What is the menopause?
Menopause is the point when a woman’s body stops producing and releasing eggs. Doctors often define the menopause as when a woman has not had a period for 12 months or more. The period between the onset of menopausal symptoms and the menopause itself is normally referred to as perimenopause.
The average age of the menopause in the UK is 51 years, with most women going through it between the ages of 49 to 52 years. The age at which a woman goes through the menopause is often similar to the age her mother went through it, but while genetics play a big role, there are a number of other factors that can influence the process.
Premature menopause, also known as premature ovarian insufficiency (POI), is when a woman goes through the menopause before the age of 40, something which affects around 1% of women.
What are the symptoms of menopause?
Symptoms of menopause can start before the menopause and end some years after, and while certain women will experience many different menopausal symptoms, others will have very few.
Symptoms may include:
- A change in menstrual cycle (periods cease)
- Hot flushes
- Night sweats
- Mood swings
- Weight gain
- Vaginal dryness
- A loss of interest in sex
Vasomotor symptoms, otherwise referred to as hot flushes and night sweats, often begin in the late 40s, and are related to the constrictions and dilation of blood vessels. They are estimated to be experienced by over 75% of women.
You may find you awaken during the night and experience intense internal heat and visible sweating, which can last up to four minutes. Although vasomotor symptoms usually subside after five to seven years, some women may have to deal with them for up to 15 years.
Theories explaining vasomotor symptoms include the effects of declining levels of oestrogen within the body and an alteration in brain control of body temperature. A gradual reduction in oestrogen is also responsible for decreased serotonin, which alters the body’s baseline temperature, increasing the likelihood of vasomotor symptoms.
Lack of oestrogen stimulation in the vaginal tissue can cause dryness in this area which can be uncomfortable and cause pain during sexual intercourse. If you are experiencing this it is worth explaining your discomfort to your partner to help them understand what you are going through. You can try over-the-counter lubricants and vaginal moisturisers to help, and discuss options such as oestrogen creams and HRT with your doctor.
Changes in menstrual cycle
All women will find their periods stop entirely eventually, but before this occurs you may find the length between your periods extends, or perhaps even shortens. You may also find that you start bleeding more heavily. Only around 10% of women will go from regular bleeding to an abrupt stop.
During perimenopause, irregular periods are common, and this is rarely any cause for concern. The regular pattern in the rise and fall of oestrogen is simply disrupted and there is now an unpredictable fluctuation of hormones during the menstrual cycle.
When menstrual cycles are prolonged, this is usually due to high oestrogen levels compared to progesterone. If ovulation doesn’t occur, progesterone isn’t produced and there is subsequently no sharp drop in progesterone to trigger the womb lining to be shed. You may find, in this case, that you if you do miss a period, you have a particularly heavy one when it does arrive.
As you approach the end of perimenopause, your periods may be very late and you may find you have several skipped periods before they stop altogether. This is due to the gradual decline in oestrogen production by the ovaries.
If you notice any vaginal bleeding or blood-stained discharge after 12 months of no bleeding, it is important that you see your doctor urgently as this is classed as postmenopausal bleeding.
A whole host of factors of factors can contribute to low mood during menopause. Hot flushes can disrupt sleep and lead to irritability and effects on mood. The changes you go through during menopause also have the potential to cause anxiety and depression.
If you feel you are experiencing psychological symptoms, it is important not to suffer alone. Consult your GP who will be able to refer you for treatment.
What treatments are available?
The good news is that if you are experiencing symptoms of menopause and they are interfering with your day to day life, there are plenty of treatment options available. However, not all of them are safe for all women, so it is important to discuss your options with your GP.
Hormone replacement therapy (HRT)
HRT has proven to be an effective treatment for hot flushes, vaginal dryness, osteoporosis, joint pain, and other symptoms.
It provides relief from these symptoms by replacing the oestrogen that the body starts lacking during menopause. HRT comes in two forms: oestrogen-only HRT and combined HRT, which contains oestrogen and progestogen, a synthetic form of progesterone. Oestrogen-only HRT is only recommended for women who have had a hysterectomy, as oestrogen unopposed by progesterone is known to increase the risk of endometrial cancer.
HRT developed a negative reputation in 2002 and 2003 when two studies suggested that women who used HRT were at increased risk of breast cancer, heart disease, and stroke. However, more recent research has shown that most of the fears were unfounded, and for the majority of women the benefits of HRT will definitely outweigh the very slight increased risk of certain conditions.
Currently, there are more than 50 types of HRT available, including tablets, skin patches, oestrogen gel, implants, creams, pessaries, and rings. Different types and different combinations work for different women.
Along with changing hormone levels, other symptoms of menopause such as hot flushes and insomnia can also aggravate lousy mood. Normally, HRT should be considered when it comes to treatment of low mood, and there is no evidence to support the use of antidepressants unless a diagnosis of depression is made.
However, CBT can provide relief for low mood and anxiety that comes about because of menopausal symptoms, and antidepressants such as SSRIs are worth considering when it comes to major depression.
Vaginal moisturisers and lubricants
In mild cases of vaginal dryness, vaginal moisturisers and lubricants might be successful treatment. However, hormonal treatment may be more effective, and local treatment is available.
Clonidine is a non-hormonal medication that can help with vasomotor symptoms. It works by causing certain blood vessels to dilate, which reduces blood pressure. However, it is only effective in some women, and is not very strong. It also has no effect on other symptoms of menopause such as osteoporosis.
Black cohosh is a herb that can be bought from health food shops, and it is claimed it can relieve certain menopause symptoms. Research into its effectiveness has yet to prove any conclusive results however. Generally, it is deemed to be safe, but has been reported to cause liver damage in certain individuals, so consult your doctor first if you are thinking of trying it.
Can lifestyle changes be enough to reduce menopause symptoms?
Simple lifestyle measures may be helpful in tackling mild menopause symptoms. Doing regular exercise helps build bone and muscle strength, which will help prevent osteoporosis, and endorphins released during exercise can help improve mood.
Eating irregularly can make symptoms such as tiredness worse due to depleted glucose, so it is important to eat a balanced diet. Coffee and spicy food, and alcohol, can make sweating worse so it might help to avoid these, and smoking lowers oestrogen levels so quitting if you are a smoker may relieve your symptoms.
This has been written by The Femedic, an educational website that deals specifically with areas of women’s health considered taboo.
The Femedic is proud to partner with Wellbeing of Women to produce educational content and resources, and to raise awareness of women’s health issues.