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July 2006
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Women in Focus

Menopause is a Normal Event
By Ibrahim B. Syed



Support from family members and friends will help the woman tackle emotional problems like depression and anxiety that occur during Menopause.


“Such elderly women as are past the prospect of marriage, there is no blame on them if they lay aside their (outer) garments, provided they make not wanton display of their beauty; but it is best for them to be modest; and Allah is One Who sees and knows all things”. (Qur’an, Surah An-Nur, 24:60).


Older Muslim women who are past the prospect of marriage are not required to wear “the outer garment.” Here the women who are past the prospect of marriage refer to those women who have attained menopause and who cannot bear children.


Menopause is defined as the time when a woman stops having her monthly menstrual cycle. The period from menopause until death when a woman is no longer able to conceive a child because her ovaries have stopped releasing eggs and estrogen is called “Climacteric.“ Almost 220 million Muslim women are presently in the post-menopausal or climacteric stage of their lives.


Natural menopause can occur as early as age 38 or as late as age 60, the average being 50 years. Women whose ovaries or uterus have been removed surgically or whose ovaries have been irradiated with large doses of X-rays or gamma- rays will experience their menopause immediately after the operation and sometime later in the case of irradiation.


Menopause is a gradual process, which in most women lasts about two years. It is a normal event in every woman’s life and should not be thought of as a disease. It is now known that most women continue to produce small amounts of estrogen often up to 30 years after their menopause, although the ovaries do not secrete it directly. The estrogen is manufactured in glands other than the ovary, in the brain and bone and especially in fat tissue in the post-menopausal woman’s body.


Symptoms of Menopause

No two women experience the menopause in the same way or at the same time. It is not known what exactly triggers the change of life, even though it is probably related to hormone levels that are adjusting to general aging process in the body. Changing hormone levels account for hot flashes, a symptom that about half of menopausal women experience. A hot flash usually lasts a few minutes and is preceded by a chill followed by heavy sweating. Sometimes, rapid heart beating, numbness and tingles also occur. Only about one in twenty women have hot flashes that are extremely debilitating. These women are unable to sleep at night and may be very tired, nervous or irritable because of the discomfort of the flashes. Luckily most women have hot flashes that are mild, and infrequent and do not disturb their life to any significant degree. One should not forget that a woman’s experience of menopausal symptoms could be influenced by a number of personal and social factors, such as how she feels about aging, her general health and her involvement with activities that enable her to feel productive and worthwhile. Hot flashes are not life threatening and, in most women they go away without treatment such as estrogen therapy.


Depression

Emotional problems during menopause, such as anxiety, depression and nervousness are based on social and cultural factors rather than changes in estrogen levels. Fortunately, Muslim women do not consider middle age to be a stressful time in their lives and do not become especially anxious or irritable around the time of the menopause.


There is no scientific evidence to justify the use of hormone therapy for those psychological difficulties that may arise during the menopausal years. Estrogen cannot give a woman self-confidence or emotional self-control. Loneliness, lack of energy, tension and crying spells may occur at anytime in a person’s life; estrogen therapy cannot relieve menopausal women from such feelings. Acknowledging these feelings and talking about them with a sympathetic family member, friend or doctor may provide increased self-understanding and relief.


Hormone Therapy

Hormone therapy (HT) for the management of menopausal symptoms and as a preventive measure to guard against health problems of older age, has dominated discussions in recent years. Hormone ‘replacement’ therapy has been around since earlier this century. It was first developed as estrogen only, but it was found to cause cancer of the endometrium (the lining of the uterus) and fell from grace. More recently, progestin was added to the estrogen in order to make the therapy safer. As menopause hormone levels drop as part of the natural process, so the concept of ‘replacing’ them is misleading. Giving hormones at or after menopause treats menopause as an estrogen deficiency disease rather than as a natural occurrence in a woman’s life.


What is HT?

Hormone therapy is a medication prescribed to add hormones when the amount normally produced by the ovaries decreases as part of the process of menopause. The two main types of hormones in HT are estrogens and progestins. They are produced artificially and attempt to resemble the hormones produced naturally by a woman’s body. In HT, these hormones may be prescribed together or alone. Women who have their uterus intact are prescribed combined therapy of estrogen and progestin. Women who have had a hysterectomy are prescribed only estrogen.


Testosterone is another hormone, which is occasionally used. In women, this hormone occurs naturally in small quantities. Its use remains controversial, as there is limited research into its short term and long-term effects.


Hormone therapy is very effective in reducing those symptoms of menopausal women that are related to the decreasing body levels of estrogen. Taking hormones for a short time while the body adjusts to its new hormone level frequently helps women with severe hot flashes Hormones do not cure the menopause; they simply help some women who have disabling symptoms get through it more easily.


(The writer is President, Islamic Research Foundation International Louisville. E-mail: irfi@iname.com. Website: www.irfi.org)