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Menopause Matters

Dr Krupali Rathod Tappoo is an Australian qualified general practitioner, a Fellow of the Royal Australian College of General Practitioners and the Medical co-ordinator for Fiji based NGO – Sai
02 Mar 2018 11:00
Menopause Matters

Dr Krupali Rathod Tappoo is an Australian qualified general practitioner, a Fellow of the Royal Australian College of General Practitioners and the Medical co-ordinator for Fiji based NGO – Sai Prema Foundation. Dr Krupali is based at TappooCity Medical Centre in TappooCity Suva and has a special interest in Women and Children’s Health.

Menopause is a global phenomenon and occurs in women all over the world.

Most women will experience some form of symptoms as a result of the body decreasing the production of estrogen.

However, each woman is different and so is the way they will experience menopause.

Many things play a role in how a women experiences menopause including her age, lifestyle, fitness level, diet, culture, and even her weight.

Menopause is the time that marks the end of your menstrual cycles. It is diagnosed after you’ve gone 12 months without a menstrual period. Menopause can happen in your 40s or 50s, but the average age worldwide is between 49 and 52 years.

Menopause is a natural biological process.

However the physical symptoms, such as hot flashes, and emotional symptoms of menopause may disrupt your sleep, lower your energy or affect emotional health.

There are many effective treatments available, from lifestyle adjustments to hormone therapy.

There are many factors that help determine when you’ll begin menopause, including genetics and ovary health.

Perimenopause often occurs before menopause. Perimenopause is a time when your hormones begin to change in preparation for menopause.

It can last anywhere from a few months to several years. Many women begin perimenopause some point after their mid-40’s. Other women skip perimenopause and enter menopause suddenly.

About one per cent of women begin menopause before the age of 40, and about five percent undergo menopause between the ages of 40 and 45.

This is referred to as early or premature menopause, or primary ovarian insufficiency.




Every woman’s menopause experience is unique. Symptoms are usually more severe when menopause occurs suddenly or over a shorter period of time.

Conditions that impact the health of the ovary, like cancer or hysterectomy, or certain lifestyle choices, like smoking, tend to increase the severity and duration of symptoms.

Aside from menstruation changes, the symptoms of perimenopause, menopause, and postmenopause are generally the same.


The most common early signs of perimenopause are:


  • less frequent menstruation
  • heavier or lighter periods than you normally experience
  • vasomotor symptoms, including hot flashes, night sweats and flushing

An estimated 75 per cent of women experience vasomotor symptoms with menopause.


Other symptoms include:

  • Vaginal dryness
  • Chills
  • Night sweats
  • Sleep problems
  • Mood changes
  • Weight gain and slowed metabolism
  • Thinning hair and dry skin
  • Loss of breast fullness
  • Depression
  • Anxiety
  • Reduced libido
  • Urinary tract infections
  • Painful or stiff joints


It is important for women to ensure that despite periods being irregular, pregnancy is still possible and if a period is missed, it’s important to consider doing a pregnancy test.


Causes of Menopause:

  • Natural decline of reproductive hormones with age
  • Hysterectomy- surgery done when the uterus is removed. There will be no further periods however the ovaries will continue to release estrogen and progesterone hormones.

If however during hysterectomy the ovaries are also removed then this would cause immediate menopause as the ovaries are no longer producing estrogen and progesterone.

  • Chemotherapy and radiation therapy for cancer can induce menopause
  • Primary ovarian insufficiency- about one per cent of women experience menopause before the age of 40.

Menopause may result from primary ovarian insufficiency – when your ovaries fail to produce normal levels of reproductive hormones – stemming from genetic factors or autoimmune disease.

But often no cause can be found. For these women, hormone therapy is typically recommended at least until the natural age of menopause in order to protect the brain, heart and bones.



  • Increased risk of cardiovascular disease in women after menopause due to low level of estrogen hormones.
  • Osteoporosis or thinning of bones
  • Urinary incontinence
  • Weight gain- metabolic rate generally slows down
  • Vaginal dryness that may cause painful sexual intercourse



Generally signs and symptoms are sufficient to say that a women is becoming menopausal.

However in some cases blood tests may be required looking at the FSH levels- which increase in menopause and estrogen level which reduces in menopause.

Thyroid function tests may also be required as an underactive thyroid may cause symptoms similar to menopause.



Menopause requires no medical treatment. Instead, treatments focus on relieving your signs and symptoms and preventing or managing chronic conditions that may occur with aging.

Treatments may include:


  • Hormone therapy- this is typically estrogen replacement through tablets, patches or vaginal creams. If a woman still has her uterus then progesterone will also be required.

Long-term therapy may have some cardiovascular risks and breast cancer risk however short term use is generally deemed safe and effective. This is a discussion that a women needs to have with her doctor.

  • Low dose antidepressants- the group of antidepressants called the Selective Serotonin Reuptake Inhibitors (SSRI’s) may reduce the symptoms of hot flashes and are used widely. This is especially useful if a woman is also depressed or has anxiety.
  • Non-hormonal vaginal lubricants for dryness


Lifestyles changes

There are many things that a woman can do to at home to help herself.


  • Exercising and managing weight
  • Communicating needs by talking to a counselor, psychologist or therapist
  • Relaxation techniques of yoga, deep breathing and meditation
  • Stop smoking and reducing alcohol intake
  • Natural supplements such as soy, vitamin e, melatonin, flax seed may help
  • Supplementing diet with vitamin D and calcium

So women of Fiji, I encourage you to think about menopause, talk about menopause and seek help if you are suffering from distressing symptoms.

Please book a consultation with your doctor to discuss this very important stage in a woman’s life.


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