CAIRO: Regularly experiencing hot flushes, a bit of insomnia, nervousness, more facial wrinkles, dryer skin and weaker vertebrae are some of the common signs of menopause - coupled, of course, with the menstrual irregularity that leads to cessation. Nonetheless, many women are still surprised with such physical symptoms, not to mention even less aware when it comes to the associated psychological effects of menopause. Even research in the area is scarce in comparison to studies of birth and maternal health, according to Officials at the World Health Organization's (WHO) Regional Office for the Eastern Mediterranean (EMRO). Dr. Ramez Mahaini, the EMRO regional advisor on women's reproductive health, points out that there is "false common knowledge that reproductive health as a field is limited to the fertile stage of women's lives. Menopause, which usually occurs between the mid 40s and late 50s, is often overlooked and ends up at the bottom of the priorities list for public healthcare expenditure in developing countries. In Egypt, about two million women are within an age bracket of 40 to 60, as opposed to 11,757,656 women in the 15 to 40 age bracket, according to the Egypt State Information service. Colloquially, menopause is still referred to in Arabic as the "age of despair. Although this phrase is a shorter version of another term meaning to lose hope in the pregnancy, it spread within the community in such a misleading manner, according to Hind Abu Soud Khattab, chairperson of the Egyptian Society for Population Studies and Reproductive Health. Thus, menopause has become a synonym of losing hope in life. Meanwhile, experts note the importance of women understanding that menopause is not the end of their lives and that both family and community should be supporting women during this critical period. Dr. Mahaini stresses that menopause concerns both men and women. Khattab notes that literacy is not usually related to the level of regarding menopause; even educated women approach menopause with the same forlorn attitude. However, there are notable improvements, according to Dr. Amr Nadim, professor of Obstetrics, Gynecology and Reproductive Medicine at Ain Shams University's Faculty of Medicine. As Arab societies are now more open to the West, more women are now aware that menopause is a stage in life where "they are still attractive, productive and sexually active, he explains. Yet, it is still limited; even some physicians are not aware of the proper approach to the issue. "A lot should be spent to improve physicians' attitude towards menopause and the way they are dealing with it, says Dr. Nadim. "Unfortunately most doctors look at menopause as a source of disease. They will do more mastectomies, more hysterectomies, etc. They are not viewing women in this transitional era of life. They should learn how to be empathetic, adds Dr. Nadim. It is no surprise then that many women going through menopause experience a lack of self-confidence and show signs of depression. According to Khattab, a considerable number of women try to conceal the fact that they are going through anything at all. This could be associated with the low level of reproductive health awareness in general. Dr. Mahaini says that often the struggle for women's rights overshadow the importance of addressing women's health. Khattab says that even when menstruation begins during puberty, it is being poorly addressed. "No one talks about it or [knows] what to do about it, she says. As girls within Arab societies are usually not prepared to this stage of their lives, women are also not prepared for menopause, which sometimes causes shock and fear. "The menopause is the time of a woman's life when reproductive capacity ceases. The ovaries stop functioning and their production of steroid and peptide hormones falls, reads a 1990s' WHO research on menopause. The research adds that the physiological changes are the result of ovarian function ending and/or the aging process. It describes the symptoms as "self-limiting to life-threatening, but are nonetheless unpleasant and sometimes disabling. The perimenopause, the onset of menopause that is often marked by signs such as hot flashes and menstrual irregularity, could take months or years - according to the WHO study, only 10 percent of the women experience an abrupt stop of menstruation. The vasomotor instability leads to the hot flashes/flushes followed by sweating and chills, which are more pronounced in slim, smoking women, explains Dr. Nadim. Other symptoms that mainly stem from estrogen deprivation include the vaginal dryness, urinary frequency and incontinence. Dr. Nadim also referred to "an increase in the incidence of cardiovascular problems including myocardial infarction and stroke . [And an] increase of incidence of postmenopausal osteoporosis with an increased incidence of femur neck and vertebral fractures. Such symptoms require medical guidance. "All women need to follow a family physician who understands the changes that are peculiar to this phase of life, Dr. Nadim says. "The physician is intended to provide guidance, help, direct the lady toward a healthier lifestyle as well as toward important check-up tests including pap smear, mammography, occult blood in stool testing, trans-vaginal ultrasound. Medication, however, is not a must. "They are to be prescribed on [an] individual basis and according to peculiar needs, he adds. It is not, however, all physiological. There are plenty of psychological syndromes that require attention, which include restlessness, emotional liability, nervousness, insomnia, crying spells, tendency toward poor memory, loss of confidence and an inability to make decisions, according to Dr. Nadim. "There is further a decrease in libido (sex drive). They may be either due to a direct effect of estrogen withdrawal or they come secondary to the physical symptoms, Dr. Nadim adds. "Alzheimer is also met with increasingly after menopause, but is probably due to the aging process. Depression can also be added to the list of symptoms, although there is no solid proof that it is directly related to menopause. "The cause of depression again is not quite understood. It may be the culmination of all the preceding psychological and physical effects or sometimes a direct effect of the oestrogen deprivation, he explains. The WHO study also notes that depression could be a result of stressful events usually associated with the mid-life period. Other organizations concerned with menopause are usually focused on the medical part concerning physicians, surveys and conferences. Dr. Nadim notes that these organizations, including the Egyptian Menopause society, which he serves on as treasurer, are not directed to women, "who are the main stakeholders. Yet, family support and individual awareness could be used instead. "Women and families need to understand the nature of the changes, Dr. Nadim explains. "They need to know that such changes are not the end of the childbearing period but the beginning of a new era of life that may be filled [with] enjoyment. "This definitely needs an understanding on the part of the family, especially the husband and the children. Counseling about changes, healthier lifestyle and possible medications are to be tailored according to specific situations. The golden rule is that in menopause: everything is all about maintaining balance.
