MENOPAUSE

MENOPAUSE OVERVIEW

Menopause is defined as the time in a woman’s life, usually between age 45 and 55 years, when the ovaries stop producing eggs (ovulating) and menstrual periods end. After Menopause, a woman can no longer get pregnant. If you are using a hormonal method of birth control, like pills, an injection, a vaginal ring, or a skin patch, talk to your doctor or nurse to find out when you should stop.

Menopause does not happen suddenly; most women experience several years of changes in their menstrual periods before they stop completely. During this time, many women also start to have menopausal symptoms. These result from declining levels of oestrogen in the body and can include hot flushes, night sweats, mood changes, sleep problems and vaginal dryness. A woman is said to have completed menopause once she has gone a full year without having a period. The average age for a woman to stop having periods is 51 years.

Menopause is a normal part of a woman’s life and does not always need to be treated. However, the changes that happen before and after menopause can be disruptive. If you have bothersome symptoms, effective treatments are available.

After hysterectomy — If you’ve had a hysterectomy but retained your ovaries, you will still go through menopause when your ovaries stop producing eggs. However, it can be hard to know when this happens because you don’t have menstrual periods. You may develop menopausal symptoms as your ovaries stop working and your blood levels of oestrogen begin to fall.

MENOPAUSE DIAGNOSIS

If you are 45 years or older and you have not had a menstrual period in 12 months, there is a good chance that you have gone through menopause. Most women in this group do not need any blood/laboratory testing to confirm this, especially if they are having menopausal symptoms such as hot flushes or vaginal dryness.

MENOPAUSE SYMPTOMS

Some women have few or no menopausal symptoms while other women have bothersome symptoms that interfere with their life. These symptoms often begin during the menopausal transition, before you stop having periods completely.

Bone protection and reducing the risk of osteoporosis is an important consideration in the menopause – see patient information leaflet OSTEOPOROSIS & BONE HEALTH.

Common symptoms of menopause include:

• Hot flushes – This is the most common symptom of menopause, affecting up to 60 to 80 percent of women. They typically begin as a sudden feeling of heat in the upper chest and face; the hot feeling then spreads throughout the body and lasts for two to four minutes. Some women sweat during the hot flush and then feel chills and shiver when the hot flush ends. Some women have a feeling of anxiety or heart palpitations during the hot flush. Hot flushes can occur once or twice each day or as often as once per hour during the day and night. Hot flushes usually begin well before your last menstrual period. It is not clear what causes hot flushes. Most women who have hot flushes will continue to have them for about four years (on average).
• Night sweats – Hot flushes are more common at night than during the day. When they occur during sleep, they are called “night sweats.” Night sweats may cause you to sweat through your clothes and wake you from sleep because you are hot or cold. This can happen one or more times per night. Waking frequently can make it hard to get a good night’s sleep. As a result of interrupted sleep, many women develop other problems, such as fatigue, irritability, trouble concentrating, and mood swings.
• Sleep problems – During the transition to menopause, some women begin to have trouble falling asleep or staying asleep, even if they don’t have night sweats.
• Vaginal dryness – As the levels of oestrogen in the body decrease before and during menopause, the tissues inside the vagina and urethra (the tube that carries urine from the bladder to outside the body) can become thin and dry. This can cause vaginal discomfort, itching, pain during sex, discomfort during urination or recurrent urinary tract infections.
• Depression – During the menopausal transition, many women develop new problems with mood, such as sadness, difficulty concentrating, feeling uninterested in normal activities, and sleeping too much or having trouble staying asleep.

MENOPAUSE TREATMENT

Not all women need treatment for menopausal symptoms. If your symptoms are mild, there are things you can try on your own that might help – see ‘ALTERNATIVES TO HORMONE REPLACEMENT THERAPY’ patient information leaflet. For more severe or bothersome symptoms, there are effective treatment options available.

Menopausal hormone therapy — Oestrogen is the most effective treatment for hot flushes. For most healthy women who are seeking help with symptoms of menopause, it is safe, low risk, and effective. It is generally given for up to five years but many women use it for longer. It is to be avoided or used with caution if there is a history of (or at high risk for) certain medical problems, including breast cancer, heart disease, and stroke.

Hormone therapy usually involves a combination of oestrogen and a progestogen (another group of female hormones), although women who do not have a uterus (eg, after a hysterectomy) need only oestrogen. Hormone therapy is available in a pill that you take by mouth; a skin patch; a vaginal ring; and a skin gel, cream, or spray. In addition to relieving hot flushes, hormone therapy may help with other symptoms of menopause as well, including vaginal dryness, depression, and other mood problems.

If you don’t need hormone therapy for hot flushes but you have problems with vaginal dryness, vaginal oestrogen can help. This is different from the oestrogen preparations used to treat hot flushes; it comes in a much lower dose. It is available as a cream, tablet, or flexible plastic ring that you insert into the vagina.

Non-hormonal treatment options — If you are bothered by hot flushes but you cannot take or would prefer to avoid hormone therapy, there are alternatives. Although hormone therapy is the most effective treatment for hot flushes, non-hormonal alternatives are a good option for many women – see ‘ALTERNATIVES TO HORMONE REPLACEMENT THERAPY’ patient information leaflet.