Menopause is a normal, natural event-defined as the final menstrual period and usually confirmed when a woman has missed her periods for 12 consecutive months (in the absence of other obvious causes) and fertility. It is not an abrupt event, but a gradual process. Menopause is not a disease that needs to be cured, but a natural life-stage transition. Menopause is the time in a woman's life when the function of the ovaries ceases due to aging, resulting in lower levels of estrogen and other hormones.

In the Western world, the most typical age range for menopause (last period) is between the ages of 40 and 60 and the average age for last period is 51 years. In some developing countries however, such as Indonesia and the Philippines, the median age of natural menopause is considerably earlier, at 44 years.

Perimenopause is the process of change that leads up to menopause. It can start as early as your late 30s or as late as your early 50s. How long perimenopause lasts varies, but it usually lasts from 2 to 8 years. Women have irregular periods or other symptoms during this time.

Causes-
Normal changes in your reproductive and hormone systems cause menopause. As your egg supply ages, your body begins to ovulate less often. During this time, your hormone levels go up and down unevenly (fluctuate), causing changes in your periods and other symptoms. In time, estrogen and progesterone levels drop enough that the menstrual cycle stops.

Conditions that affect the timing of menopause-
1.Surgical removal of ovaries
2.Chemotherapy and radiation therapy in treating cancer
3.Premature ovarian failure- Normally, the ovaries produce both estrogen and progesterone. Changes in the levels of these two hormones occur when the ovaries, for unknown reasons, prematurely stop producing eggs. When this happens before the age of 40, it is considered to be premature ovarian failure. Unlike premature menopause, premature ovarian failure is not always permanent.

Symptoms-
The signs and symptoms of menopause, however, often appear long before the one-year anniversary of the final period. They include:

• Irregular periods
• Decreased fertility
• Vaginal dryness and atrophy
• Hot flashes
• Sleep disturbances
• Mood swings- irritability, anxiety, depression
• Memory loss
• Increased abdominal fat
• Thinning hair
• Loss of breast fullness
• Weight gain
• Changes in skin texture- including wrinkles
• Growth of hairs on upper lips, chin, chest and abdomen due to secretion of testosterone hormone.
• Urinary incontinence and urinary tract infection

Complications-
1.Osteoporosis, Osteopaenia.
2.Heart diseases, increase chances of stroke.
3.Poor bladder an bowel control

Investigation-
Because hormone levels may fluctuate greatly in an individual woman, even from one day to the next, hormone levels are not a reliable method for diagnosing menopause. Even if levels are low one day, they may be high the next day in the same woman. There is no single blood test that reliably predicts when a woman is going through the menopausal transition. Therefore, there is currently no proven role for blood testing regarding menopause except for tests to exclude medical causes of erratic menstrual periods other than menopause. The only way to diagnose menopause is to observe the lack of menstrual periods for 12 months in a woman in the expected age range.

Treatment-
Menopause is a natural part of growing older. So treatment is required for it unless symptoms bother you. But if symptoms are upsetting or uncomfortable then there are treatments that can help.
The first step is to have a healthy lifestyle. This can help reduce symptoms and also lower your risk of heart disease and other long-term problems related to aging.

• Make a special effort to eat well. Choose a heart-healthy diet that is low in saturated fat and includes plenty of fish, fruits, vegetables, beans, and high-fiber grains and breads.
• Include plenty of calcium in diet to help bones to stay strong. Get 1,200 mg a day after age. Low-fat or nonfat dairy products are a great source of calcium.
• Get regular exercise. Exercise can help in managing weight, keep heart and bones strong, and lift the mood.
• Limit caffeine, alcohol, and stress for better sleep. These things can make symptoms worse.
• Quitting smoking can reduce hot flashes and long-term health risks.

If lifestyle changes are not enough to relieve symptoms, other measures are:

• Meditative breathing exercise (called paced respiration). Breathing exercises may help reduce hot flashes and emotional symptoms.
• Black cohosh. This herb may prevent or relieve symptoms. But experts don't know about its long-term safety.
• Soy (isoflavones). Some women feel that eating lots of soy helps even out their menopause symptoms. It may also help keep your bones strong after menopause.
• Yoga or biofeedback to help reduce stress.

If severe symptoms are present then ask doctor about prescription medicines. Choices include:

• Low-dose birth control pills before menopause.
• Low-dose hormone replacement therapy (HRT) after menopause.
• Antidepressants.
• A medicine called clonidine (Catapres) that is usually used to treat high blood pressure.

All medicines for menopause symptoms have possible risks or side effects. A very small number of women develop serious health problems when taking hormone therapy. Be sure to talk to your doctor about your possible health risks before you start a treatment for menopause symptoms.
Remember, it is still possible to become pregnant until you reach menopause. To prevent an unwanted pregnancy, keep using birth control until you have not had a period for 1 full year.

Role of homoeopathy
Homeopathy can help during menopause by treating physical and emotional symptoms caused by the drastic changes in a woman's hormones. Homeopathic remedies are highly individualized and there are literally dozens of remedies that can be useful for menopausal symptoms, depending on your unique configuration of symptoms. This strengthens the body's vital defenses and restores a healthy balance and sense of well-being.

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