What does the term ‘menopause’ actually mean?
I have many women in their late 40s who present to clinic enquiring whether a delay in their menses means they have finally hit menopause? My question is always – has your menses been delayed for a year? If the answer is no then I explain that only once there has been no menses for at least 12 months, then we can safely say a woman has reached menopause. On average most women will reach menopause around 50 years of age.
What is the ‘peri-menopause’?
For these same women, I explain that an irregularity in their menstrual cycle may mean they are in ‘peri-menopause’, which is the time around menopause. Together with this irregularity some women will begin to experience the symptoms of menopause.
What are the symptoms of the menopause?
The most common symptoms include hot flushes, night sweats, disruption in sleep and distruption in mood (more anxious, low mood, irritability). The severity of these symptoms and how long they will last will vary from woman to woman. For some these may last a few months, for others this may be longer. Of course other causes must be ruled out first before attributing the symptoms to menopause.
What causes the menopause?
Women are born with a finite number of eggs in their ovaries. Each month most women will ovulate and release at least 1 egg. Eventually this supply runs out and hormone production (in particular oesterogen) from the ovaries will abate resulting in the state of menopause.
Are there long term health problems related to the menopause?
Long-term changes to a woman’s body will occur due the menopause. The link between osteoporosis (thinning of the bones) and oesterogen deficiency is well documented, resulting in hip and vertebral fractures. It is therefore important to consider further evaluation with bone densitometry testing for women who are at very high risk.
An increased risk of cardiovascular disease has also been linked to the menopause as the protective effect of oestrogen is lost. Women are at higher risk of developing a stroke or heart attack after menopause.
Hair and skin become drier and thinner, this includes the skin within the genital area, giving rise to some urogenital problems for some women.
What is HRT? What are the benefits of taking any medication?
HRT stands for Hormone Replacement Therapy. Depending on a women’s condition either one or two of the female hormones (oestrogen and progesterone) can be replaced in a continuous or cyclical method to treat the symptoms of menopause. In recent years HRT has received ‘bad press’ due to it’s association with a number of cancers and heart disease.
When a woman presents to me requesting HRT, I want to understand what is the most disrupting symptom to the woman, After ruling out other possible causes, we then talk through the treatment options as there are now more ‘natural’ or alternative treatments to HRT. For some women, these options may not be suitable or result in little improvement of their symptoms, in which case HRT may be considered after a thorough discussion of the benefits and risks. The aim of HRT is to alleviate the symptoms of menopause, which for some women are very depilating and can negatively affect their quality of life. If a woman has no contraindication to HRT, then the lowest possible dose that will control her symptoms is started. Regular reviews including mammograms and pap smears are arranged and after an agreed period of time a trial off HRT is recommended to see whether the symptoms of menopause have abated and HRT can be stopped.
Menopause is a natural event that every woman will experience. It is important for women to understand the symptoms that can occur during the peri-menopause period before menopause is reached. Women should be encouraged to seek help if these symptoms are disruptive as there are a number of effective treatment options available, HRT only being one of them. If HRT is thought to be the best option, then women, together with the advice of their doctor, should educate themselves about the benefits and risks of HRT in order to make an informed choice. Although menopause may mark the end of a woman’s ‘reproductive life’, hopefully with a little help for those who need it, this transition can occur as smoothly as possible with minimal symptoms and continued zest for life.