Menopause, a universal reproductive phenomenon is of great concern to many women as they advance in age. This is as a result of insufficient knowledge and understanding and lack of available information to assist them and their families during the period of transition.  Menopause is the natural and inevitable part of a woman’s life. It is the end of a women’s menstrual cycle which inevitably marks the end of her reproductive years.
Naturally, women are born with all their eggs, which are stored in their ovaries. Their ovaries also make the hormones estrogen and progesterone, which control their period (menstruation) and the release of eggs (ovulation). Menopause happens when the ovaries no longer release eggs every month, leading to the stoppage of menstruation. Menopause is a regular part of aging when it happens after the age of 40.
However,some women can go through menopause early. This could be as a result of surgery or damage of their ovaries during cancer treatments and is known as premature menopause.
According to studies natural menopause is different in each woman and comes in three stages.  Perimenopause is the first stage which usually begins several years before menopause, the ovaries slowly make less estrogen and at this point stop releasing eggs. Many women at this stage start experiencing menopause symptoms.  Menopause is the second stage. This is one year after the menstruation has stopped. The ovaries have stopped releasing eggs and making most of their estrogen.  Postmenopause, the third and final stage happens years after menopause.  Menopausal symptoms such as hot flashes usually ease. But health risks related to the loss of estrogen increase as women get older.
In a medically reviewed study by Dr Gabriela Pichardo in June, 2022,she revealed that, most women nearing menopause would begin experiencing some array of what are called Vasomotor symptoms (VMS). The most common is hot flashes, sudden feelings of warmth that spread over the upper body, often with blushing and sweating. These flashes can range from being  mild in most women to severe in others.
Dr Pichardo added that, women may also notice uneven or missed periods, vagina dryness,sore breasts, leading to more  frequent urination, lack of sleep, emotional changes, dry skin, eyes and mouth. Other symptoms which develop later include, fatigue, depression, crankiness, racing heart, headaches, joint and muscle aches  and pains, weight gain, hair loss and changes in sex drive.
Other symptoms according to other researchers include facial hair increase, being angry /agitated /impatient or abusive, being teary or crying for no reason, reduced or enlarged breasts size, burning feet on “fire”, dizziness, increased appetite, leg cramps and restless legs, low self -esteem,” going crazy”, anxiety, poor memory, dyspareumia, post – menopausal bleeding and lack of energy.
Reports indicate that the most prospective mean age of menopause for women in the United States is 52 years. These ages stand in  contrast to the mean ages for menopause of 51 years for United Kingdom, 50 years for China,50 years for Japan,48 years for Nigeria, 47 years for Pakistan, 45 years for India and 44 years in the Philippines.
Reports also have it that there are particular cultural beliefs which impact on women’s understanding and reactions to menopause.  Widespread  in a belief that sexual intercourse would no longer be possible after menopause. That menstrual periods are considered to cleanse the body of semen. If women have intercourse after menopause it is believed that semen will remain in the body and produce stomach bloating and then death.
Consequently, lack of knowledge about menopause made some women misinterpret symptoms as signs of serious illness .
In different interviews with The Tide in Port Harcourt, some women in their 50s expressed their experiences concerning menopausal symptoms.
“I am 53  years old and Iam just experiencing menopausal symptoms. My period is irregular.  I feel heat most times all over my body which makes me uncomfortable and at times extreme cold and then few minutes later heat again. I discussed it with some people, they said it was menopause, that it is a phase that will pass”, said a civil servant resident in D/Line area of Port Harcourt.
Another respondent, a teacher in a government secondary  school in Iwofe area of Port Harcourt, Rivers State shared her experience.
“I know about menopause, so when I started experiencing the symptoms, I went to see a doctor to confirm. I was 45 years then and just had my last twin children. I experienced hot flashes from head to toe, hotness of body, restlessness, constant sweating like Iam pregnant, fever, body pains, irregular periods,low sex drive, eating different things like “esu” (nature chalk). Infact, I felt like I ate poison and needed cure. I went to the doctor and was diagnosed as adinomyosis and was given drugs.
