What is Menopause?
The Menopause occurs to all women as part of their natural reproductive life. It is when your periods stop and you are no longer able to get pregnant. This is caused by a decrease in the hormones, oestrogen and progesterone, which in turn do not stimulate the lining of the womb (endometrium) in the normal cycle.
This is usually a gradual process involving the following:
- Perimenopause: the period from the beginning of menopausal symptoms.
- Post-menopause: defined when there have been no periods for twelve months or immediately after surgical removal of the ovaries.
The average age of the menopause is 51 in the UK (normal age range 45 – 57).
Around 1 in 100 women become menopausal before the age of 40. This is known as premature ovarian insufficiency (POI), which can be caused by surgery, chemotherapy, radiotherapy, genetic, auto-immune or unknown reasons.
How do you diagnose menopause?
The diagnosis of menopause and the transitional process is dependent on the pattern of your periods and the symptoms experienced.
Measurements of hormone levels are not routinely done, but are most useful when early or premature menopause is suspected, when fertility appears to be reduced or after hysterectomy with conservation of ovaries where there is no bleeding pattern to follow.
Common symptoms associated with menopause are:
- Irregular periods, absent periods, heavy bleeding
- Hot flushes
- Night sweats
- Mood changes including low mood, anxiety, irritability
- Brain fog
- Low self esteem
- Decreased sex drive
- Poor sleep
- Bladder issues
- Vaginal problems including increase in infections
- Vaginal dryness and / or soreness
- Changes in skin and hair
- Joint pains
How can I improve symptoms of menopause?
Lifestyle: A healthy lifestyle can help reduce the symptoms of menopause and ensure healthy bones and heart. This can be done through the following:
- Balanced Diet
- Regular exercise
- Reduction in caffeine and alcohol
- No smoking
- Reduction of stress levels
Complementary/Alternative Therapies: There are a number of therapies to consider including acupuncture, herbal remedies, aromatherapy, reflexology and homeopathy. These are becoming popular especially for symptomatic relief but there is limited scientific research to support their effect and safety.
Psychological therapies: Cognitive behavioural therapy (CBT) develops practical ways of managing problems and provides new coping skills and useful strategies for a range of menopausal symptoms including anxiety, hot flushes, night sweats and fatigue.
Hormone replacement therapy (HRT) and menopause
Hormone replacement therapy is the most effective and widely used treatment for menopausal symptoms. It is very much an individualised treatment depending on your history, family history, and preferences.
Content: All HRT preparations contain oestrogen which is what is needed to be replaced to reduce the symptoms of menopause. If you do not have a uterus (after having hysterectomy) then you can take oestrogen only preparations. For all other women the hormone progesterone needs to be taken as well since oestrogen leads to thickening of the lining of the womb (endometrium) which can lead to bleeding and increase the risk of endometrial cancer.
Testosterone can also be prescribed for women experiencing low sexual drive where HRT alone is not effective.
Benefits: The main benefits of HRT are that it helps to relieve menopausal symptoms. HRT can also help in the prevention of osteoporosis and cardiovascular disease in peri and post-menopausal women.
The Cochrane data-analysis have shown a reduction in cardiovascular events and deaths in women taking either oestrogen only or combined HRT within 10 years of menopause or under 60 years of age. In addition to this the Cochrane group and the follow up data from WHI found that there doesn’t appear to be an increased risk in cardiovascular events or mortality in women initiating HRT more than 10 years after the menopause.
Risks: The risks of HRT are dependent on the woman taking into consideration age, weight, medical and family history so should be individualised.
The subject of breast cancer risk with combined HRT was raised after the Women’s Health Initiative (WHI) study in 2012. However, the long-term study published in 2020 has shown that for most women the benefits outweigh the risks. This can be found on the British Menopause Society (BMS) website.
Some types of tablet HRT can increase the risks of blood clots and stoke (this risk is less with transdermal use of HRT where it is given through the skin).
Preparations: There are a number of ways that HRT can be taken.
Combination preparations: These can be taken in the form of tablets or patches. If you are perimenopausal this is taken as a sequential combined HRT (with a regular monthly withdrawal bleed). If you are postmenopausal this can be taken as a continuous preparation.
- Oestrogen: This is available as tablets, patches, gel, or spray.
- Progestogens: This is available as tablets, or as an intrauterine device. If you are perimenopausal, progestogens are given as part of a week cycle of oestrogen to lead to a 4 weekly bleed. If you are postmenopausal then progestogen is given every day.
- Vaginal: This is especially beneficial if you are suffering from vaginal and bladder symptoms and involves topical oestrogen and not wanting to take one of other forms of HRT
It is recommended to start with the lowest dose and increase if there has been no effect on symptoms.
Please note for perimenopausal women it is important to use contraception on top of HRT since the hormone doses are not effective for contraceptive purposes!
Side-effects: Bleeding can be noted in the first 3 months but should settle. Symptoms of beast tenderness, bloating can also be experienced. If side effects are not controlled then you can consider changing preparations.
Menopause and work
Women represent nearly half the UK workforce. Nearly 1 in 4 women consider leaving their workplace during the menopause due to the symptoms they have experienced and lack of support.
It is important to be aware that the above treatments can help with your symptoms and thus improve your quality of life. Ensure awareness among colleagues and managers and seek ways that adjustments can be made in your work-life balance so that you are not suffering. Speak about it since you will find that you are not alone! Read more on our blog