What is the menopause and what are the symptoms?
Strictly speaking, the menopause is the last menstrual period. However, most
women think of the menopause as the time of life leading up to, and after, their last
period. It is often called the 'change of life'. It occurs because as you get older your
ovaries make less oestrogen (the main female hormone). The average age of the
menopause in the UK is 51. However, it may be sooner or later than this. For
example, you may have an early menopause if you have a hysterectomy.
What are the possible symptoms and problems of the menopause?
The menopause is a natural event. You may have no problems. However, it is
common to develop one or more symptoms which are due to the low level of
oestrogen.
Short-term symptoms
Hot flushes occur in about 3 in 4 women. A typical hot flush lasts a few minutes and
causes flushing of your face, neck, and chest. You may also perspire (sweat) during
a hot flush. Some women become giddy, weak, faint, or feel sick during a hot flush.
The number of hot flushes can vary from every now and then, to fifteen or more
times a day. Hot flushes tend to start just before the menopause, and typically
persist for 2-3 years.
Sweats commonly occur when you are in bed at night. In some cases they are so
severe that sleep is disturbed and you need to change your bedding and
nightclothes.
Other symptoms may develop such as headaches, tiredness, palpitations, being
irritable, difficulty sleeping, depression, anxiety, aches and pains, loss of libido (sex
drive), and feelings of not coping as well as before. It can be difficult to say whether
these symptoms are due to the hormone changes of the menopause. For example,
you may not sleep well or become irritable because you have frequent hot flushes,
and not directly because of a low oestrogen level. Also, there may be other reasons
why these other symptoms develop. For example, depression is common in women
in their 'middle years' for various reasons.
Long-term changes and problems
Skin and Hair. You tend to lose some skin protein (collagen) after the menopause.
This makes the skin drier, thinner, and more likely to itch. You may have less
underarm and pubic hair. Some women have an increase in facial hair.
Genital area. Lack of oestrogen tends to cause the tissues in and around the vagina
to become thinner and drier. These changes can take months or years to develop.
How long do menopausal symptoms last?
Without treatment, most menopausal symptoms are self - limiting, which means that
they gradually stop happening naturally. This usually happens 2-5 years after the
symptoms start, but some women can experience symptoms for many more years.
If you experience vaginal symptoms, such as dryness, itching and discomfort, it is
likely that they will persist or worsen over time if left untreated.
Diagnosis
If you think you are experiencing menopausal symptoms and you are finding them
difficult to deal with, you should see your GP. There is no definitive test to diagnose
the menopause but the level of follicle stimulating hormone (FSH) in the blood can
be used to confirm a diagnosis as the level rises in women who are menopausal.
The GP will also assess by considering your age, any symptoms and if your periods
have stopped.
Treatment
Few women seek medical help for symptoms of the menopause but if you find the
symptoms are interfering with your daily life, there are treatments, which may be of
benefit. There are treatments available with or without hormone replacement therapy
(HRT).
What is HRT (hormone replacement therapy)?
HRT contains oestrogen which replaces the oestrogen that your ovaries no longer
make. HRT comes as tablets, skin patches, gels, nasal spray, cream, or skin
implants. If you have not had a hysterectomy, the oestrogen is combined with a
progestogen hormone, which protects you from an increased risk of cancer of the
uterus, (a risk if you just take oestrogen alone.)
What are the benefits and risks of HRT?
Benefits. HRT usually stops hot flushes. It can reverse the changes around the
vagina. If you are irritable because of menopausal symptoms, you may feel generally
better as menopausal symptoms improve. If you take HRT for several years, it helps
to protect against osteoporosis (bones that become more fragile which can break
easily) and bowel cancer.
Risks. HRT causes a slight increase in the risk of developing: a serious blood clot
(thrombosis), breast cancer, stroke, heart attack, ovarian cancer, and possibly
dementia.
How long is HRT taken for?
To ease menopausal symptoms, you may be happy to accept the small risk of taking
HRT for 1-3 years. After 1-3 years the worst of the flushing-type symptoms have
often gone and HRT is no longer needed. If the genital symptoms such as vaginal
dryness persist after stopping HRT, an option is to use an oestrogen cream or
pessary in the vaginal area.
A few years ago HRT was widely used to prevent osteoporosis. However, research
has shown that there are potential serious health risks with taking HRT (described
above). So, HRT is not used to prevent osteoporosis for most women. However, if
you have an early menopause, HRT may be advised until you are aged 50. You
have an increased risk of developing osteoporosis if you have an early menopause.
The health risks of taking HRT are not thought to apply, or be very small, until you
reach the usual age of menopause (about aged 50).
Non-HRT treatments for hot flushes and night sweats
Lifestyle: Some women find that regular exercise, lighter clothing, sleeping in a
cooler room, and reducing stress reduce the number of hot flushes. Some women
find that things such as spicy foods, caffeine (in tea, coffee, cola, etc), smoking, and
alcohol may trigger hot flushes. Avoiding these things may help in some cases.
Progestogen tablets: HRT usually refers to replacing the oestrogen hormone.
Progestogen hormone has also been shown to reduce flushing in some women,
although to a lesser extent than oestrogen-based HRT. The risk of taking a
progestogen hormone is less than taking an oestrogen hormone.
Soy foods have been studied and seem to have a modest benefit to reduce hot
flushes. However, the studies are not conclusive. Soy foods have been a staple part
of the diet in parts of the world for thousands of years and are presumed to be safe.
So, it may be worth trying to increase the amount of soy foods that you eat.
In general, for other complementary therapies there is not much evidence to say that
they reduce menopausal symptoms.
