Soak in 15–30 minutes of sunshine a day

Dietary tips for menopausal women

• Get enough calcium. Eat and drink 2 to 4 servings of dairy products and calcium–rich foods a day to ensure that you are getting enough calcium in your daily diet. Include curd, paneer, broccoli and legumes
• Pump up your iron intake. Eat at least 3 servings of iron–rich foods a day. Iron is found in lean red meat, poultry, fish, eggs, leafy green vegetables, nuts and enriched grain products
• Get enough fibre. Help yourself to foods high in fibre such as wholegrain bread, cereals, pasta, rice, fresh fruits and vegetables.
• Eat fruits and vegetables. Include at least 2 to 4 servings of fruits and 3 to 5 servings of vegetables in your daily diet. Drink at least eight 8 to 10 glasses of water a day.
• Maintain a healthy weight. Lose weight if you are overweight by cutting down on portion sizes and reducing foods high in fat, not by skipping meals. Saturated fat is found in fatty meats, whole milk, ice cream and cheese. Limit cholesterol intake to 300 mg or less per day.
• Use sugar and salt in moderation. Too much sodium is linked to high blood pressure. Also, go easy on smoked, salt–cured and charbroiled foods – these foods contain high levels of nitrates, which have been linked to cancer.
• Limit alcohol intake. Women should limit their consumption of alcohol to one or fewer drinks per day (3 to 5 drinks per week maximum)

( Source: Indian Menopause Society (IMS)