I'm a 54-year-old woman. I consider myself fairly healthy. I eat well, exercise regularly and am a normal size. My problem is the menopause. My last period was two years ago but I am still suffering flushes and sweats all the time. They are particularly embarrassing during the day. I have a fairly pressurised job which involves presentations to clients. My symptoms are ruining my confidence. I have heard hormone replacement therapy is considered dangerous. What can I do to relieve my symptoms and how much longer are they likely to last?
I have no doubt many women reading this column empathise with you. Menopause is, by definition, the end of menstruation but the process itself may start many years before and extend after.
It occurs between the ages of 40 and 58, with the average age being 51. It seems cruel that nature drops this change at a time in a woman's life when many other things may be happening.
Children may be leaving home, parents may be growing elderly or dying and women themselves may become grandparents.
Many enter menopause not knowing what to expect or how long it will last. This lack of information can lead to fear and anxiety.
The important thing to remember is that the end of menstruation is as natural a process as the beginning of it and this does not need to be a time of fear, upset or discomfort.
The years leading up to the end of menstruation can start up to 10 years prior to the final menstrual period. This phase is referred to as perimenopause and during this time periods may change or become more erratic. Hot flushes and urinary symptoms such as passing urine more often or episodes of stinging or discomfort passing urine occur in some.
The phase of actual menopause starts with the last menstrual period and lasts officially 12 months. Symptoms vary hugely, with some cruising through this time symptom-free while others suffer disabling symptoms.
Hot flushes are episodes of an intense feeling of heat and redness that passes from the chest up to the face.
These may occur quite frequently and can cause night sweats, which disrupt sleep. Other common symptoms include episodes of cystitis or urinary infections, vaginal dryness, skin changes, weight gain, and mood changes.
Once a year has passed since the last menstrual period the phase becomes post-menopause. Menopausal symptoms last on average from six months to five years but in a small percentage (about 15pc) of women may carry on much longer than that. So you are two years into menopause.
Relief from menopausal symptoms can become a bit of a crusade for those affected. For many years, hormone replacement therapy (HRT) was routinely prescribed but two large studies in 2002 showed that it significantly increased the chance of stroke, heart attack and breast cancer and prescriptions dramatically reduced.
The greatest risk is to those women on HRT for more than five – and especially – 10 years. HRT is still prescribed in those with disabling symptoms but at the lowest dose effective for the shortest time possible. HRT is effective for hot flushes and vaginal and urinary symptoms.
Women today can expect to live over 30 years into menopause. Remedies can help reduce symptoms but even untreated they will ultimately pass. I would advise starting with some of the over-the-counter or alternative preparations available.
If these are not working for you, talk to your GP. If you are healthy with a low risk for breast cancer or cardiovascular disease and you don't smoke a temporary prescription for HRT can help.
Menopause should not be feared. It is a normal physiological process. The fact is life expectancy is growing all the time and new generations can hope to live well into their 90s and beyond.
Understanding the changes your body is going through and realising that this may be the end of one cycle but is also the beginning of another that leaves you free from periods, pms and fear of pregnancy can help make you feel a bit more positive. In the words of Mark Twain: "Age is an issue of mind over matter, if you don't mind it doesn't matter."