"I ALWAYS dreamed of finishing school, getting a jog, getting married and having kids – in that order. However, things don’t always go according to plan. I was in school longer than I was supposed to be, when I finished, I was in between jobs for four years till I settled with one. Meeting a guy seemed harder than I imagined and the two relationships I had been in after school turned out to be a disaster. By 34, I had actually considered just getting pregnant and taking care of my baby.”

These are the words of Alicia (not real name) who, like most desperate women, considered having a baby, in or out of wedlock out of fear of waking up one morning and realising that biology wasn’t on their side. Unfortunately for Alicia, that is exactly what happened.

"I got so consumed with work that I barely got time for anything. Eventually, my yearning for a baby somehow vanished. As I glided through my thirties, I started getting irregular periods. I thought it was something to do with my diet. I ignored it. It wasn’t until I went to see my mother and told her about it, that she advised me to see a doctor. When I did, imagine the shock I got when after the tests came back, it was pre mature menopause! I was 39.”

Like Alicia, Mary (not real name) has been a hardworking woman all her life.  She has always maintained a very busy and active schedule. She is involved in her church as a volunteer and leader, supporting local charities, working fulltime, and babysitting her grandchildren regularly. But in the last couple of years, she has slowly lost control on her emotions. She breaks into outbursts over small things.  She has been removed from volunteer positions at her church for being argumentative and confrontational.  

Like Mary, Women all over the world experience this ‘temporary’ life change behavior caused by the effects of menopause.  

Menopause is the term used to signify the end of menstruation in women. It refers to the time when a woman stops ovulating. Once this happens she ceases to have her periods any more.  

Doctors say the physical change of menopause is natural and normal.  But every day is a challenge when enduring menopause. You suffer from pain, anxiety, night sweats and mood swings. 

Research on menopause in Rwanda is not extensive and the average age of women going into Menopause in Rwanda has not been established by research.  However, although the time spent in menopause (now up to one third of the life cycle) has increased with the phenomenon of increasing longevity, the actual age of menopause generally, approximately 50-51 years, has not changed.  Women from ancient Greece experienced menopause at the same age as modern women, with the symptomatic transition to menopause usually commencing at age 45.5-47.5 years.

When it strikes early

When a woman experiences early or premature menopause, it can be shocking, most especially if she is unaware of the signs and symptoms of early menopause. This off guard experience leads to physiological and emotional consequences.

According to Dr Alphonse Butoyi, a gynecologist at Kibagabaga Hospital, there are known tangible reasons why a woman would encounter menopause earlier than expected. 

"It’s rare to find a woman in menopause at an age of 38, but the cases are there. Although once a month I get women complaining about the symptoms of menopause, the signs and symptom defer from woman to woman,” Dr Butoyi discloses. 

He further says that signs and symptoms of menopause include, hot flushes and night sweats,  loss of libido (sexual desire), mood swings or changes such as depression, palpitations (changes in heart rate) nagging and constant headaches, anxiety or tiredness as well as sleeping problems like insomnia and many more. 

According to menopause.org, the most common menopause-related discomfort is the hot flash (sometimes called a hot flush). Although the exact cause is still a matter of speculation, hot flashes are thought to be the result of changes in the hypothalamus, the part of the brain that regulates the body’s temperature.

If the hypothalamus mistakenly senses that a woman is too warm, it starts a chain of events to cool her down. Blood vessels near the surface of the skin begin to dilate (enlarge), increasing blood flow to the surface in an attempt to dissipate body heat. This produces a red, flushed look to the face and neck in light-skinned women.

It may also make a woman perspire to cool the body down. An increased pulse rate and a sensation of rapid heart beating may also occur. Hot flashes are often followed by a cold chill. A few women experience only the chill.

"Menopause always causes a wide range of physical and psychological symptoms but the first significant symptom which makes women realise that they are about to go in their menopause is usually a change in the pattern of their menstrual period. Women usually encounter menopause at the age of 45 to 50 though it can go till 55 years of age and at times it can be as early as 38 which is abnormal,” Dr. Butoyi explains.

He adds, "Menopause causes hormonal imbalance thus women experiencing menopause need hormonal treatment, especially estrogen. But the natural remedies are the most recommended.” 

Gerald Ruzindana, a Consultant at Amazon Nutrition and Complementary Therapy Limited in Remera, advises any woman experiencing menopause to have a balanced diet to deal with the hormonal changes or hormonal imbalance. 

