Dr Morton's - Managing the Menopause
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Managing the Menopause

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Written by Dr Karen Morton
Consultant Obstetrician and Gynaecologist

We only get one life… don’t accept ‘the change’ as meaning a change for the worse! Key points:

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What is the menopause?

If stripping off your jacket and wiping the perspiration from the side of your nose (embarrassing enough) was all that was required to keep you performing top notch at work and at home, then life would be simple. Unfortunately, as the majority of women ’d’un certain age’ will tell you, there are a whole range of health issues which rear their head at this time. 

Maximum knowledge will help you decide what, if anything, apart from exercise and a healthy diet, you intend to do about menopausal symptoms. Every woman is different in terms of her philosophy on HRT. Her medical situation which will affect what she can and can’t take; and whether the symptoms which bother her may or may not respond to hormone treatment. 

Are there different phases of the menopause?

‘The menopause’ is a single date in time. The date of the last period ever. It means that all the eggs have gone (we are born with a finite number; not like sperm which are made all the time from puberty until death) from the ovaries. Of course this might not be obvious if a woman has had her uterus removed or has a coil in place; but no matter…… the principle is the same. Then there are a number of years during which women get symptoms of declining ovarian function; often called ‘the perimenopause’. Unfortunately the symptoms may continue (and worsen) for years and years ……. and years! And finally there are the long-term consequences of having no oestrogen about, such as bone-thinning, middle-aged spread and vaginal dryness amongst other things.

In terms of hormonal changes, the most important one is the fall in oestrogen levels. The pituitary gland (the master gland which sits at the base of the brain just behind the bridge of your nose, and is the size on a pea) tries its best to drive the ovaries harder by releasing huge amounts of follicular stimulating hormone (FSH) and luteinising hormone (LH), but eventually the ovaries simply can’t respond. Progesterone is only ever produced by the ovaries after an egg has been released, and its only role is in telling the womb lining (endometrium) to prepare for the fertilised egg. It is needed to sustain early pregnancy, but it plays no role that we know about in general health. The ovaries also make a small amount of testosterone. That continues at a very low level after periods have stopped. The role of testosterone in women’s health is uncertain. It is also produced by the adrenal glands.

One major problem is the timing of this major life event. It happens at precisely the same time as children can be at their most difficult as older teenagers, and parents are becoming elderly and more dependant. Women often have big, demanding jobs as well. Sleepless nights due to waking up drenched in sweat, or periods which go on and on are the final straw.

Specific menopausal symptoms

Irregular periods

This may be anything from missing 1 or more periods through to bleeding continuously and heavily to the point of severe anaemia. It is egg production which gives the rhythm of periods, and once eggs stop being produced regularly, regular periods will stop. There can occasionally be some other problem underlying chaotic bleeding so do speak with one of our gynaecology team I case other investigations are needed. 

Sweating and hot flushes

Everybody knows what it feels like to sweat, but waking up drenched in sweat is something else. Cucumber clothing have designed some fantastic nightwear for women made of a fabric which draws the sweat away from the skin and avoids the need to change your pyjamas. If you’ve ever had a hot flush then you won’t be able to imagine it. It simply makes you think you are on fire and as if everybody in the room is looking at you. Actually they aren’t, but it completely saps your self-confidence and fills you with embarrassment. There are some excellent CBT techniques to help with this, and for sure the flush will pass and some mind over matter can be really helpful.

Extreme tiredness

Low energy and exhaustion is, of course, a multifactorial thing. Low iron levels due to heavy periods, sleep deprivation due to night sweats, and anxiety about everything and nothing are all very draining. It’s important to have tests to check that your thyroid gland is working well and tests for anaemia. You may be lucky and have boundless energy if you start HRT but realistic expectation is that you will be better but that life in general may be taking its toll on your energy levels. It’s almost impossible to disentangle symptoms of hormone deficiency and symptoms of getting older.

Gaining weight and middle-age spread

As we get older there is a natural tendency to become ‘too busy’ to take proper, regular, vigorous exercise. Rushing about to meet deadlines and generally always having too much to do is not the same thing. That said there is a physiological change in weight distribution which occurs after menopause which women really hate. In fact in our recent survey of the things which women hate most about menopause this was their top hate. Fifty sit-ups every day will help, and obviously diet is key. 

Aching joints and bones

Aging itself can lead to development of aches and pains. Joints that are used a lot can develop osteoarthritis, and backs start to get a bit stiffer. It is unlikely that the loss of oestrogen will have any sudden impact on this. Rather it is the long-term absence of oestrogen which leads to loss of bone density and osteoporosis. Different women have different risk factors for this. There is definitely a hereditary component so if your mother developed a stooping spine, do get advice about having a bone density done. This should definitely be a factor you take into account when deciding about HRT. 

Poor sleep or ‘insomnia’

There can be lots of reasons for not sleeping well. Being woken up by drenching sweats is certainly one of them. Lying awake worrying about things can be a feature of anxiety which may be helped by HRT or even some talking therapy. Waking at 3 or 4 in the morning and not being able to get back to sleep may a symptom of true depression. Many women reject the idea that they may have anxiety or depression as part of a mental health problem, saying 

Urine leakage and running to the loo all the time

The bladder and the urethra are almost as dependant on oestrogen nourishment as the vagina. Getting up at night and general bladder irritability may become a problem. Oestrogen cream put into the vagina will be absorbed through to the base of the bladder and the urethra and help these symptoms. It is a time for really working hard on the pelvic floor and for avoiding food and drink which irritate the bladder. Caffeine is the worst, but different foods affect different bladders and it is worth some experimentation like with an irritable bowel.

Anxiety at the menopause

Worrying about everything and nothing is the most under-estimated symptom of declining ovarian function. It is often said that women become anxious at this time of life because their children are leaving home and their parents are needy. Both may be true, but this does not account for their steep rise in anxiety which occurs at this phase of life. Consider HRT if appropriate, but at the very least, do seek help and advice. The well-being of women of this age is central to the health of their family and often to businesses as well.

Skin changes: wrinkles and dryness

Of course skin quality will deteriorate with age, and with it go thread veins and droopy eye-lids. Good moisturiser is essential but whether the very expensive creams are any better than cheaper versions is doubtful. Hair fall bothers many women too and there really isn’t anything that can be done about it.

Women cope with the change in their appearance in different ways; helped or otherwise by the attitude of their partners.

Loss of libido

Or ‘Knowing you ought to have sex with your partner and not wanting to’.

May women feel as if they have lost their sex drive. They say that their husbands ‘are very good’ and they mean tolerant of no sex, but secretly or otherwise they are worried that if they do not provide their partners with sexual satisfaction that their marriage will be at risk. In the main they are right, because sex is very important to most men and has to be done. There is no reason why a woman would want to do it if it hurts so it is important to ensure that the vagina is well nourished with oestrogen cream even if a woman does not want, or cannot have, HRT through the blood stream. Sometimes HRT tablets or patches do not supply a sufficient dose of oestrogen to the vagina and cream or pessaries are needed as well. Do seek advice about this as sometimes a small split at the entrance to the vagina can make sex dreadfully painful. Our gynaecologists will be able to advise.

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This page was last updated on 19/08/2016.

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