Menopause – your questions answered

I’m sure you know that October is World Menopause Month, and as women make up over half of the world’s population and we will all go through menopause eventually. We wanted to finish this month by covering all the questions you may have about this mysterious thing called menopause. The reason? A lot of people don’t know very much about menopause and are not comfortable talking about it! Evidence suggests that a large proportion of women begin menopause with no idea of what to expect or what is happening to them. Let’s try and change that. Let’s talk about menopause so we can all be better educated and better prepared.

What is menopause?

Menopause is the point in life when we stop having periods. It usually happens between the ages of 45-55 with the average age in developed countries being 51.

The time around the menopause (when symptoms start, or periods begin to change) is called the perimenopause.

Menopause is defined as the time when it has been 12 months since your last period. You do not need blood tests or special tests to “diagnose” menopause but you may want to monitor the decline of estrogen, FSH and progesterone if you suspect you are going into menopause. Sometimes special tests are also needed if you go through menopause earlier than expected.

What causes menopause?

Menopause happens when our ovaries stop releasing an egg each month. We are born with all the eggs we will ever have. They reduce in number throughout our life until they “run out”. This point when our eggs “run out” is the menopause.

Usually, your periods will become more irregular and less frequent in the years or months before they stop completely. But for some people, they will just suddenly stop. Everyone is different.

It is the eggs in our ovaries that produce oestrogen (one of the female hormones), and as the number of eggs decreases, the level of oestrogen in our body also decreases. This can cause menopausal symptoms.

Menopause can also be caused artificially. If you have chemotherapy or other treatments for cancer, this can cause an artificial menopause by “switching off” the production of oestrogen. If you have your ovaries surgically removed (this operation is called an oophorectomy) then you will also experience menopause after this. Sometimes the symptoms of sudden menopause might be more severe than a gradual “natural” menopause.

Other underlying medical conditions can also cause menopause. Such conditions include Addison’s disease or Down’s syndrome. The NHS website has more information about this.

What happens during menopause?

Symptoms of menopause

The symptoms of menopause are caused by the changing hormone levels during this time. There is a huge range of symptoms that people can experience. Some people have no symptoms at all and menopause is a breeze. Some people have symptoms that are severe and debilitating and can impact their quality of life. And a lot of people sit somewhere in the middle. Approximately 80% of women will have some menopausal symptoms.

The most commonly known symptoms include:

• Hot flushes
• Night sweats
• Vaginal dryness
• Pain/discomfort during sex
• Reduced interest in sex (libido)
• Difficulty with sleeping
• Concentration or memory problems
• Mood changes (e.g. low mood or anxiety)
• Headaches
• Aches/pains in joints of muscles
• Increased frequency of urinary tract infections (UTIs)
• Changes in weight/body shape

These symptoms can start quite a long time before your periods stop and can continue up to several years afterwards.

What treatments are available?

All people with periods will go through menopause at some stage. But there are treatments that can help with the symptoms if they are causing problems.

There are many women who go through menopause without needing any medication or interventions. It is entirely your choice whether to have treatment or not. Below are some options that may be appropriate for you if you are finding your menopausal symptoms are interfering with your life.

Hormone replacement therapy

Because the symptoms of menopause are caused by reduced oestrogen, replacing the oestrogen can improve the symptoms. Hormone replacement therapy (HRT) is sometimes called menopausal hormone therapy (MHT) and is when you take hormones to replace the ones your body is no longer making.

HRT is very good at improving the symptoms of menopause, but it is not suitable or acceptable for everyone. It is available in lots of different forms (e.g. tablets, skin patches, gel etc). The symptoms that HRT is most effective for are hot flushes and night sweats (and their consequences such as poor sleep, mood changes, trouble concentrating etc.).

HRT has a long and complicated history in the medical field. There is a small increased risk of breast cancer and blood clots, and these risks can be affected by other medical conditions. For this reason, HRT must be discussed with your doctor/nurse but it is now well-established to be safe and effective in most women. Ideally, you should take the lowest dose of hormones that helps your symptoms for the shortest time you need it.

