It is not entirely disputable if one said a woman is symbolically defined by two stages in life: the onset of menstruation and menopause. The former signifies the beginning of womanhood and the latter its end. Before menstruation, a woman is all but a child—nothing more or less. After menopause, she is just another ‘older person’ hitting en route to the elderly bracket.

Okay, not like we are being mean to women here; fact is, a woman feels a bit weird and empty in post-menopause.

Simply put, a menopause is the time in woman’s life in which the menstrual cycle ends. But the onset of menopause can be as depressing as it is scary. The cocktail of disruptive symptoms during menopause includes depression, anxiety, exhaustion, aching muscles, night sweats, memory loss—and yes, hot flushes (sudden brief sensation of heat associated with menopause and some mental disorders).

Dr John Muganda, head of gynaecologist department at King Faisal Hospital, Rwanda, says the onset of menopause is from the age 45 and above—although there are cases where women have reached menopause a few years before.

He says some women can have complications while others don’t and that at the start of menopause, some women can have acute complications that are experienced for long and for others it can take a short period and it stops.

"To diagnose menopause, periods have to stop for at least six months, then after that period, we can confirm that it is menopause. We don’t have many signs unless for those who have just complications like body pain, abdominal pain, they can feel heat in the body; sometimes they have dyspareunia where intercourse is painful,” Dr Muganda says.

Habyiza, a 55-year-old woman from Kayonza District, says it’s been 13 years since she stopped experiencing her menses.

"I used to feel cold and all of a sudden I got hot flushes, my muscles and the back were all aching. Basically, my whole body was different and it was hard feeling my joints in the body,” Habyiza says.

During that time, she says she gained weight. But this could be expected of a condition that causes depression and anxiety.

Florence started menopause last year and she is trying to cope up with the new phase in her life.

"I have pain in the knees, in the back but it was most severe in the first few months. At first, I saw dark blood and for the following month there was very little blood, eventually the periods disappeared,” the 48-year-old woman from Rukara Sector in Kayonza, says.

"I started feeling hot flushes and then felt a wave of cold at the same time. I had to go to the hospital because I thought it was family planning affecting me. The doctors never told me the cause but gave me medicine. I later learnt from my friends that it was menopause.”

She says the new phase in her life mostly affects her intimacy with her husband because she is now too weak and emotionless to attend to her husband.

Dr Rachna Pande, a specialist in internal medicine at Ruhengeri Hospital, says menopause occurs due to change in hormonal levels. Around middle age, estrogen levels decline.

Put another way, menstruation occurs due to shedding of inner lining of uterus, which had built up around ovulation to receive a baby. With advancing age ovaries stop producing eggs and hormonal level changes stop the process of buildup of endometrium and subsequent shedding.

Dr Wulf H. Utian, a South African pioneer in menopause research, in an article in a magazine, Menopause Management, says menopausal vasomotor symptoms can have a significant negative impact on quality of life (in younger and older women, contributing to physical as well as psychosocial impairment.

Becoming flushed and sweating profusely in a social or work-related situation may cause extreme anxiety for many women, and may lead to social isolation.

Symptoms of menopause

"Around menopause, women suffer from hot flushes, palpitations, vague body pain, depression and others. These symptoms are due to overlay of hormonal as well as social problems, it is at this time typically age related changes start appearing over a woman like wrinkling of skin, greying of hair and others, which depresses her,” Dr Pande says.

"If a woman is married, the husband becomes more involved in his career, rather than romancing, thus making the woman feel ignored.”

Menopause, she added, increases susceptibility of a woman to high blood pressure and heart problems because estrogen protects against these problems before menopause.

How women react

There are different reactions from different women regarding menopause.

Some are, unfortunately, completely ignorant and have to be explained all, some take time to accept the situation, whereas others accept it happily and move on with their chores.

"Those having severe depression or anxiety-related symptoms are given tranquilisers to help overcome their symptoms,” Dr Pande says.

"Apart from cases where there are really severe complications, otherwise women are prepared for menopause. At the age of 45 all women should be prepared that at a certain time they will stop having periods.”

Dr Muganda says sometimes reaching that phase of womanhood is a solution of many problems, citing women who experience painful periods.

"There are some illnesses like tumors/ fibromyoma which stop growing when the periods stop, also, many women struggle with family planning so when you start menopause it becomes a solution,” he says.

Dr Muganda says women sometimes make a big deal out of menopause because they lack enough information of what they should be focused on.

He says at that age, there are many things to focus on, like cervical cancer screening, breast cancer, ovarian cancer and others, very critical conditions that need to be assessed other than being focused on menopause.

Dr Subira Manzi, a senior consultant gynaecologist King Faisal Hospital, Rwanda, says women in menopause continue with their normal work unless there are complications.

"Due to lack of hormones, menopause makes the sex life of women a bit hard. Couples have to understand sex can’t be as enjoyable and as frequent as when they were in their 20’s. It’s just a matter of understanding between the partners so that the sexual drive is not completely lost,” he added.

Expert view: Dealing with menopause

Mental stress, alcohol, middle-age obesity augments this problem.

Experts say women in this phase of life should take nutritious diet. Where need be, iron and calcium supplementsn are given.

Dr Pande says if women keep themselves busy, the depression, anxiety and other related symptoms do not affect them much.

"Estrogen replacement therapy had been initiated about two decades ago to relieve symptoms of menopause but is very controversial now due to the side effects of prolonged estrogen exposure after menopause like risk of cancers, blood clotting, high lipid levels, among others,” Dr Pande says.

She also advised that the best option for these women is to take up some creative work at this age. For example, one can teach skills to younger generation to keep themselves occupied if not in a job or some business.

"Keeping good company of cheerful and well-meaning friends is helpful. The family also needs to be counselled to respond to her needs and give her due attention, "Dr Pande says.

Dr Manzi says helping women in menopause starts by understanding their culture, their lifestyle and that by that lifestyle, one can talk of important foods, important exercises to the patients.

"We start with understanding the culture and then talk to them according to what they can understand, according to what can be easy to be applied in terms of food intake because when women reach menopause, they tend to be less active, to have a slow metabolism and, therefore, more chances of gaining weight,” he says.

"There are situations when it’s necessary to give some medication such as for hormone replacement.”

The gynaecologist said menopause means there is no release of some hormones, for treatment, doctors have to replace what is missing, which ultimately helps lessen the symptoms.”

"Menopause is irreversible; when a woman starts menopause and later experiences bleeding, you have to go for a checkup because it is abnormal bleeding,” Dr Manzi said.

Dr Muganda advised women to consider regular checkups when they clock the age of 40.

He said how the complications are dealt with depends on the confirmations of the real situation.

The doctor said there is need to assess if the complications are related to only menopause.

"When we confirm that it is menopause, we consider how it is severe by doing a follow up for a certain period because it is expected to reduce, and if it doesn’t, it is better not to take medication because the medication given is hormones, which have complications,” he added.