Managing the Menopause

The menopause is a natural occurrence in every woman’s life. During the menopause, the levels of key hormones such as Oestrogen and Progesterone decline, leading to monthly periods and fertility to stop. For most women this will occur between the ages of 45 to 55.

However, the menopause is not something that happens overnight and the gradual process leading up to this time is called the perimenopause. During the perimenopause, women may experience the traditional symptoms of the menopause, but often continue to experience periods. Once periods have been absent for 12 months, women are generally considered to have transitioned from the perimenopause to the menopause.

The symptoms of both the perimenopause and menopause are similar and wide ranging. Not every woman will experience every symptom, and symptoms can change and vary over time. Some women experience symptoms for months, whereas some women unfortunately can experience some symptoms for years.

The symptoms experienced can have a significant impact on a woman’s wellbeing including her relationships, her work and social life. For this reason, it is important to always try and speak with your GP, if your symptoms begin to impact your daily life, as there are many treatment options that can be considered depending on the symptoms experienced. The symptoms can be split into two categories: physical symptoms and mental health symptoms.

The traditional physical symptoms most people know about include:

• Hot sweats (sometimes referred to as hot flushes or night sweats)
• Periods stopping
• Insomnia

However, we know that women can also experience symptoms such as:

• Palpitations
• Headaches
• Muscle aches
• Joint pain
• Changes to the skin
• Reduced libido (sex drive)
• Urinary symptoms

Women often also experience changes relating to their weight and body fat, with weight often being more stubborn and difficult to lose during the menopause.

Some of the more troubling symptoms for women include changes to their vulva and vagina with symptoms of vaginal dryness being most common.

The mental health symptoms can be particularly distressing to women, as they are not often anticipated and can come as a shock.

Symptoms include:

• Fluctuating moods
• Decreased moods
• Anxiety
• Irritability

Some women also report changes to their concentration and their ability to focus.

There are a number of different strategies to deal with the menopause and these should be targeted specifically to the symptoms experienced. Whilst it can sometimes feel difficult or embarrassing to talk about how you are feeling, it’s really important to not suffer the symptoms of perimenopause or menopause in silence.

Often women ask how they can manage their menopause symptoms naturally before considering any medical treatment. Assessing your general wellbeing and lifestyle routines can help build a solid foundation for managing the menopause.

Regular weight bearing activity, , such as aerobics or jogging, can help maintain bone density (as bones can naturally thin as a result of the menopause - a process called osteoporosis), as well as having a healthy balanced diet.

For women experiencing hot flushes, managing your environment to maintain a cool temperature, can be crucial in managing your symptoms. Opt to wear lighter weight clothing, materials such as cotton and linen, to allow your body to breathe and maintain a cooler temperature. Try and reduce your exposure to hot and spicy foods, and reduce your caffeine and alcohol consumption.

Speaking to friends, family or a therapist can be helpful when dealing with stress or mood changes. Cognitive behavioural therapy (CBT), a taking therapy technique, can be an incredibly effective tool at managing problems such as anxiety and depression.

There are a number of herbal remedies available over the counter, aimed at relieving the symptoms of perimenopause and menopause. There is limited research available for these although research is ongoing. Some over the counter supplements (such as Red Clover or St. Johns Wort) can interfere with regular prescription medication so it is always best to speak to your doctor before considering these.

Many women experiencing the perimenopause or menopause benefit from including calcium rich foods (such as dairy products) in their diet. Calcium is crucial for maintaining healthy bones and bone density. The body needs vitamin D (usually obtained from sun exposure) to help efficiently absorb calcium, so a regular vitamin D supplement can be very helpful. Often these can be combined as a single supplement for ease.

Hormone replacement therapy (HRT) is the mainstay of medical management for the symptoms of menopause. As the natural levels of hormones decline during the menopause, the aim of HRT is to support the body with additional hormones. HRT is not suitable for every woman and there are many different types and versions of HRT, that’s why it’s important to speak with your doctor to explore which options may be the best suitable for you. Treatments can be either applied topically or directly to the affected area (such as topical oestrogen given for symptoms of vulval and vaginal dryness), or can be in the form of a patch (applied to the skin) or tablet. Treatments can also vary in the amount and types of hormones contained, with some only containing oestrogen and some containing both oestrogen and progesterone, and your doctor can work with you to find a regime that best suits you.

There are also non-hormonal treatments that your doctor can consider for specific symptoms - often suitable if patients are unable to take HRT or if they choose not too. Treatments such Gabapentin or Clonidine can help manage symptoms of hot sweats. Some antidepressant medication can be helpful for persistent symptoms of low mood or anxiety, such as Sertraline or Citalopram.

All medications have the potential for side effects, and your doctor can explore these with you. However, for the majority of patients, the benefits of HRT and other treatments to manage the menopause outweigh the risks of treatment.

The most common side effect of HRT include:

• Breast tenderness
• Headaches
• Vaginal bleeding

There are potential serious side effects such as:

• Developing blood clots
• Increased risk of types of cancer such as breast, ovarian and endometrial cancer

These risks increase inline with the duration of your treatment - with those taking HRT for many years having a higher risk then those who use the treatment for a shorter period of time. Please always discuss any potential side effects with your GP, as they will be able to assess the risk of HRT with your medical history.