Menopause has a variety of symptoms, the occurrence and severity of which can vary greatly. In more severe cases, these symptoms can have such an impact on the ability to carry on with normal routines that they adversely affect the quality of life.

In most cases, women will typically experience hot flashes, night sweats and insomnia, which leads to increased fatigue and irritability. Other possible symptoms include palpitations, headaches, an aching body, anxiety, decreased self-confidence, depression, and loss of libido. The urinary tract and vagina may also develop problems, such as vaginal dryness, vaginal inflammation, frequent urination and urinary incontinence. Not surprisingly, menopause can place a strain on a woman’s relationship with her spouse.

The loss of oestrogen is a major cause of problems faced during menopause. As the oestrogen levels fall, the hair becomes dry and some women experience hair loss. The skin becomes thin and dry, causing wrinkles, while the fingernails also become brittle.

In addition to the symptoms mentioned above, menopausal women are at increased risk of the following conditions:

l Osteoporosis

Because oestrogen helps to maintain appropriate levels of calcium in the bones, the shortage of oestrogen caused by menopause leads to the bones thinning and becoming more brittle over time. This heightens the risk of hip fractures, broken arms, and broken legs. As there are no obvious symptoms, menopausal women are advised to undergo a bone density test every two years.

l Cardiovascular diseases

Because oestrogen also protects a woman from the time she begins menstruation until menopause by reducing her cholesterol levels, the risk of heart disease and strokes increases during menopause. Even women with previously strong and healthy hearts are exposed to a greater risk of cardiovascular disease during menopause. Some of the early warning signs to watch out for include fatigue, insomnia, difficulty breathing, pain in the neck and shoulder area, stomach indigestion, and nausea. However, it should also be noted that women with heart disease often do not experience any chest pain during atherosclerosis (blocked arteries).

l Stroke

Low oestrogen levels also adversely affect the LDL level, and this is another risk factor for menopausal women as it can lead to a stroke. One of the main early warning signs to watch out for is a numbness or weakness in one part of the body, which then disappears in 30 minutes. Other indicators of an imminent stroke include feeling disoriented and having difficulty seeing, speaking or walking. When any of these symptoms occur, medical advice should be sought immediately to minimise the risk of a stroke and subsequent paralysis.

Because of the potential dangers, all women are recommended to visit their doctor for a full health examination as they enter menopause. While screening for cervical cancer, ovarian cancer and breast cancer are the most common tests performed on menopausal women, it is also advised that they undergo a more thorough examination.

Hormone Replacement Therapy (HRT) can be administered to replace the lost oestrogen with substances that have a similar molecular structure. While this can significantly improve the quality of life for menopausal women experiencing extreme symptoms, it is not necessary in all cases. Whether HRT is prescribed should be decided by the doctor after taking into consideration each woman’s particular situations and condition. For example, HRT should not be prescribed if a woman has breast cancer, endometrial cancer, deep vein thrombosis, or liver disease. Also, HRT should be used with caution if the patient has gallbladder stones, diabetes, high blood pressure, tumour in the uterus, asthma, SLE or migraine. In addition to deciding whether a woman is suitable for HRT, the doctor will also determine which type of HRT to recommend in order to improve the woman’s quality of life.

In addition to HRT, there are some steps that all women can take to maintain good health during menopause. A nutritious diet, regular exercise, sufficient rest, and a stress-free lifestyle can all play an important role in minimising the negative impacts of menopause. Menopausal women should try to eat a varied diet from all five major food groups. Foods which are high in calcium and naturally occurring oestrogen, such as soybeans, are strongly recommended, while fatty foods, alcohol, caffeine and smoking should all be avoided. Women should also aim to exercise least three times a week.

Understanding menopause and managing its risks can go a long way to helping women carry on as normal a life as possible during their “golden years”. While eating nutritious food, exercising regularly, and getting plenty of rest can minimise the risks and effects of menopause, even more important is an annual health check-up that includes a mammogram, a Pap smear test, a bone density test, and a blood test so that any potential complications can be identified and treated before they develop.

DR YAOWALUK RAPEEPATTANA is a specialist in obstetrics and gynaecology with the Women’s Health Centre at Samitivej Sukhumvit Hospital. Call (02) 711 8555-6.

A large cyst can be felt in the breast and usually feels like a soft grape or a water-filled balloon. The cysts usually disappear after menopause, except in cases where the women are taking hormone therapy.

Symptoms of breast cysts include:

A smooth, easily movable round breast lump with distinct edges

• Breast pain in the area of the breast lump
• Increase in breast lump size and tenderness just before the period, and decrease in breast lump size after the period

One important thing to know is that a simple cyst does not increase the risk of developing breast cancer. If you detect the presence of any new breast lumps or if an already identified breast lump seems to have grown, please seek medical attention in order to get it checked out.

Each of the breasts contains 15-20 lobes of glandular tissue. The lobes are further divided into smaller lobules that produce milk. Ducts then carry the produced milk. Breast cysts develop when an overgrowth of glands and connective tissue blocks the milk ducts, causing them to widen and fill with fluid.

Microcysts are too small to feel, but will be seen during such imaging tests as mammography or ultrasound.

Macrocysts are large enough to be felt. Most of them can be clearly felt at 2.5 centimetres. Large cysts can put pressure on nearby breast tissue, causing breast pain.

The cause of breast cysts remains unknown but it is believed they may be the result of excess oestrogen in the body. Screening and diagnosis of a breast cyst usually begins after a breast lump is identified by you or a doctor: The process will incorporate the following steps.

