MENOPAUSE
WHAT IS MENOPAUSE?
Menopause is a term that means that it is more than one year since your last period. The term perimenopause means that you are around this time and is often characterised by a change in your periods and menopausal symptoms.
Perimenopause can last five to eight years or even longer. The average age of menopause in the UK is 51.
Natural menopause occurs due to the ovaries no longer producing eggs and producing less oestrogen. Early menopause can happen at any age and there may not be a clear cause however, some surgical procedures, underlying health conditions, or previous medical treatments can cause this.
SUMMER BLUES
Symptoms of menopause are generally caused by the ovaries producing less oestrogen. Ovaries also produce testosterone and during menopause testosterone levels also drop and can be responsible for some symptoms.
WHAT ARE THE SYMPTOMS?
Many people are aware of hot flushes, night sweats and a change in their periods being symptoms of menopause but not all women will experience hot flushes and night sweats. You should also know that periods do not just stop; they often become more irregular and heavier.
There are a huge number of other symptoms that can occur as part of menopause, these include:
Irritability
Low mood
Difficulty sleeping
'Brain fog' and poor concentration
Headaches
Tiredness
Heart palpitations
Joint stiffness, aches and pains
Anxiety
Loss of sex drive/libido
Discomfort or dryness in the genital area
Dry skin
Recurrent urine infections (UTIs).
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HOW IS MENOPAUSE DIAGNOSED?
In the majority of people, this is done based on your symptoms. If you are aged 45 or over and have menopausal symptoms - with or without a change in your periods - often no further tests are needed.
If you are under this age, your GP may need to take a blood test on two separate occasions.
In addition to these symptoms, we also know that osteoporosis (reduced bone density) becomes more common after menopause.
You may find it useful to complete the Greene Climacteric Score sheet, print it out and take it to your GP appointment: www.menopausematters.co.uk/greenescore.php
Comparing scores in the future can also help to monitor how medication is helping.
WHEN CAN I STOP USING CONTRACEPTION?
Although as you get older it is harder to fall pregnant, it is still possible to fall pregnant around the time of your menopause.
Therefore, you should think about using contraception until one year after your periods change or stop if you are 50 or older, or two years after your periods change or stop if you are under 50.
WHAT CAN I DO TO COPE?
Lifestyle changes can help your symptoms:
Ensure you have enough calcium and vitamin D - this can help to reduce your risk of osteoporosis
Reduce your alcohol intake - this can help with hot flushes and night sweats Exercise Diet
Stop smoking – this can help with hot flushes and night sweats. You are also likely to have an earlier menopause if you smoke Sleep and relaxation.
All of these measures can help on their own, or in conjunction with medication like hormone replacement therapy (HRT).
Sometimes there are reasons why people cannot have HRT and these can be discussed with a doctor. In these cases, there are other medications that can sometimes help.
However, if you can take HRT this directly replaces some of your hormones that have been reduced as part of menopause and therefore is often more effective.
SUMMER BLUES
WHAT ABOUT HRT?
HRT replaces the hormone levels that are low due to menopause/perimenopause. It consists of oestrogen and sometimes other hormones – progesterone or testosterone.
If you still have a womb, you will need to take progesterone as well as oestrogen. Some people find that testosterone can also help their symptoms but this would only be started after blood tests and would need regular monitoring tests during its use.
IS HRT DANGEROUS?
HRT does have some risks and many people are aware of these, especially due to media coverage. The main risk that people often ask about is cancer, particularly breast cancer, blood clots, heart disease and strokes.
HRT does not cause breast cancer but progesterone can cause an increase in your baseline risk This increased risk returns to normal once you stop taking HRT The below picture may help you to understand this risk better. It is important that you stay breast aware and engage in the NHS breast screening programme.
These links will provide more information about the breast screening programme and how to check your breasts effectively: www.nhs.uk/conditions/breast-screening-mammogram www.nhs.uk/common-health-questions/womens-health/how-should-i-check-my-breasts https://cdn.macmillan.org.uk/
WHAT ABOUT BIO-IDENTICAL HRT?
Body identical HRT is available via prescription on the NHS - this means that the hormones are identical to those produced by the body. These are derived from a vegetable similar to sweet potatoes - yams.
You may have also read about bio-identical HRT - this is not available on the NHS and is not regulated or subject to quality control in the same way as HRT that is prescribed by a doctor.
HOW DO I TAKE
HRT?
HRT can be taken in a variety of forms - patch, gel or tablet, the Mirena coil can also be used as part of your HRT. This can be discussed further with a nurse or doctor during your appointment.
WHERE CAN I GET OTHER INFORMATION?
www.menopausematter.co.uk www.balance-menopause.com www.rockmymenopause.com
REFERENCES
Menopause - NHS www.menopausematters.co.uk www.balance-menopause.com www.rockmymenopause.com Confidence in Menopause Course (FourteenFish)
Written by Dr Grainne Evans May 2022
