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Menopause basics

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Overview of menopause

Menopause is a natural process of ending menstruation and childbearing capacity. This is the last stage of a gradual biological process in a woman where the ovaries decrease producing the female hormones estrogen and progesterone. Menopause normally occurs between the agees of 45 and 55 years.

Stages of Menopause

Menopausal stages include the following:

Premenopausal period

In this period, the menstrual cycles are irregular. The production of the hormone, estrogen reduces and gradually stops. This period lasts from 6 months to 1 year.1


This is the cessation of the menstural period.

Postmenopausal period


This is the period when the woman has gone through one year without a menstural period.

Physiological Changes during menopause

The following are some of the physiological changes:

  • Increased total cholesterol and LDL-cholesterol
  • Calcium loss from bones causing loss of bone density
  • Increased body fat
  • Atrophy of the tissues of the urinary tract and reproductive organs

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Symptoms of menopause

  • Hot flashes
  • Cold sweat
  • Irregular menstural bleeding
  • Depressed mood
  • Decreased apetite
  • Decreased interest in pleasurable activities
  • Insomnia
  • Feelings of worthlessness
  • Indecisiveness
  • Suicidal plans

Causes of menopause

Menopause is a natural event and occurs between 45 and 55 years of age. Menopause- related mood disorders may be due to hormonal changes,2 life stressors,3 psychological or social conditions and preexisting conditions to develop depression.4

Management of menopause

Managing the symptoms of menopause include the following:

  • Prescribing selective serotonin reuptake inhibitors (SSRIs). 
  • Hormone replacement therapy may be suggested in case of mild depression. The hormone estrogen may be considered when antidepressants fail to work. Hormonal treatment is helpful in managing depressive symptoms during the perimenopausal period and not the postmenopausal period.5
  • Drugs like paroxetine, paroxetine CR and venlafaxine ER are used to treat hot flashes.6
  • Estrogen is used in treating insomnia, which relieves the vasomotor symptoms reasponsible for disrupting sleep.7
  • Women with surgically induced menopause are at an increased risk of later complications like osteoporosis, depression, etc. and will benefit from hormone replacement therapy.
  • Calcium supplementation is also an important aspect, since it combats bone loss, associated with menopause.

Group Therapy

The elevated levels of depression and physical symptoms of menopause is associated with the ‘negative aspects of menopause’ and hence group therapy involves educating women and helping them to learn and cope up with anxiety, depression and irritability.8

Preventing Early Menopause

Menopause is a natural phenomenon in a woman’s development and cannot be prevented. However, early menopause and problems related to menopause can be prevented by,

  • Controlling blood pressure, cholesterol, and risk factors related to heart disease
  • Avoiding smoking
  • Consuming diet with low fat
  • Exercising regularly
  • Taking vitamin D and calcium

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1.National Institutes of Health. National Institutes of Health State-of-the-Science Conference statement: management of menopause-related symptoms. Ann Intern Med. 2005; 142(12 Pt 1): 1003–1013.
2.Steiner M, Dunn E, Born L. Hormones and mood: from menarche to menopause and beyond. J Affect Disord. 2003; 74(1): 67–83.
3.Sloan DM, Kornstein SG. Gender differences in depression and response to antidepressant treatment. Psychiatr Clin North Am. 2003; 26(3): 581–594.
4.Soares CN. Perimenopause-related mood disturbance: an update on risk factors and novel treatment strategies available. In: Meeting Program and Abstracts. Psychopharmacology and Reproductive Transitions Symposium. American Psychiatric Association 157th Annual Meeting. 2004: 51–61.
5.Claudia P, Andrea C, Chiara C, Stefano L, Giuseppe M, Vincenzo DL. Panic disorder in menopause: a case control study. Maturitas. 2004; 48(2): 147–54.
6.National Institutes of Health. National Institutes of Health State-of-the-Science Conference statement: management of menopause-related symptoms. Ann Intern Med. 2005; 142(12 Pt 1): 1003–1013.
7.Miller EH. Women and insomnia. Clin Cornerstone. 2004; 6(Suppl 1B): S8–S18.
8.Robinson GE, Stirtzinger R. Psychoeducational programs and support groups at transition to menopause. In: Steward DE, Robinson GE (eds). A Clinician's Guide to Menopause. 1997: 165–180.