Thursday 27 July 2017

The Menopause - everything you need to know about the change

Changes in your hormonal health can be difficult. But we can help you make your way through this new chapter in your life

Menopause
Menopause
Hot flushes are a common symptom of the menopause

Ailin Quinlan

It gets more hits than any other topic on Dublin's Well Woman Clinic website and can present with a long and often terrible list of symptoms.

These can range from sweating, hot flushes and floating anxiety, to panic attacks, mood swings, irritability, sleep disruption, forgetfulness and irregular periods.

On top of that, some sufferers experience heart palpitations and chest tightness, shortness of breath, urine leakage, weight gain, aching joints, vaginal dryness, reduced sex drive and lots, lots more.

Menopause is defined as a woman's last menstrual period - but, as any woman who has experienced the condition will tell you, there's generally a lot more to it than that.

Hot flushes are a common symptom of the menopause
Hot flushes are a common symptom of the menopause

As we all know, periods happen as a result of hormones produced by the ovaries - oestrogen and progesterone.

However, as a woman ages, her hormone production level reduces.

The fall in hormone levels, particularly oestrogen, is believed to be the cause of the menopausal symptoms that so many women experience.

The average age for a woman's last period is between 50 and 51 years old, but this varies widely, with early menopause occurring in some women under the age of 45.

Others may continue to have periods up to age 56 or 57, while premature ovarian insufficiency may cause women as young as 30 to become menopausal.

Women will generally start to experience some menopausal symptoms for up to two years before their periods stop for good.

Following the last period, many continue to experience symptoms for two years while some women even have occasional flushes or night sweats well into their 60s or even 70s.

"If you're under the age of 50 and haven't had a period for two years, you're officially post-menopausal," says Dr Shirley McQuade, Medical Director of the Well Woman Centre.

But if you're over 50, she says, you need to have stopped having periods for a full year before you are officially post-menopausal.

A big problem with menopause is that the symptoms can be so vague - they can vary from woman to woman and some women have none at all.

Women can also experience symptoms which vary considerably from one month to the next.

"It is very confusing," Dr McQuade acknowledges.

This is probably why that sometimes, after symptoms begin, women don't always immediately connect them with menopause.

"If someone solely has chest tightness, for example, or chest pain, they may think it's something to do with their heart," Dr McQuade says. "If it's aches and pains, they might think 'rheumatism'.

"We've had people come in who first went to cardiologists and rheumatologists, as well as people who have been put on anti-depressants," she says. It hasn't helped matters that menopause has traditionally been a taboo subject, rarely discussed openly, but thankfully that's changing, if only gradually.

Today's women want to know what they're facing, says McQuade. Sites such as the Well Woman Centre website, which offer clear, unequivocal and authenticated information, are attracting a lot of traffic.

"The topic of menopause is getting the highest hits of any on our website," says McQuade.

"It can be hard to get good information on it because many women don't want to talk about menopause."

Even if their friends are going through menopause at the same time, many women may not wish to discuss the topic openly, she says. Quality, well-researched internet sites offer a hugely important resource.

"The information on menopause went up on our site last autumn and since then the site has received 18,000 hits alone and the number of hits is escalating," McQuade says, adding that, at a conservative estimate, the menopause section of the site is receiving 1,000 visits per month.

Aisling Grimley, who founded the dedicated Irish menopause website mysecondspring.ie in 2013 - the site gets 70,000 hits a month from all over the world - is determined to improve knowledge about the condition, and to this end has just launched an e-book on the site, The Best Friend's Guide to Menopause, offering advice on perimenopause, menopause and beyond.

"I founded the website because there was a glaring lack of understanding about the basics of menopause. I wanted to address that," Grimley says. "Lack of understanding is a huge issue and it is caused by the lack of discussion around menopause."

In terms of treatment, hormone replacement therapy (HRT) is the most effective prescription medication for menopause, according to the Well Woman Centre.

