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Menopause

 

What is menopause?

 

It is the pause of the menses - a biological stage in your life when periods cease permanently. This is due to the cessation of ovarian activity that happens when the ovaries run out of eggs. Oestrogen stops being produced and this is what causes menopausal symptoms. In the UK the average age for menopause is 51 years. You are menopausal if you are older than 45 years and had no periods for 12 months. FSH is a blood test that can help to make the diagnosis of menopause, especially when the symptoms are not typical.

 

The period leading to the menopause is called perimenopause (or climacteric) and is the transition to the menopause. During the perimenopause, the periods may be irregular or heavy. You are peri-menopausal if you have hot flushes, night sweats and irregular periods.

 

If menopause happens before the age of 40 years, it is called premature menopause (also premature ovarian failure or premature ovarian insufficiency). Risk factors for premature menopause are:

  • Genetic reasons such as chromosomal abnormalities or a strong family history.

  • Autoimmune conditions such as diabetes, thyroid disorders or Addison's disease.

  • Surgery, chemotherapy or radiotherapy.

 

What are the symptoms of menopause?

 

How severe and how long the menopausal symptoms will last for vary in each woman. They may start in the years before the menopause and last for several years. The most common ones are:

 

  • Vasomotor symptoms: 75% of the menopausal women experience hot flushes and night sweats; in 25% these symptoms are severe. It may take up to 7 years for this to resolve. They may last for several minutes, can be associated with excessive sweating, palpitations or anxiety and can be very distressful.

  • Mood changes: Depression, anxiety and irritability are very common during the menopause.

  • Pain and aches from the muscles and joints.

  • Sleep disturbance. Night sweats and hot flushes disturb a good  night sleep. If it continues for a long period of time, it can lead to irritability and difficulties with short-term memory and concentration. 

  • Sexual disorders. This can be a complex issue that has both physical and psychological elements. The vaginal wall becomes thinner after the menopause and during sex it may crack and become irritated or even painful. This is complicated by loss of libido, another symptom of menopause.

  • Urinary symptoms: The vaginal dryness apart from painful intercourse may lead to recurrent lower urinary tract infections (UTIs). Another menopausal symptom is urinary incontinence which can be very distressing.

 

How do we manage the menopause?

 

The management of menopause begins with the assessment of your symptoms, how severe they are and how much they affect your quality of life; which symptoms are most troublesome and if you would like any treatment. Do you have any risk factors for osteoporosis (thinning of the bones), blood clot or breast cancer?

 

After this initial assessment we can discuss what the available treatments are and how can they be tailored to you, their risks and benefits, and if  you need HRT or can manage without.

 

Managing the menopause without HRT.

 

Certain lifestyle modifications can reduce the severity of menopausal symptoms. For example:

  • Hot flushes and night sweats: regular exercise, weight loss (if applicable),  lighter clothing, sleeping in a cooler room, reducing stress, and avoiding possible triggers such as spicy foods, caffeine, smoking, and alcohol.

  • Sleep disturbances: avoiding exercise late in the day and maintaining a regular bedtime.

  • Mood and anxiety disturbances: adequate sleep, regular physical activity, and relaxation exercises.

  • Cognitive symptoms: exercise and good sleep hygiene.

 

If these make no difference then non-hormonal and/or non-pharmacological treatments may offer symptom relief.

  • Hot flushes and night sweats: Fluoxetine, citalopram or venlafaxine may be considered, however they are off-licence. Black cohosh may be helpful however, its safety is unknown and different preparations may vary. 

  • Vaginal dryness: A vaginal lubricant or vaginal moisturiser.

  • Mood disturbance-anxiety: Self-help groups, anti-depressants or cognitive behavioural treatment.

 

 

Managing the menopause with HRT.

 

If lifestyle modifications prove ineffective in managing the menopause symptoms, then the other alternative is HRT (Hormone Replacement Therapy). It comes in a variety of preparations - tablets, patches, gels, vaginal rings and creams. HRT which is absorbed through the skin is generally safer than tablets. 

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