IT is about time the menopause was in the spotlight – and long may it continue to be.
Its symptoms can, for some women, span decades of their mid to late life.
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You may think “hot flushes” when you hear menopause, an image of a woman getting hot and bothered and fanning herself.
But there are 34 recognised symptoms, most of which are invisible to others, including joint aches and pains, headaches, and dry, itchy skin.
The genitals and urinary tract can be affected, leading to sore, itchy, painful vulva and vagina, pain during sex and recurrent urinary tract infections.
Even less obvious are the psychological symptoms women can experience.
Low mood and depression, anxiety, “brain fog”, insomnia, fatigue and loss of libido are all symptoms commonly raised by women in menopause.
The effects can be so severe that one in ten women report having thoughts about suicide.
So you can see why it is important to keep the conversation with menopause going. Here I tackle some of the main questions:
What is menopause and why does it happen?
MENOPAUSE simply means the last period; and after you have not had a period for 12 months you have been through menopause.
Perimenopause is the time leading up to menopause, when periods become more irregular until they stop when there are no eggs left.
The hormones oestrogen and progesterone are on a downward trend but fluctuate during perimenopause until they flatline at menopause.
The average age of menopause is 51, according to research on white women, but African American and Hispanic women have menopause on average 8.5 months earlier.
Globally, the average age appears to be even younger.
You don’t need blood tests for diagnosis of menopause, but if you are under the age of 45, they are offered to rule out other causes of symptoms.
Approximately one in 20 women will have an early menopause, before the age of 45.
For some women symptoms will start up to a decade before the final period – and we can’t predict how long they will last or when their intensity will peak.
A quarter of women will have no symptoms at all, or at least, very few.
What treatments are there?
WE tell women to see their GP when their symptoms bother them and are affecting their lives. You can have treatment in perimen-opause as well as postmenopause.
GPs will offer medication to ease symptoms as appropriate, but may also discuss lifestyle changes (more on that later).
The most famous treatment is hormone replacement therapy, which does exactly what it says on the tin – it replaces the hormones that have decreased.
If you are prescribed HRT you will certainly be given oestrogen. You’ll also be given progesterone to prevent the womb lining from becoming thickened, but if your womb has been removed by hysterectomy, it is not generally needed.
Testosterone may be offered to help treat low libido.
Many women have feared HRT due to studies earlier this decade that seemed to show it increased the risk of heart attacks, breast cancer and stroke.
With the help of your doctor, you will weigh up the generally small risks
Dr Philippa Kaye
However, the women in these studies used an older version of oral HRT that we don’t use now, and they started HRT aged 63 years, on average.
This is more than a decade after the average age of menopause.
Research since then has shown that starting HRT within the first ten years doesn’t seem to have the same risks.
So let’s be clear: For the majority of women who can take HRT, starting within the first decade after menopause, is safe.
The change in risk of a stroke or heart attack depends on how and when you start taking HRT.
There is a small increased risk of breast cancer with HRT, but this is approximately the same rise as that related to smoking and drinking alcohol, and you can decrease your risk by trying to maintain a healthy weight and exercising regularly.
What’s more, other benefits of HRT should not be underestimated!
These include a decreased chance of osteoporosis, muscle loss, bowel cancer and more.
With the help of your doctor, you will weigh up the generally small risks and compare them to benefits on a case-by-case basis.
There are also non-hormonal prescribable treatment options such as cognitive behavioural therapy (CBT), which can predominantly help mental health-related symptoms.
What lifestyle changes can relieve symptoms?
AS a doctor, it is never a question of either when it comes to medication or lifestyle changes.
A healthy diet may help your symptoms. For example, cutting out caffeine and spicy food can reduce hot flushes and sweats.
Decreasing alcohol can help improve your sleep, fatigue, mood and hot flushes.
Calcium and vitamin D are vital in the diet to help protect your bones.
And foods rich in phytoestrogens (plant-based oestrogens), such as tofu and soybeans, may be helpful.
Exercise is vital at any age, but during this time it can help protect your bones, decrease symptoms such as fatigue and hot flushes, boost your mood, improve your sleep, and reduce your risk of various cancers.
Remember, it’s about looking after your mental health, too.
When it comes to menopause products, there is a huge amount on offer
Dr Philippa Kaye
Make sure you attend cancer-screening programmes for women your age, such as mammograms or smears, and do your self-checks for lumps, bumps and changes.
When it comes to menopause products, there is a huge amount on offer – everything from “speciality” chocolate to pyjamas, face creams and supplements.
When we don’t feel at our best we are vulnerable. After all, wouldn’t it be nice if a set of sheets might be the answer to our symptoms?
While these products may help some people, there is no evidence for effectiveness of many of them.
An expensive face cream or shampoo labelled “for menopause” may well contain similar ingredients to a cheaper one.
The way through is to get empowered and informed so that you can make evidence-based decisions about your health, which is why I wrote the book!
- The Science Of Menopause by Dr Philippa Kaye, out now (published by DK, £16.99).