It relieves symptoms such as hot flushes and night sweats, and can thus help with the resultant disturbed sleep pattern - and, if they are linked to tiredness, help also with lack of concentration and forgetfulness.

Vaginal and urinary problems can gradually improve with HRT tablets, gel or patches, while vaginal pessaries may work well for vaginal dryness.

For women who cannot take HRT, clonidine tablets can be used to reduce hot flushes, while some anti-depressants can also help with these symptoms.

HRT, says Dr McQuade, remains the main treatment for menopausal symptoms.

"It's the go-to treatment, and it's what we should look at for helping with lots of different symptoms," she says. However, she says that before HRT is prescribed, doctors will check to see if a woman's symptoms are severe enough to warrant treatment.

The benefits of HRT, she says, is that almost all women will get some relief from symptoms such as hot flushes, sweats at night and palpitations, and the medication can help with disrupted sleep and anxiety levels.

"In fact, hot flushes and night sweats can be resolved by HRT within a matter of two to three weeks, and so can the aches and pains," she says.

The downside of HRT is that it contains oestrogen, which can cause headaches, and progesterone, which can cause mood swings and breast tenderness.

Fluid retention is another common effect seen at the start of treatment, while nausea can also occur - although these side effects tend to disappear as a woman's system adjusts to the therapy.

More serious side effects include an increased risk of clots developing in the legs or lungs, with a higher risk of stroke in the first year of taking it.

There is also an increased risk of breast cancer, but it is low: in the 50-65 age group, about 32 in every 1,000 women will on average, develop breast cancer. If that same group is on oestrogen (HRT) for five years, 34 out of 1,000 are likely to get breast cancer.

If the same group of women take combined HRT - ie, a mix of oestrogen and progesterone for five years, 38 per 1,000 will develop breast cancer.

It's important not to stop taking HRT too soon, Dr McQuade warns. "Menopause symptoms can last for eight years, so if you stop too early the symptoms may return.

"However, if you stay on it, all the evidence shows that the benefits outweigh the risks during your 50s."

By the time you stop taking the medication, she says, the disruption which caused the symptoms will usually have settled down.

Recent years have seen a welcome awareness of menopause - women are better informed, observes consultant gynaecologist/obstetrician, Dr Mary McCaffrey.

There's more discussion around the condition, she says, and also more openness towards HRT.

Dr McCaffrey finds that an increasing number of women are seeking consultations to discuss the implications of menopause and its various treatments, possibly because claims about the links between HRT and breast cancer have been shown to be over-emphasised.

Dr McCaffrey points to studies by the British Menopause Society and the US Menopause Society which show that HRT is safe for the majority of women. However, she emphasises, HRT - which she points out, also helps protect against conditions such as osteoporosis and heart disease - is not the only answer for woman.

"There are alternatives," she says, adding that anti-depressants can help hot flushes and night sweats for women, for example, with breast cancer, who cannot use oestrogen.

"We would also consider Omega 3s for brain function, vitamin D for bones, Starflower Oil for breast tenderness. Vitamin E oil can be used for vaginal dryness, also vaginal oestrogen for vaginal dryness in terms of tablets or a slow-release oestrogen ring."

Younger women who experience early menopause, also known as premature ovarian insufficiency, can go through the condition in their 30s for a variety of reasons, including surgery on their ovaries or chemotherapy.

"They will develop menopause symptoms at a much earlier stage, so it's very important for them to seek medical advice in order to look at oestrogen replacement."

Increased life expectancy means that it's important that women are in a position to make well-informed decisions around menopause, McCaffrey says.

"With the life expectancy we can expect today, most people will live into their 80s and 90s, so women will be at least one-third of their life post-menopause.

"Therefore the core message is that women will live at least one-third of their lives with a lack of oestrogen. They must be aware of the implications of this in terms of conditions like osteoporosis, heart disease and brain function," McCaffrey says.

* Useful websites

www.mysecondspring.ie; www.menopausematters.co.uk

For women with Premature Ovarian Insufficiency:

www.thedaisynetwork.org.uk

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