As we age, many changes take place, and not all of them are easy to cope with. Many women are surprised by the changes that come with menopause.
Menopause is the time when a woman's menstrual cycle stops. After 12 consecutive months without a period, a woman who used to have a period is considered to be in menopause.
It occurs when periods stop due to lower hormone levels, usually between the ages of 45 and 55. It can, however, happen earlier.
Dr John Ong'ech, an obstetrician and gynaecologist at Kenyatta National Hospital, explains that during menopause, women experience a decrease in estrogen (female sex hormone) levels, which leads to physical changes in the vagina, vulva, and cervix. These changes can lead to symptoms such as vaginal dryness, mood swings, insomnia, and urinary tract infections.
Formerly known as vaginal atrophy, these changes now called the genitourinary syndrome of menopause affect many postmenopausal women.
"The good news is that these changes can be treated and reversed," says Dr Ong'ech.
To manage the symptoms, he recommends the use of vaginal estrogen — a type of local hormone replacement therapy (HRT).
"When you go through your monthly cycle, you ovulate, and the system produces estrogen and progesterone. When a woman goes through the menopause, the estrogen disappears," he explains.
"Vaginal estrogen is used to treat vaginal dryness and irritation that can occur during menopause," he adds.
However, he points out that not every woman with this condition is suitable for vaginal estrogen.
"To make sure it's safe to use, it's important to tell your doctor or nurse if you have any allergies to estrogen or other medicines, have been or are being tested for breast cancer, have a family history of breast cancer, a history of other types of cancer, diabetes, or high blood pressure," he clarifies.
Vaginal estrogen comes in different forms, including tablets, pessaries, creams, gels, or rings that are inserted into the vagina. When estrogen is used only in the vagina, it is called local HRT.
Dr Ong'ech explains that the dosage of vaginal estrogen depends on the specific medication used.
He generally recommends using HRT daily to reach the required level of estrogen to reverse symptoms. However, the duration of use may vary depending on the patient and the symptom being treated.
"It starts replacing the estrogen immediately," he says.
If vaginal estrogen alone is not enough to relieve symptoms, a higher dose of HRT may be considered. Vaginal estrogen usually requires a prescription, except for the Gina brand (vaginal tablets), which can be bought from a pharmacy.
Dr Ong'ech is quick to point out that while vaginal estrogen can help with dryness and irritation, it will not treat other menopausal symptoms such as mood swings or insomnia.
Patients, he warns, are more likely to get breast cancer if they have higher levels of the hormones estrogen, progesterone, or testosterone.
"In post-menopausal women, those who are predisposed to breast or womb cancer may develop the disease if they are given estrogen. It's important to identify suitable candidates before giving estrogen to temporarily relieve postmenopausal symptoms," says Dr Ong'ech.
He explains that it's important to understand that hormone imbalance is different from the natural hormonal changes that occur during menopause.
Hormonal imbalance typically occurs in women who do not have regular periods and do not ovulate. That's why it's important to see a doctor for proper diagnosis and treatment of any hormonal imbalance issues.
"Hormone imbalance is often misunderstood. A woman with a hormonal imbalance is someone who does not have a regular period and does not ovulate,” he says.