Non-HRT treatments for vaginal dryness
You can buy vaginal lubricants and vaginal moisturizers from pharmacies which can
help ease vaginal dryness. Some women only notice the dryness when they have
sex. In this situation, if you place a small dose of lubricant inside the vagina before
having sex it will usually help.
(Note: you may not be aware that there are oestrogen creams which ease the
vaginal symptoms of the menopause. Strictly speaking, they are a form of HRT, but
have less risk than taking HRT tablets.
What about side effects when taking HRT?
Side effects are problems that are not serious, but may occur in some women. They
tend to go if you stop treatment. Side effects with HRT are uncommon. Always read
the leaflet that comes with the packet, which gives a full list of possible side effects.
They include the following.
In the first few weeks some women develop slight nausea (feeling sick), some
breast discomfort, or leg cramps. These tend to go within a few months if you
continue to use HRT.
HRT skin patches may cause irritation of the skin.
Some women have more headaches or migraines when they take HRT.
Dry eyes (lack of tears) are also thought to be more common in HRT users.
A change to a different brand or type of HRT may help if side effects occur. Various
oestrogens and progestogens are used in the different brands. If you have a side
effect with one brand, it may not occur with a different one.
So, should I take HRT, and for how long?
The benefits have to be balanced against the risks. You have to decide what is right
for you, with advice from your doctor or nurse, depending on your circumstances. As
a general rule:
For short-term treatment of menopausal symptoms
If you are troubled with menopausal symptoms, the balance of risks and benefits is
probably in favour of taking HRT. You may be happy to accept the small risk of
taking HRT for 1-3 years to be free of these symptoms. You should take the lowest
dose which keeps symptoms away. Many women find that after 1-3 years the worst
of the flushing-type symptoms have gone and they no longer need HRT to prevent
them. If the genital symptoms such as vaginal dryness persist after stopping HRT, an
option is to use an oestrogen cream or pessary in the vaginal area (see below).
For healthy women without symptoms and a menopause at around 50 or over
HRT is usually not advised as there is little to be gained, and even the small risks of
HRT are then unacceptable.
If you just have genital symptoms such as a dry vagina
An option which may be advised by your doctor is to use a vaginal oestrogen cream
or pessary. This gives the benefits of easing the symptoms, but with less risk than
using HRT tablets, patches, etc, as less oestrogen gets into the bloodstream.
What about taking HRT to help prevent osteoporosis
A few years ago HRT was widely used to prevent osteoporosis. However, recent
research has shown that there are potential serious health risks with taking HRT
(described above). So, we now know that the balance of risks and benefits is usually
not in favour of taking HRT to prevent osteoporosis for most women.
However, if you have an early menopause, HRT may be advised until you are aged
50. This is to help to prevent osteoporosis (and ease menopausal symptoms if they
occur). You have an increased risk of developing osteoporosis if you have an early
menopause. The health risks of taking HRT are not thought to apply, or be very
small, until you reach the usual age of menopause (about aged 50).
Some other points about HRT
HRT does not act as a contraceptive. Therefore, if you are still having periods when
you start HRT, or have only recently stopped having periods, you should still use
contraception. Your doctor will advise when you no longer need to use
contraception.
You should not take HRT if you have severe liver disease, or cancer of the uterus or
breast.
If you have had a previous blood clot in a vein, or have a family history of a bloodclotting problem, you may be advised not to take HRT until certain blood tests are
checked.
Non-HRT treatments for hot flushes and night sweats
Progestogen tablets: HRT usually refers to replacing the oestrogen hormone.
Progestogen hormone has also been shown to reduce flushing in some women,
although to a lesser extent than oestrogen-based HRT. The risk of taking a
progestogen hormone is less than taking an oestrogen hormone.
Selective serotonin reuptake inhibitor (SSRIs)
There is a small amount of evidence that some types of this class of antidepressant
can improve hot flushes. However, this is very new research and the exact role of
SSRIs in the treatment of the menopause is yet to be clarified.
Complementary treatments
Because of the recent concerns regarding HRT, complementary treatments have
become more widely used. The most commonly used for menopausal symptoms
are: sage, evening primrose oil, ginseng and Vitamin E.
Soy foods have been studied and seem to have a modest benefit to reduce hot
flushes. However, the studies are not conclusive. Soy foods have been a staple part
of the diet in parts of the world for thousands of years and are presumed to be safe.
So, it may be worth trying to increase the amount of soy foods that you eat.
In general, there is not much evidence to say that complementary treatments reduce
menopausal symptoms.
Self-help
Coping with hot flushes - wear layers of clothing, which you can easily peel off and
put on again. Wear natural fibres. Use cotton bedding and nightclothes, which
absorb moisture more efficiently.
Avoiding hot flushes - keep hot drinks such as tea and coffee, alcohol and spicy
foods to a minimum. Avoiding tea and coffee is also a good idea because caffeine
can cause insomnia and lead to calcium being lost from the body. Try a herbal
alternative
Don't smoke - smoking increases the risk of heart disease and osteoporosis, so if
you've been thinking about giving up but never quite got around to it, now is the time
to quit for good.
Stick to a healthy diet and get plenty of exercise - this will help to keep stress levels
to a minimum, as well as being of physical benefit. It's never too late to start.
Drink plenty of water - it's a great cleanser and purifier and can help with many of the
symptoms, including hot flushes, headaches and dry skin.
Continue to use contraception - for two years after your last period if you're under 50,
or otherwise a year.
Try to stay positive - and remember, this is only a temporary phase in your life.
Get support - having people around you who understand what's going on is
invaluable.
More information
NHS Direct – Menopause FAQs. www.nhsdirect.co.uk
The Daisy Network – Early/Premature Menopause Support.
www.daisynetwork.org.uk/