• The doctor will physically examine the breast. However, this breast examination cannot identify whether a breast lump is fluid-filled or solid and other tests will be needed.
• A breast ultrasound can help the doctor determine whether a breast lump is fluid-filled or solid.
• Fine-needle aspiration is performed. The doctor inserts a needle into the breast lump and withdraws fluid. If the fluid is not bloody, no further testing is needed. If the fluid appears bloody, the doctor will send a sample of the fluid for lab testing. If no fluid is withdrawn or the breast lump does not disappear, it suggests that the breast lump or a portion of it is solid and a sample of cells will be sent for analysis to check for cancer.

No treatment is necessary for simple breast cysts. The doctor may recommend closely monitoring a breast cyst to see if its size changes.

There are three treatment options

• The fine-needle aspiration procedure, which is used to diagnose a breast cyst also serves as treatment when the doctor removes all the fluid from the cyst resulting in the breast lump disappearing and the symptoms clearing up. The doctor will locate the position of the breast cyst and insert a needle to withdraw fluid. For more accuracy, ultrasound will be used to guide the accurate placement of the needle. After the fluid has been withdrawn from a breast cyst, a recurrence or new cysts are very common.
• Hormone use: Using birth control pills to regulate the menstrual cycles may help reduce the recurrence of breast cysts. Discontinuing hormone replacement therapy during the postmenopausal years may reduce the formation of cysts as well.
• Surgery: In some cases, the surgical removal of cyst is necessary. Surgery may be considered for an uncomfortable breast cyst or if a breast cyst contains blood-tinged fluid or shows other worrisome signs of cancer.

For prevention of breast cysts, you should wear a well-fitted and supportive bra to help relieve some discomfort. Avoid coffee. While there is no scientific proof that coffee consumption is linked to breast cysts, some women find relief from their symptoms after stopping coffee consumption. Reducing salt in the diet is also recommended because sodium increases the congestion of excess fluid retained by the body.

A breast self-examination should be done at least once each month. In case of finding any abnormality, seek immediate medical attention.

DR DUANGMANI THANAPPRAPASR is an Obstetrics-Gynaecologist attached to the Women’s Health Centre at Samitivej Sukhumvit Hospital. Call (02) 711 8555-6.

So what is known today about this disease?

Zika is an arbovirus, which means a virus transmitted by a mosquito. It belongs to the flavivirus family that includes the dengue, chikungunya and Japanese Encephalitis viruses. Zika is not a new virus. It was first identified in the Zika forest in Uganda in 1947, hence the name, and was responsible for outbreaks in Micronesia in 2007 and in French Polynesia in 2013. Sexual contamination of the Zika virus has recently also been demonstrated in the USA but this route of transmission is likely to remain negligible in comparison with mosquito bites.

Right now, Zika outbreaks are mainly hitting Latin American countries and some West-Indies islands. However as the vector is the ubiquitous mosquito from the Aedes genus, there is a significant likelihood that the virus will spread too in other tropical countries in Asia (including theMekong countries), Africa as well as the southern parts of the western hemisphere due to the new expansion of Aedes in these latter regions. To date, only a few cases have been reported in Thailand over the last few years. Contrary to the Anopheles mosquitoes that transmit malaria, the Aedes mosquitoes are particularly well adapted to urban areas.

In about 80 per cent of the cases, a Zika infection is essentially a benign illness inducing no or mild symptoms. When symptoms do occur, the patient may present a skin rash, mild headache, low-grade fever, muscular and joint pains, fatigue and red eyes (conjunctivitis) for a few days. Some of these symptoms may be suggestive of other tropical diseases, in particular dengue.

The diagnosis is confirmed by specific tests to identify or isolate the virus in the blood.

The main issues with Zika infection are the suspected neurological complications that include the possible newborn defect named microcephaly -a congenital brain condition where a baby’s head is much smaller than average size – and the Guillain-Barre syndrome a progressive and potentially severe neurological disorder in adults that may be – although rarely – irreversible. Despite the 20-fold increase in microcephaly in some Brazilian states and the proven maternal-foetal transmission of Zika during pregnancy, the association of Zika with the birth defect complications is based on epidemiological data and not yet formally established. However, some public health authorities have already issued various recommendations for pregnant women. These include specific Zika screening and/or avoid travelling in endemic Zika areas and/or considering postponing planned pregnancy and/or strictly following advice to prevent mosquito bites.

There is no antiviral medication to treat Zika virus infection and no vaccine to prevent it. In symptomatic cases, the treatment is limited to relieving the intensity of fever and joint pains. Aspirin should be avoided due to the risk of haemorrhage induced by possible concomitant dengue infection.

The Guillain-Barre syndrome complication is treated with supportive care because there is also no cure for this disorder. However most patients eventually recover from this syndrome. On the other hand and depending on its severity, the microcephaly complication usually leads to lifelong developmental and neurological problems that can be life-threatening.

The basic prevention of Zika infection, like other arbovirus diseases, is then to avoid mosquitoes bites as much as possible. For children, leisure or playgrounds infested by insects should be avoided at anytime of the day. Long sleeved clothing should be worn. The use of repellent, preferably one containing DEET (N.N-diethyl-3-methylbenzamide), in regular applications every two to four hours, is recommended as well as the use of mosquito nets. Aerosol insecticide may occasionally be sprayed in the house.

Despite huge challenges, global prevention nevertheless starts from implementing serious public health measures to reduce standing water in the urban environment, which tends to lead to a significant reduction in the mosquito population.

DR GERARD LALANDE is managing director of CEO-Health, |which provides medical referrals for expatriates and customised |executive medical check-ups in Thailand. He can be contacted at gerard.lalande@ceo-health.com.