| Managing the menopause |
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Page 1 of 2 ‘The change’ affects some women worse than others, but far from being all doom and gloom, it can lead to new opportunities, says Norma Goldman
Hot flushes, night sweats, irregular or no periods... sound familiar? If so, you may be going through the menopause, often called “the change of life”. The average age of the menopause is 51, but younger women – and older ones – can be affected too. If the menopause occurs before the age of 40, doctors call it a “premature menopause”. This happens to around one in every 100 women naturally, but it can also be brought on by surgery (removal of the ovaries). In some women, the menopause doesn’t set in until they reach their early 60s. The good news is that you don’t have to suffer in silence as there are ways to ease the symptoms. What is the menopause?Medically, the “menopause” means your last menstrual period. But the term is usually used to describe the changes that lead up to this time. In most women, these changes don’t take place overnight but can last several years – called the “perimenopause” or “climacteric”. As you get closer to the menopause, your oestrogen levels fall and your ovaries release fewer eggs. Your monthly periods may become irregular and heavier, and you may even experience some spotting between them. Eventually, they will stop completely.Symptom checkEvery woman is different. A few women hardly notice the menopause, while some have a dreadful time. Hot flushes occur in 75 per cent of menopausal women in the UK. At their worst, they strike once or twice a day for several minutes at a time. When you have a hot flush, you may suddenly feel hot around your face, neck and chest. You may sweat heavily, your heart may beat faster and you may feel faint and dizzy. Night sweats are severe hot flushes occurring at night. Not surprisingly, these can make you lose a lot of sleep. Other common menopausal symptoms include headaches, aches and pains, vaginal dryness (and painful sex), bladder weakness, mood swings, a loss of concentration and irritability. The menopause also has some long-term effects. Low oestrogen levels can affect other parts of your body, leading to brittle bones (increasing the risk of osteoporosis) and an increased risk of heart disease and stroke. HRT decisionsHormone replacement therapy (HRT) can make menopausal symptoms less severe, and reduce the risk of developing osteoporosis. It works by replacing your body’s lost oestrogen. If you have your ovaries, you need progesterone as well as oestrogen to protect your uterine (womb) lining from endometrial cancer – called “combined HRT”.There are many different HRT products in various doses and forms. There are tablets, patches, skin gels, vaginal creams/ tablets/pessaries/rings, implants and nasal sprays – each form has its own pros and cons. In addition, some HRT products are taken without a break every month, while others give you a withdrawal bleed (like a monthly period). In most women, HRT doesn’t cause side-effects. However, initial symptoms can occur, similar to those seen with the contraceptive pill – nausea, breast tenderness, weight gain and fluid retention. Many women don’t want to take HRT – they worry in particular about the risk of breast cancer, following HRT health scares in recent years. There is evidence that HRT can increase the risk of breast cancer and deep vein thrombosis (blood clots), and may increase the risk of heart disease and stroke, although more research is needed. Current thinking is that if you take HRT for moderate to severe menopausal symptoms, you should be prescribed the lowest dose possible for the shortest possible time. For most women with menopausal symptoms, the risks are small and are outweighed by the benefits of HRT’s short-term use (less than five years). The only women who can’t take HRT are those who are currently pregnant, or who have breast cancer, endometrial cancer or a deep vein thrombosis. If you are considering HRT, you should discuss the pros and cons in relation to your own circumstances, medical history, family history and severity of your symptoms with your doctor. Most women take HRT for two to three years. The benefits and risks of taking HRT should be discussed annually with your doctor or nurse, as your health or circumstances can change. HRT alternatives
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If you don’t want to go on HRT, or can’t take it, what are your options? There are some prescription medicine alternatives to HRT, but these do have side-effects and are not always effective. You can also buy over-the-counter treatments for individual menopausal symptoms like vaginal dryness, sleeplessness or mood swings (ask a pharmacist for advice).