"Natural and alternative remedies have been widely recognised for dealing with menopause symptoms. For example the recommended foods such as whole grain foods, legumes, fresh vegetables and fruits have nutrients that help in dealing with hormonal imbalance,” Ruzindana explained.

He also said that foods with Vitamin E and calcium are recommendable and very important when a woman is in menopause.  

"Besides dieting, the women in menopause also have to exercise since it helps in balancing hormones as well as dealing with stress, mood swings and sleeping disorders. For example if a woman is in menopause and she is working long tiring hours, she should drink 300ml of water every two working hours,” Ruzindana emphasised. 

What food does one need during menopause? 

Medical experts advise that all postmenopausal women should be encouraged to employ lifestyle practices that reduce the risk of bone loss and osteoporotic fractures: maintaining a healthy weight, eating a balanced diet, obtaining adequate calcium and vitamin D, participating in appropriate exercise, avoiding excessive alcohol consumption, not smoking, and utilizing measures to prevent falls. 

Periodic reviews of calcium and vitamin D intake and lifestyle behaviours are useful. After menopause, a woman’s risk of falls should be assessed annually and at any time her physical or mental status changes.

Supplementation with 1000-1500 mg of calcium per day remains a mainstay of prevention therapy, as does vitamin D supplementation and regular weight-bearing exercise. He warned that excessive salt, animal protein, alcohol, and caffeine offset these benefits. 

Early signs of menopause are clues to the onset of the symptoms of menopause in a relatively early time. Some of the more common early signs of menopause, or premenopause symptoms and peri-menopause symptoms, may include:

• Changes in monthly cycle• Mood swings, irritability• Headaches• Hot flashes/flushes• Chronic fatigue• Depression• Aches and pains, cramps• Changes in body hair• Yeast infections• Increase in PMS• Changes in sleep pattern• Loss of interest in love life• Water retention• Night sweats• Less vaginal lubrication• Fluctuations in blood sugar

Coping tips for women

Self-Care at home

Hot flashes: Several nonprescription treatments are available, and lifestyle choices can help. 

• Many women feel that regular aerobic exercises can help reduce hot flashes, bit controlled studies have not proved any benefit.

• Foods that may trigger hot flashes, such as spicy foods, caffeine and alcohol should be avoided. 

Heart disease: A low-fat, low-cholesterol diet helps to reduce the risk of heart disease.

Weight gain: Regular exercise is helpful in controlling weight.

Osteoporosis: Adequate calcium intake and weight-bearing exercise are important. Strength training (lifting weights or using exercise bands in resistance training) can strengthen bones.

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THE STAGES OF MENOPAUSE

According to avogel.co.uk's "How long does the menopause last” , menopause stages include the following. 

Pre-menopausal

The term pre-menopausal is also used to define the time up to the last menstrual period (which you don’t know is the last one until 12 months later), so it’s not very precise. If you like, it’s the run-up to the run-up to your last period, during which time you may start to get the first clues that your menopause is on the horizon.

Perimenopausal

The perimenopause is the time around menopause during which the menstrual cycle changes are occurring but a whole 12 months of amenorrhoea has not yet occurred. You may have stopped your periods, but you haven’t yet had 12 months of no-periods, so you can’t officially claim to be post-menopausal.

During this time many combinations of symptoms are experienced by different women, although some may just stop their period and experience nothing else – anything is possible!

Postmenopausal

When you have your last menstrual period you officially become post-menopausal. Obviously, you don’t know it’s your last period until you’ve had a year of no periods. Even then, you may have another couple later on, but officially you can claim to be post-menopausal after 12 months of no periods.

How long you will spend in each of these phases is completely individual. We can give you averages, such as, ‘Most women experience the majority of their symptoms over a 2-year period of time’, but that will just annoy those women who find themselves still up to the eyeballs in hot flushes after 5 years.

The average is around 52 years old, but many women start in their 40s and some not until their late 50s, so really you just have to see what happens for you.

Menopause is never a bad thing; it’s a natural thing every woman has to go through. But being diagnosed with premature or early menopause, and the loss of fertility, can be devastating. No woman welcomes it with open arms before she is able to leave her DNA on earth.

According to womenshealth.gov, women who want to have children and go through early menopause may feel extremely upset. If you want to be a parent, talk to your doctor about other options, like donor egg programs or adoption. Your doctor may suggest that you see an infertility specialist.

You also can talk to your doctor or a therapist about painful feelings from the loss of fertility and other effects of reaching menopause early.