Sharing similar experiences,another respondent, an estate surveyor based in Port Harcourt stated thus:
“I started experiencing menopause symptoms at 44 years.  I did not understand my body at first . I thought I was going crazy.  I experienced lack of concentration, restlessness, distractions, mild hot flashes, waist pain, increased stomach, weak teeth and bones, weaker eye sight, lack of interest in sex. Infact, I did not believe what was happening to me. I had to discuss the situation with an older woman who told me that it was menopause”.
Also, a staff in one of the media organisations in Rivers State told The Tide that:
“I noticed the symptoms at 47 years old, with hot flashes, especially in my breast area, hotness of body sometimes and cold shivers often times, low energy, infact holding a bottle of water was a problem, body pains, irregular periods, large appetite, fainting experiences, dizziness  and vaginal dryness.  I did not understand that it was menopause”.
The management and treatment of menopausal symptoms depend on each individual woman’s experiences. Studies have it that healthy living, herbal and complementary therapies are the solutions.
However, many women can cope with mild menopausal symptoms and do not need to take any medications or use therapies.  Some women may manage their symptoms well with lifestyle measures such as eating well and getting regular physical activity. Other women with symptoms that are affecting their quality of life will need to seek treatment to help them manage their symptoms.
Menopause is  a unique experience for all women, and a range of management options are available for the different symptoms including healthy living, menopausal hormone therapy or MHT, treatments to manage vaginal dryness. Non –  hormonal prescription medications and complementary therapies. Though some treatments are well supported by valid scientific research, it is important and advisable to see a doctor before you start a treatment.
Coping with menopausal symptoms can be helped by balanced and nutritional diet, exercise and relaxation.  Healthy weight is important  though some studies have suggested that exercise can reduce hot flashes.  Women should reduce intake of caffeine, alcohol  and spicy foods, stop smoking.  Rather, they should eat foods with phytoestrogens such as whole bean soy products, whole grains barley, brown rice), legumes (beans). To manage hot flashes, carry small hand fans, use water facial spray, have cool drinks available, wear layers of clothing so you can take off what you need to when you are hot. Meanwhile, reports have it that many women suggested that more information should be made available on menopause to prepare women, educate family members and help reduce negative connotations and family conflict, especially with their spouses during the period of transition,  since experiences by many women had it that a loss of libido was often misinterpreted by their partners  that they were having an affair.
Also, information should be passed on by mothers and grannies to daughters.
It is therefore, suggested that community education may have more benefit if directed towards men as well as women.
Also reported are, that most health workers, especially in developing countries lack adequate resources or understanding on how to approach the topic or give appropriate advice to women.
A Rivers State Government Matron/Nurse in an interview stated that she has worked  as a nurse with the primary health care management board for several years, there are no such programmes for women on menopause.
According to her, “basically we deal with women on child bearing age, the partners we work with have not come out with such programmes. However, government should partner with menopause associations to help women in the state,” she said.
In a related interview, a medical doctor who works in a government hospital in Port Harcourt, Rivers State, stated that in developed countries government encourages women to go for regular check of their reproductive system at least once a year,  free of charge or some on discounts . In Nigeria, a lot of women are not aware of the transition to menopause and its implications, because they are nonchalant about their health status. The doctors are overstressed and cannot help in giving talks to women about menopause at every given opportunity. Another worrisome issue is that, some women lie about their age, some even take ten years off their normal age, which is a problem.
However, since 2009, the International Menopause Society  (IMS) in collaboration with the World Health Organisation(WHO) has designated October 18 every year to be celebrated as World Menopause Awareness Day. The purpose of the day is to raise awareness of menopause and support options available for improving health and well-being of women as they age.
This is an opportunity for the Rivers State  Ministry of Health and the  Women Affairs counterpart to partner with relevant associations and groups to sensitise  women in the urban and rural areas in the aspect of understanding  menopause, its attributes, symptoms, management and healthy ageing.

By: Ibinabo Ogolo