Menopause

What is menopause?

Most women become menopausal between the ages of 45 and 55, with the average age of onset at around 50. Menopause is considered “early” when it occurs between 40 and 45 years. “Premature menopause” may occur before the age of 40 due to either natural ovarian function ceasing, following surgery to remove the ovaries, or as a result of cancer treatments.

Menopause can last up to six years, and is associated with several symptoms such as hot flushes, night sweats, memory loss and sleeping difficulties. Menopause itself cannot be treated, but if the symptoms are problematic, there are ways of managing them. The type of symptom, its severity and its impact on your quality of life will determine whether and how it should be managed. Treatment options include hormone replacement therapy (HRT).

What are the signs and symptoms?

The signs and symptoms of menopause vary. As the production of oestrogen by the ovaries starts to slow down, most women will notice a change in their menstrual cycle. Bleeding can become longer, shorter or irregular. It may also become lighter or heavier depending on the individual.

While some women will barely notice any symptoms, others may find menopause debilitating. The change in hormone levels can cause hot flushes and/or night sweats, trouble sleeping and vaginal dryness. The severity of these symptoms varies from person to person, but it is often genetic.

The following symptoms are often experienced during or after menopause, however some may be related to other symptoms (e.g. tiredness may result from disturbed sleep due to night sweats), or be age-related:

• Joint aches and pains;
• Headaches;
• Sore breasts;
• Bloating;
• Reduced sex drive;
• Urinary frequency;
• Tiredness;
• Difficulty sleeping;
• Mood changes including sadness, irritability, loss of self-esteem; and
• Lack of concentration/forgetfulness.

Diagnosis:

Your doctor will usually diagnose menopause based on your age, family history and symptoms. If you haven’t had a menstrual period in 12 months then you are normally considered to be past menopause.

There are also tests available that can highlight any changes in the levels of hormones associated with menopause, but these are uncommon, and not routinely recommended.

Complementary medicine and lifestyle approaches

Changes in lifestyle and other non-medical treatments can help deal with the symptoms of menopause. These include:

• Lifestyle modifications, such as regular light exercise, wearing light clothing and stress reduction;
• Sleeping in a cooler room and relaxation therapy, to help with sleep ; and
• Avoidance of substances that can trigger hot flushes, such as caffeine, smoking, alcohol and spicy foods.

Once you pass menopause, your risk of certain conditions, such as heart disease and osteoporosis, increases. As smoking also increases your risk factor of developing these conditions, it is highly recommended that you quit smoking.

It’s also a good idea to establish a relationship of open communication with your doctor, to get the most out of your treatment. This can include:

• Providing him or her with your personal and family history relating to menopause and other health issues (for example, cardiovascular disease, breast cancer);
• Asking about how lifestyle changes can help relieve symptoms;
• Discussing any symptoms that are troubling you;
• Talking about the harms and benefits of HRT for your individual situation;
• Sharing information about any medicines, including over-the-counter and vitamins or herbs, you are taking or thinking about taking; and
• Keeping a record of any symptoms you experience, including their duration and severity, to discuss at each appointment.

Alternative treatments:

Complementary medicines are widely used to treat menopause, but evidence of their effectiveness is lacking. There are some clinical trials that show that red clover, soy iso-flavones and black cohosh reduce overall menopausal symptoms, but not significantly. There has also been anecdotal evidence (for example testimonials) supportive of complementary treatments. But this is not particularly reliable when you consider that menopausal symptoms fluctuate naturally, and other research found sufferers reduced symptoms of hot flushes by up to 60 per cent when they took a placebo. It is hard to be sure whether complementary treatments are having an impact, or whether it’s just that symptoms are inconsistent.

Some people have also experienced serious side-effects as a result of taking complementary medicines. Supplementing with black cohosh, for example, has been linked to liver problems, with some cases requiring liver transplant as a result of liver failure. Complementary medicines can also interfere with other medications, and natural products that contain oestrogen and/or progesterone may have similar risks as HRT. Speak to your doctor before you take anything to reduce menopausal symptoms.

Traditional medicine-based treatment:

HRT has been a common treatment for women suffering severe symptoms of menopause since the US Food and Drug Administration first approved oestrogen products in 1941. In its heyday, it was thought to have many health benefits, including prevention of heart problems. Then, in 2002, studies showed that some kinds of HRT increased the risk of breast cancer, stroke and coronary heart disease, causing HRT usage to drop dramatically. However, HRT is still the most effective option available for women requiring a medicine to manage their symptoms, and the increased risk of health problems is relatively small.

Despite this, HRT is only recommended for moderate to severe menopausal symptoms, and for relatively short periods of time (a few years, as opposed to the longer term as recommended in past). Different drugs, formulations (for example, creams, pills, patches, implants) and doses may be recommended. Some women can’t use HRT—for example, it’s not recommended if you’ve already had breast cancer or heart disease. Those with a family history of these conditions may also choose not to undergo HRT, because of the possibility of increasing their risk of these diseases. If you’re considering any treatment options, it’s therefore important to provide your doctor with your complete family medical history, and to discuss the individual risks and benefits of each option.

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