Menopause

What is Menopause?

Sometimes called the “change of life”, the menopause is the point in a woman’s life when her periods stop and her fertility ends. Absence of a menstrual cycle for 12 months indicates a woman is in the menopause, occurring in the majority of women between the ages of 45 and 55.

In some women the menopause occurs earlier, before the age of 40 and is classed as an early or premature menopause. This can occur naturally or as a result of medical procedures, radiotherapy or rarely infections.

Though not an illness, for many women the menopause and the period leading up to it, the peri-menopause can be a difficult time with many suffering from symptoms which can have a real effect on their quality of life.

What causes it?

Menopause is a natural part of the aging process, it is caused by falling levels of the sex hormone oestrogen produced by the ovaries. This leads to a disruption in the menstrual cycle and the associated symptoms. There is no definite test for the menopause though some doctors measure levels of FSH (follicle stimulating hormone), which rises during the menopause, to confirm diagnosis in women experiencing the symptoms.

What are the symptoms?

Experienced by over 70% of women, symptoms can start years before reaching the menopause, during the peri-menopause period. Most symptoms are self-limiting gradually reducing 2-5 years after starting. For some women they can however last for up to 15 years.

Symptoms include:

• Changes in the menstrual cycle. Often the first sign of the menopause presents as irregular periods becoming more or less frequently, often accompanied by heavier blood loss.
• Night sweats and hot flushes, very common symptoms experienced due to the falling oestrogen levels and some times accompanied by palpitations and faintness.
• Vaginal symptoms include vaginal dryness, itching and discomfort due to thinning of the vaginal walls. Without treatment symptoms can persist or worsen over time.
• Urinary symptoms are experienced by some women with increased bouts of cystitis, urinary frequency and incontinence.
• Loss of libido (sex drive) due to reduced hormone levels and vaginal discomfort.
• Sleep disturbance due to anxiety and insomnia as well as a result of the night sweats.
• Acne caused by a more oily skin and clogged pores.
• Mood changes include anxiety, irritability and depression aggravated by sleep disturbance. This can also be compounded by the fact it may be a stressful time in a woman’s life with teenage children, aging parents and heavier work responsibilities.

Long term risks associated with the menopause

• Osteoporosis (thinning of the bones) due to the reduction in oestrogen levels
• Increased risk of heart disease and stroke due to changes in cholesterol levels

What are the treatment options available?

Women have a range of options from prescription medicines from their doctor, complementary remedies and self help techniques. Women suffering from symptoms which are having a big impact on their daily lives should seek help from a medical professional.

From your doctor

• Hormone Replacement Therapy (HRT) is the most common form of treatment for the menopause providing relief from hot flushes, vaginal symptoms including dryness and itchiness and the associated urinary symptoms. It comes in many different forms including tablets, transdermal patches, implants and creams. As well as relieving the menopausal symptoms it protects you from developing osteoporosis and reduces the risks of developing bowel cancer. However it can very slightly increase your chances of developing breast and some other cancers and stroke. Consult with your doctor who will talk you through the risks and the different options available. You may need to try several different products before finding the one that works best for you.
• Clonidine is used to treat the night sweats and hot flushes. It can have side effects such as dry mouth, drowsiness, depression and constipation.
• Anti-depressants including citalopram, fluoxetine, paroxetine and venlafaxine have been used successfully to treat the hot flushes.
• ReplensMD a vaginal moisturiser relieves vaginal dryness for up to three days at a time.

Complementary and herbal remedies

• Phytoestrogens – whilst there is not enough evidence yet to recommend Phytoestrogens which occur naturally in plants, one type isoflavones may reduce hot flushes. Women with breast cancer should consult a healthcare professional before taking.
• Herbal remedies – there is no evidence to support the taking of remedies such as black cohosh and evening primrose oil and they can in fact interact with other medicines you may be taking from your doctor so consult with a healthcare professional before taking.
• Homeopathic remedies there have been very few studies of their use in the menopause but there is some evidence they can help when prescribed by a qualified homeopath.
• Other remedies – Valerian is a very mild sedative contained in products like Kalms and Nytol Herbal that can help with the disturbed sleep and is considered safe and non-addictive. Caution should be used next day if driving.
• Vaginal lubricants – including KY jelly and the longer lasting ReplensMD can reduce the vaginal dryness and discomfort during sex
• Magnetic therapy –some women have found some relief of symptoms with the Ladycare magnetic device.

Self-help techniques you can try

• Exercise – regular exercise can improve hot flushes, night sweats and mood swings. It also reduces the risk of osteoporosis and heart disease associated with the menopause and will help to limit the weight gain some women experience during the menopause.
• Diet – eating a healthy diet of regular meals can reduce the mood swings and irritability. A diet rich in Soya also reduces menopausal symptoms. Avoid spicy food and caffeine and reduce alcohol consumption to prevent night sweats and sleep disturbance. A diet with plenty of oily fish and low fat dairy products will help to maintain calcium and vitamin D levels reducing the risk of osteoporosis. Drink plenty of water to reduce the risk of cystitis and to help with headaches and dry skin.
• Clothing –stick to lighter cotton fabrics if you suffer from hot flushes and wear several layers so you can easily remove some when you become warm. Keep your bedroom cool at night and use cotton sheets to aid sleep.
• Incontinence – Pelvic floor exercises can help with the stress incontinence.
• Relaxation – Yoga and meditation is relaxing and helps with the psychological changes including the mood swings and anxiety, as will massages and aromatherapy.
• Smoking – stopping smoking will help to reduce the risk of heart disease

Can I still get pregnant during the menopause?

Whilst during the menopause your fertility levels start to drop you are still at risk of getting pregnant. Use contraception for two years after your last period if under 50 and for one year if over 50.