Every year on October 18, World Menopause Day is celebrated to increase awareness of menopause and the available support options for enhancing health and well-being. Typically, experts encourage women to engage in this worldwide awareness campaign by printing and distributing these materials, hosting community events, and sharing social media posts related to World Menopause Day.

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The theme for World Menopause Day 2023 is "Cardiovascular Disease”. Researchers have recently discovered that a woman’s reproductive experiences (including menstruation, pregnancy, breast cancer treatments and menopause) can affect the chances of developing cardiovascular disease later in life, stressing that awareness of this can help determine an individual’s risk.

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The World Health Organization states that menopause is one point in a continuum of life stages for women and marks the end of their reproductive years. After menopause, a woman cannot become pregnant, except in rare cases when specialised fertility treatments are used.

According to Dr Uwineza Mireille Aimée Uwineza, an obstetrician and gynaecologist at Legacy Clinics, menopause is when a woman’s periods stop due to lower hormone levels. It usually affects women between the ages of 45 and 55, but it can happen earlier.

Menopause is caused by the loss of ovarian follicle function and a decline in circulating blood ovarian hormones (oestrogen and progesterone) levels. It affects anyone who has a period, Uwineza added.

She explained that there are two types of menopause, that is, induced and natural.

"Induced menopause is menstrual that stops after surgical removal of the ovaries, chemotherapy or radiation damage to the ovaries, or from the use of other medications to intentionally induce menopause as part of the treatment of certain diseases, while natural menopause is a physiological process that marks the end of the reproductive period. Here, the ovaries stop producing hormones (especially oestrogen),” she said.

Women experiencing menopause typically go without a period for a year, provided they are not using contraception or have any other condition that could explain the cessation of menstruation, such as pregnancy. The age range of 45 to 55 is considered normal for menopause, while its occurrence before this timeframe is referred to as premature menopause.

Uwineza advised seeking medical attention if one experiences prolonged menstruation, excessive bleeding, or hot flashes. These symptoms can occur during the premenopausal period, when a woman still has regular periods, or due to bleeding disorders.

"One can detect the signs and symptoms of menopause if they experience pain during sex, and signs of osteoporosis like joint pain, a degenerative bone disease. These bones are damaged due to a lack of oestrogen (a sex hormone that is necessary for maintaining sexual and reproductive health),” she said.

Dr Stephen Rulisa, a chief consultant in obstetrics and gynaecology at CHUK and a professor of obstetrics and gynaecology at the University of Rwanda, believes that women can recognize the onset of menopause when their menstrual periods stop or become irregular. Other signs and symptoms of menopause include higher body temperature, night sweats, vaginal dryness, and decreased libido, anxiety and depression, insomnia, and memory problems.

Rulisa further explained that while the duration varies from individual to individual, it generally begins around 45 and ends around 55 years, although it could be longer, further adding that menopause can be diagnosed by measuring hormone levels or observing symptoms.

Uwineza also pointed out that a pathological fracture, which is a bone break caused by an underlying disease, could be one of the complications of menopause. This type of fracture can occur without any significant trauma.

She said complications like cardiovascular diseases, a group of disorders of the heart and blood vessels, could also be aggravated by menopause.

Uwineza further stated that menopause can trigger coagulation disorders (conditions that affect the blood’s clotting activities), weight gain, or obesity.

She added that some women with menopause experience dental changes, for instance, their teeth become fragile, broken, or are lost easily, and the breast density decreases.

Uwineza recommended consuming a calcium-rich diet to enhance bone density, engaging in regular exercise, and preventing hypertension and other health issues prior to the onset of menopause.

She said the only medication for menopause is Hormonal Replacement Therapy (HRT). Both progesterone and oestrogen are good for the body as they prevent endometrial cancer in that particular age group.

"It is unfortunate that the community health insurance (Mutuelle de Santé), doesn’t cover Hormonal Replacement Therapy. I call upon the Ministry of Health to ensure that all women can access this treatment.”

Uwineza emphasised that menopause is a natural process, not an illness. She urged women to embrace it, reassuring them that it does not signify death. Instead, she encouraged them to seek guidance from healthcare professionals.