Understanding the menopause
Mood swings, hot flushes, irregular periods, sleep problems? Then you could be suffering the classic symptoms of the menopause.
The average age for a Caucasian woman to hit the menopause is 51. In Afro Caribbean women it tends to be a bit later. An early menopause is considered to be under the age of 40.
The menopause is when a woman’s menstrual period stops permanently, or when a woman is at the end of her reproductive potential. It’s a fascinating fact that only three species of female live beyond their reproductive potential – human, killer and pilot whales.
But why do women have problems? Isn’t the menopause just nature taking it’s course?
Prof Hasib Ahmed, Consultant Gynaecologist at Benenden Hospital, said that as women are living longer the increased longevity means that women are spending more time in the post reproductive phase. As such the women are more likely to suffer the consequences of loss of ovarian function including menopausal symptoms, thinning of the skin and bones.
Symptoms typically include hot flushes (which some women describe as “tropical moments”), night sweats, poor sleep, loss of concentration, emotional ups and downs and sometimes joint pain. The intermediate effects are loss of skin elasticity, the skin can become drier, the vagina can become drier and the bladder can also be affected, resulting in a need to empty the bladder more frequently. There can be a long term thinning of the bones resulting in osteoporosis (brittle bones) and osteopenia (when the bone density is reduced). There can also be weight gain due to a slowed metabolism.
The good news is that women do not need to suffer in silence. There is lots of help available. Some GP surgeries now have specially trained menopause nurses who could suggest very simple solutions to mild symptoms. However, if a woman needed a prescription or felt her symptoms were severe she would need to see a GP, who would either treat her or refer her to a specialist.
Professor Ahmed said: “There are many different treatments and we endeavour to find one to suit the individual woman’s needs. Hormone Replacement Therapy can be prescribed if appropriate. There are tablets, patches, gels, intravaginal tablets and there is also a hormone containing coil the Mirena. Many women are embarrassed to discuss the manifold changes happening to them and choose to suffer in silence. Many alternatives to alleviate these very common symptoms are available and very effective in most women. Treatment should be tailored to meet the patient’s individual needs.”
HRT had a lot of bad press back in 2002 after a major study suggested links with increased risk of breast cancer and stroke. However , updated analysis of the original data and subsequent studies have shown that when an appropriate HRT is used in the correct setting the increased risks of serious problems, such as blood clots and breast cancer are small. The benefits of HRT are generally felt to outweigh the risks.
There are also non pharmalogical or natural ways to tackle the menopause which some women say work for them. Soya products are rich in isoflavones which are phytoestrogens. Phytoestrogens are plant-based foods that can have an oestrogen-like effect on the body. Aside from soybeans, soy can be found in products such as tofu and soy milk. Red clover and black cohosh, available from health food shops, are also said to help, although to date there is no hard evidence to support this.
There is also bio-identical HRT which is tailored to a woman’s individual and precise needs but robust scientific evidence is rather limited.
Prof Ahmed said: “I find that HRT patches work particularly well. The hormones go straight through the skin and into the blood stream and the patient receives a steady dose rather than peaks and troughs that you can get with tablets. However, it is a case of whatever works for the patient, according to their individual needs. What might be best choice for one patient may not be the best option for another.”
The definition of menopause is when menstrual periods have stopped for more than a year, as periods can stop for a while and then start again. Ovarian function declines gradually so many symptoms start before the periods have completely stopped. Indeed, one of the common causes of symptoms are a change in the nature of periods including very heavy and irregular bleeding as the menopause approaches. The Mirena coil has revolutionised management of women with this type of symptom.
It is impossible to say exactly when a woman will go through the menopause. Although the age of girls starting their periods has got steadily younger since the start of last century, the age of the menopause has remained the remarkably constant. An early start of the menstrual cycle or periods is a reflection of a greater number of egg precursors in the ovaries. As such women who start menstruating at a young age tend to menstruate for longer go through the menopause later than most.
And it’s not just women that suffer in their late forties and early fifties – so do men! There is growing evidence that the andropause, or the manopause, does exist. Around this age men also experience a hormonal shift which can cause physical, emotional and cognitive changes.
There are many different treatments and we endeavour to find one to suit the individual woman’s needs".
Prof Hasib Ahmed, Consultant Gynaecologist at Benenden Hospital