Menopause is the natural ending of the menstrual cycle which usually occurs when a woman enters the age of 45 – 55 years. A woman can be said to have reached menopause if she does not experience menstruation for 12 consecutive months.

Menopause is not only marked by the cessation of menstruation. Menopausal women also experience many changes, ranging from physical appearance, psychological condition, to sexual desire . In addition, postmenopausal women cannot get pregnant again.

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Body changes during menopause can occur gradually or suddenly. The period when these changes occur is called the perimenopause. This period can last several years before menopause and generally starts around the age of 40, but can also occur earlier.

Causes of Menopause

Menopause is a natural process that occurs when a woman gets older. As you get older, the ovaries will produce less and less female hormones. As a result, the ovaries will no longer release eggs and menstruation will stop.

However, in some cases, menopause can also occur earlier, namely before the age of 40. Early menopause can occur due to:

Primary ovarian insufficiency

This condition occurs due to genetic disorders or  autoimmune diseases , which make the ovaries stop functioning. Primary ovarian insufficiency is a rare event that only occurs in 1% of the world's female population.

Surgical removal of the uterus (hysterectomy)

After a hysterectomy, a woman will not experience menopause immediately, but tends to experience menopause earlier. However, menopause can occur immediately after  a hysterectomy if the ovaries are removed.

Cancer treatment

Chemotherapy  or radiotherapy to treat uterine cancer can damage the ovaries, triggering early menopause. However, the risk of early menopause depends on the chemotherapy drugs used, the location of the radiotherapy, and the patient's age at the time of treatment.

Menopause Symptoms

Symptoms of menopause begin when a woman enters  perimenopause , which is a few months or years before menstruation stops. The duration and severity of symptoms can vary for each woman.

Symptoms or signs of menopause can include:

1. Changes in the menstrual cycle

Women during perimenopause will begin to experience changes in their menstrual cycle, such as:

  • Menstruation becomes irregular, sometimes late or earlier than usual ( oligomenorrhea )
  • The blood that comes out during menstruation can be less or even more

2. Changes in physical appearance

Changes in physical appearance that are commonly experienced by perimenopausal women are:

  • Hair loss
  • Dry skin
  • Sagging breasts
  • Joints feel sore and stiff
  • Decreased muscle and bone mass
  • Weight gain

3. Psychological changes

Psychological changes that occur in perimenopausal women can include:

  • Mood swings or  moody
  • Difficulty concentrating
  • Easily tired
  • Hard to sleep
  • Depression

4. Sexual changes

Perimenopausal women can also experience sexual changes, such as:

  • The vagina becomes dry
  • Decreased libido  (sex drive)

Apart from these changes, other symptoms that can be found in perimenopausal women are:

  • Feeling hot or stifling, making it easy to sweat ( hot flashes )
  • Night sweats
  • Migraine
  • Headache
  • Joint pain
  • Heart beat

When to see a doctor

Consult with your doctor if you find streaks of blood coming out of your vagina during perimenopause, or after 12 months have passed since perimenopause. Immediately seek medical help if the symptoms you experience are very disturbing in your activities.

Menopause Diagnostics

A woman is said to be experiencing menopause when she has stopped menstruating for 12 consecutive months. Menopause is also preceded by the emergence of various changes during perimenopause.

Doctors can determine the diagnosis of menopause based on the patient's age, clinical history, and symptoms. However, to further confirm the diagnosis, or if other causes of menopause are suspected, the doctor will do a blood test to check the levels of hormones in the body, such as:

  • Estradiol
    This hormone can show how much estrogen levels are produced by the ovaries during menopause testing. Low levels of estrogen in the blood are a sign of menopause.
  • Follicle-stimulating hormone (FSH)
    Elevated levels of FSH in the blood are a sign of menopause.
  • Thyroid-stimulating hormone (TSH)
    Checking TSH hormone levels aims to ensure that the patient does not experience hypothyroidism or decreased thyroid hormone, which can cause symptoms similar to menopause.

Menopause Treatment

Generally, menopause is a natural condition that does not require further treatment. However, if the symptoms of menopause are very disturbing, the doctor will suggest several treatment options that can help relieve symptoms of menopause.

The following are options for treating menopausal symptoms:

Hormone replacement therapy

There are two types of hormone replacement therapy that can be used to relieve menopausal symptoms, namely:

  • Estrogen hormone replacement therapy, which is therapy given to women who have undergone uterine removal surgery
  • Combination therapy (estrogen and progesterone), which is therapy given to women who experience menopause naturally

Please note that this therapy is not recommended for women who have a history of endometrial cancer, breast cancer , liver disorders, stroke, or women who suffer from blood clotting disorders.

Estrogen hormone replacement therapy can be estradiol tablets or topical estradiol . Patients need to consult further with their doctor regarding appropriate treatment.


In addition to hormone replacement therapy, several types of drugs can also be given to treat menopause symptoms, namely:

1. Antidepressant drugs

This drug is given to control the symptoms of  hot flashes  and mood disorders, when estrogen pills cannot be given for health reasons. Examples of antidepressant drugs that doctors can prescribe are paroxetine, venlafaxine, and fluoxetine .

2. Gabapentine

This seizure drug is given to treat sweat that appears at night. Gabapetin can also be used as an alternative treatment for women who cannot use estrogen therapy as a treatment for hot flashes .

3. Clonidine

Clonidine  is used to treat high blood pressure (hypertension), as well as to relieve the symptoms of  hot flashes .

4. Minoxidil

Hair care products containing 5% minoxidil can be given to treat hair loss. It is recommended to use this product once a day to thicken hair.

5. Sleeping pills

Sleeping pills can be given to treat sleeplessness, but they should only be consumed under a doctor's supervision.

After 3 months of treatment, patients are advised to go back to the doctor. After that, re-examination can be done every year. The goal is to ensure the effectiveness of the treatment that has been given, while monitoring the patient's health condition.

Menopause Complications

Menopause is marked by a decrease in hormone levels, such as the hormone estrogen. This condition can cause several complications, namely:

  • Osteoporosis
  • Diseases of the heart and blood vessels (cardiovascular)
  • Urinary incontinence or uncontrolled urine loss
  • Impaired sexual function, such as vaginal dryness or loss of vaginal elasticity
  • Mood changes, such as being easily moody or irritable
  • Sleep disturbance due to hot flashes , which are hot and hot suddenly in the neck and chest which makes the sufferer sweat easily and feel uncomfortable
  • Weight gain, which begins during perimenopause and continues through menopause

Menopause Prevention

Menopause is a natural process in a woman's body that does not require special treatment. However, there are efforts that can be made to prevent menopausal symptoms from getting worse, namely:

  • Avoid spicy foods and hot, caffeinated, or alcoholic drinks
  • Creating a cool and comfortable home environment
  • Wear cotton clothes to keep your body cool
  • Applying relaxation techniques, including  meditation , breathing control, yoga, and tai chi
  • Using a water-based vaginal lubricant

In addition, to prevent diseases that can arise due to menopause, women are advised to live a healthy lifestyle. Here are some things to do:

  • Exercise regularly, at least 30 minutes every day
  • Get enough rest
  • Do not smoke or consume alcoholic beverages
  • Adopt a healthy diet and increase fiber intake from fruits and vegetables
  • Limit intake of fat, sugar and oil
  • Consult a doctor about the need to take calcium and vitamin D supplements
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