Some things to note

• If you have a uterus (have not had a hysterectomy) it is important to take progesterone AND oestrogen, not just oestrogen alone. This is important as oestrogen alone can increase the risk of endometrial cancer (cancer of the lining of the uterus/womb). If you do not have a uterus then you can take oestrogen alone.
• HRT is not contraception (birth control). It is still possible (even if very unlikely) to get pregnant around the time of menopause.
• If your menopause occurs before the age of 40, it is usually recommended to take HRT until the “normal” age of menopause (around the age of 50). This is because losing oestrogen this early in life can have long-term consequences for your health.

There are some women (such as those who have had breast cancer) who should not take HRT. This is something to discuss with your doctor.

Some women would prefer not to use HRT, and this is completely your choice. It is not the only option for managing menopausal symptoms.

Non-hormonal medications

Sometimes antidepressants can be helpful if people are struggling with their mood around menopause.

Oestrogen cream that is applied into the vagina can be used for vaginal dryness or pain with sex. This is safe in most women but if you have had breast cancer it is important to check with your doctor.

Psychological therapy

Telling people that psychological therapy can help with menopausal symptoms sometimes sounds like I am saying that the symptoms are all in your head. That is not the case at all! The symptoms are very much real and can be very debilitating. Psychological therapy works because our minds are very powerful. All sorts of physical parts of our bodies can be affected by our mindset/emotional state. This applies to menopausal symptoms too. Cognitive behavioural therapy (CBT) can be helpful for menopausal symptoms, especially those related to mood.

Other treatments

Wearing light clothes and keeping your room cool at night can help with hot flushes and night sweats. Some people find that spicy food, smoking, alcohol or caffeine trigger their hot flushes so avoiding these can help.

Exercise, yoga, meditation and making sure you get lots of rest can help some people with symptoms such as anxiety or low mood.

There are a lot of treatments that are sometimes called “natural hormones” or herbal remedies that exist for menopause. It is often not clear how safe or effective they are and they can also interact with other medicines, so it is important to speak to your doctor or pharmacist about what you are taking and planning to take.

General lifestyle

“Menopause treatments” are sometimes used as a band-aid to improve symptoms that might be worsened by “unhealthy” habits. Things like caffeine, alcohol and smoking are all known to increase hot flushes or other symptoms of menopause. It is important that we are making healthy choices at every stage in our life. Whether or not we choose to take medication for menopause, it is important to consider all aspects of our health and wellbeing.

What is early menopause?

“Early” menopause is when your periods stop before the age of 45. “Premature” menopause is when it happens before the age of 40. Sometimes this is called “premature ovarian insufficiency” or “premature ovarian failure”.

Approximately 1 in 100 women experience premature menopause.

Do I need to see a doctor?

If your menopausal symptoms are bothering you or interfering with your life it is a good idea to speak to your doctor about things that might help. Your GP might refer you to a specialist if your symptoms don’t improve with treatment or if you cannot take HRT.

If you start having symptoms of menopause before the age of 45 it is also important to speak to a health professional. This is because premature menopause can increase the risk of osteoporosis or heart disease in the long term.  This is why HRT is usually recommended in this situation.

Are there any “complications”?

The reduction in oestrogen following menopause can have implications for your health. However, we can reduce these risks by making sure we follow a healthy lifestyle and look after all aspects of our wellbeing.

Osteoporosis

Oestrogen is important for keeping our bones strong. After menopause, we are at increased risk of osteoporosis (a condition where your bones become “weak”). This might increase your risk of fracture (broken bones) if you fall or injure yourself. Some people require treatment for this to prevent fractures. If you are worried about your bone density or have a family history of osteoporosis, then speak to your doctor.

You can reduce your risk of osteoporosis by making sure you exercise regularly, get plenty of sunlight (or take vitamin D if you don’t get a lot of sunshine), stop smoking, reduce alcohol intake, and eat a healthy diet. HRT can also help reduce the risk of osteoporosis but this alone is not a reason to take it.

Heart disease

It turns out that oestrogen is protective against heart disease. This is why men are more likely to have heart attacks/strokes than women (before menopause). After menopause, women’s risk of heart disease is similar to that of men.

What now?

So now that we have started the conversation, let’s encourage everyone else to talk about menopause too. The more we talk about it, the more we will learn and the less scary menopause will become.

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