Time to break the silence on menopause; help is at hand for women struggling with its effects, says KZN Health MEC

12 June 2023

KWAZULU-Natal Health MEC Ms Nomagugu Simelane says the time has come for society to break the silence on menopause, whose effects can expose women to a myriad health problems and place a huge strain on inter-personal relationships.

Menopause, which usually affects women between the ages of 45 and 55, is a period during which women stop menstruating. This may trigger significant changes in the chemical "messengers" that "tell the body how to work," otherwise known as hormones.

It is important to note that Menopause is not a sickness or a disease, but a normal physiological process that all women go through when they reach a certain age.

The known effects of menopause include mood swings, anger, weight gain, stress, anxiety, depression, hot flashes (sudden feeling of warmth in the upper body, with increased intensity on the face neck and chest), sleep disturbance, decreased libido, vaginal dryness, weakening of the bones, and increased susceptibility to heart disease.

MEC Simelane says it's a shame that despite these realities, there is still just too little awareness about Menopause - particularly in the Black community - as well as the available options for hormone replacement therapy to help struggling women cope better.

And it's high time that, that changed, says the MEC.

During the latest episode of her Department's weekly multimedia programme KZN Health Chat on Friday, MEC Simelane shared the platform with the Head of Obstetrics & Gynaecology, Prof Tshidi Sebitloane.

There was consensus among them that there is a dire need for heightened public awareness on menopause.

MEC Simelane said: "There tends to be a lack of information, particularly among Black women, when it comes to understanding exactly what menopause is. You find families fighting because, the man of the house doesn't understand that his partner has gone through a phase where her hormones are changing. He may find it difficult to deal with these changes and say, 'Why are you so moody today? What's going on? You were not like this. This must mean you're up to something!'

"Whereas if we speak openly about such matters, it may become easier for him to understand that, "Ok, my wife or partner is now within that age range, which means she may be going through menopause, which affects her hormones, mood, and how she works. All of this may affect the situation at home [and in the workplace]."

Unpacking the science behind menopause, Prof Sebitloane said menopause was at the opposite end of menarche, the first occurrence of menstruation.

Prof Sebitloane also sounded a warning bell for women to watch out for post-menopausal bleeding, which may be a strong sign of cancer of the uterus - and seek help urgently. (The uterus is the hollow, pear-shaped organ in a woman's pelvis. Also known as the womb, it is where the unborn baby develops and grows.)

Said Prof Sebitloane: "Menopause comes at the end of the reproductive age. Its onset is around the ages of 45 to 55, with an average of about 52. So, in actual fact, by age of 55 a woman ought to have stopped having her periods. The signal is when the periods come to an end. But there are many other signs that go along with it.

"There are indeed occasions of premature menopause. For instance, if it comes before the age of 40, that becomes a concern, because menopause goes along with the 'closing down' of the hormones.

"When you get to an age where you don't get your period for about 12 months, at the right age - between the ages of 45 and 55 - we consider that menopause.

But, should you go back to menstruating after 12 months of 'closure,' we must consider that as post-menopausal bleeding, meaning we need to do an investigation, it could be abnormal.

"A person should not go back to having her periods once they've reached menopause. So, if it ever happens, you must come forward and undergo tests, so that we can rule out cancer, because that is always our biggest concern when that happens. You then need to receive attention.

"As indicated, there are many symptoms of menopause, and one of them is the reduced strength of the bone, which usually affects the spine. That is why you see some people walking with their backs hunched. Other symptoms may include hot flushes, difficulty with sleep, irritability and many others.

"Some people can't tolerate all of these symptoms, and then decide to come forward and seek help. If it happens that you can't tolerate the emotions and all of that, the doctors will put you on hormone replacement therapy. They basically give you back those hormones which have 'closed down.'

Women who are struggling with menopause are urged to visit their local clinic and speak to a healthcare professional. They will then be assessed and, if deemed necessary, get referred to a higher level or care.

MEC Simelane said: "What we'd like fellow compatriots to know and understand is the fact that there is therapy in the Department of Health.

"Let us speak to health professionals and enquire about hormone replacement therapy. Part of our job as Government is to bring knowledge to the people, knowledge that they were not privy to in the past. We are urging them to take this knowledge and use it."

Issued by the KwaZulu-Natal Department of Health

Additional information: troublesome symptoms which may affect some women during the time of menopause

It is important to realise that symptoms of menopause may start a year or more before the last menstrual period.

One of the common problems is that the periods become irregular. You may miss a period for month or two before the next period comes. That is normal. If the bleeding becomes very heavy or seems to be very frequent, then please check with your local clinic or hospital, so that they can look for the cause and give you treatment.

Hot flushes are a very typical symptom of menopause and are related to the hormone changes. Hormone therapy is available at all hospitals and is very good at treating hot flushes, so please request it from your health worker if the hot flushes are affecting your quality of life. However, hormone therapy can have side effects especially if taken for over 5 years so try stopping the hormone therapy after each year, as the hot flushes may have gone away.

If you prefer not to take hormone therapy, and want to try other ways of dealing with the hot flushes, like doing yoga, or changing your diet, that is also fine. It is up to you, because the hot flushes are not dangerous or damaging for your health. Before starting any hormone therapy, the health worker much check that you are in good general health, and must check for any other medical conditions such a high blood pressure or diabetes. A breast examination is necessary to check for any lumps and a pap smear should be done unless you have already had one recently. Another common symptom of menopause is vaginal dryness. This is not dangerous, but if it is causing a problem for you (affecting your quality of life), the first thing to try is to apply some type of lubricating cream, gel or oil that can be bought from the pharmacy or supermarket. Sometimes it is difficult to know whether symptoms such as mood swings, depression, weight gain, loss of libido are due to the hormone changes or just due to ageing or other factors in your life (stress at work, children have left home, relationship problems etc). Hormone therapy is not usually recommended for these types of symptoms. But if you are feeling very anxious or depressed, please seek help from your local health facility. There is treatment, both in terms of medication, and various types of counselling that can help.

Premature menopause:

A few women will have their last period before age 40. This will not cause any sudden medical problems, but it will mean the bones may become weak when the woman gets older, placing her at increased risk of getting bone fractures. If your periods have stopped before the age of 40 (no period for 12 months) please make an appointment at your local health facility. They will need to arrange some tests to look for the cause of the early menopause and most likely you will need to take hormone therapy for many years to keep the bones strong. Do note that some types of hormonal contraception (depot injection or implant or some types of intrauterine contraceptive device) can make your periods stop while you are using the method. But your periods should come back after stopping the contraception. If your periods have stopped because you are on one of these methods of contraception, then please don't worry; that is normal.

Post-menstual bleeding

Any women who has already gone through menopause, that is she had her last period more than 12 months ago, but now starts bleeding again, must attend her local health facility as soon as possible. This is a danger sign, and must be checked without delay.