Mrs. Bolanle is a 53-year-old shop owner who has increasingly become moody and irritable.
Sometimes, she would be happy and suddenly switch and may start crying for no clear-cut
reason. She also feels more tired than usual and has been sleeping poorly. She went to the clinic
for checks as she was convinced that she was unwell. The doctor took a careful history,
conducted a physical examination, and then requested some tests. He subsequently reassured
her that there was nothing wrong with her per se, as the symptoms she was experiencing were
due to menopause. Mrs. Bolanle did not really understand, and the following conversation
ensued:
Mrs. Bolanle: Thank you Doc. But what does this really mean? I have vaguely heard about
menopause, but I don’t understand.
Doctor: Okay, let me start with some explanations. First, there are chemicals that control how
our brain works and how we feel – whether we are happy or sad, or experience pleasure. These
feel-good chemicals are very essential to our day-to-day functioning. They serve as the
messengers that give instructions to control our body’s physical and chemical functioning.
Second, hormones are specific examples of these chemical messengers. And the female body
has some special types of hormones, called estrogen and progesterone which control
menstruation and fertility in women. The ovaries of the woman produce these hormones,
which also exert some effects on mood. This, explains why some females from adolescence,
may have noticed that preceding the period of their menses, they are transiently moody, and
irritable and may experience other mood changes that are referred to as premenstrual
syndrome (PMS).
Lastly, these hormones control the menstrual cycle from puberty till midlife when the menses
become erratic, and then eventually stop, in their 40s and 50s, as the production of estrogen
gradually reduces over time. Thus, menopause is said to have set in, when a woman in this age
range, has not experienced her menses for up to 12 months. Perimenopause describes the 5 –
10 years leading up to eventual menopause, over which the estrogen levels begin to gradually
drop.
Mrs. Bolanle: Okay, so how do all these explain how I have been feeling lately?
Doctor: Very good, remember I said I was starting with general explanations of the changes that
occur in a woman’s body as a result of chemicals, such as hormones. Do you remember the
names of these hormones?
Mrs. Bolanle: Of course, I remember estrogen and progesterone, which reduces until the levels
are so low that menses eventually stop. And when the menses have stopped for up to a year,
then menopause has occurred. Doctor: Excellent. So, the next step is to understand that these changes in estrogen levels and
other chemicals affect our brains and body differently. These may include a) physical symptoms
such as feelings of internal heat (hot flashes), tiredness, poor sleep, uncomfortable night
sweats, and forgetfulness; b) emotional symptoms such as mood swings including tearfulness,
feelings of sadness, irritability, difficulties with concentration and lack of motivation.
So, you can clearly see that all the symptoms you complained about when you first came in, are
all within the physical and emotional symptoms of menopause.
Mrs. Bolanle: Thank you Doc, but my best friend, Mrs Taiwo is already 55 years and she is not
having these problems. She stopped menstruating almost 5 years ago and she is very fine. Why
is mine different?
Doctor: Okay, menopause occurs with minimal and barely noticeable symptoms for the
majority of women. And every woman will have her own uniquely different experience of
menopause. Only when the symptoms are causing significant discomfort does it become a
focus of medical intervention. Indeed, many women, once they understand what is going on,
feel reassured and become comfortable with it – without needing any medical intervention.
Mrs. Bolanle: Thanks a lot for these explanations. I already feel reassured now. Is there
anything else I should know?
Doctor: I am glad to hear that you feel reassured. Please keep in mind that this age period is
often characterized by several life changes that are also stressful. Children grow and leave
home, parents are aging and dying, marital difficulties/divorce may be occurring, financial
worries, concerns about retirement, etc all exacerbate the feelings of stress; when added on
top of the menopausal symptoms.
Mrs. Bolanle: So, what should I do now?
Doctor: There are simple measures that can help. These include regular physical exercise,
paying attention to general physical health and medical conditions, and adequate rest and
sleep. However, if symptoms are very uncomfortable, you may need to see a gynecologist who
may consider the use of hormonal replacement therapy. Serious emotional symptoms such as
anxiety and depression may also require the use of anti-depressant medications and
psychotherapy.
Mrs. Bolanle: Thank you so much Doc. I feel better now.
Doctor: You are very welcome Ma.
Tribune Article for the column “Your Mental Health & You”
Thursday, 27th April 2023
Asido Foundation
Asivuri Consulting
