Menopause

Menopause

Menopause is a natural biological process. But the physical symptoms, such as hot flushes, and emotional symptoms of menopause may disrupt your sleep, lower your energy or affect emotional health. There are many effective treatments available, from lifestyle adjustments to hormone therapy.

 The menopause is sometimes known as the 'change of life' and is marked by the ending of menstruation (when a woman's periods stop).

A woman's periods do not usually stop suddenly. They generally become less frequent, the odd period is missed and then they stop altogether

During the time leading up to the menopause (perimenopause), the hormonal and biological changes that are associated with the menopause begin. As a result of these hormonal changes, many women experience both physical and emotional symptoms, such as hot flushes, night sweats and irritability

 Without treatment, most menopausal symptoms gradually stop naturally. This usually happens two to five years after the symptoms start, although some women experience symptoms for many more years.

Hot flushes and night sweats

A hot flush is a sudden feeling of heat in your upper body, which can start in your face, neck or chest, before spreading upwards and downwards.

The skin on your face, neck and chest may become red and patchy, and you may start to sweat. You may also experience a change in your heart rate. It may become very rapid, or it may be irregular and stronger than usual (known as palpitations).

Hot flushes that occur at night are called night sweats. Most hot flushes only last a few minutes and are most common in the first year after your final period.

Sleep disturbance

Many menopausal women have trouble sleeping due to night sweats, but sleep disturbance may also occur as a result of anxiety.

You may find that a lack of sleep makes you irritable, and that you have problems with your short-term memory and ability to concentrate.

Vaginal symptoms

During the time leading up to the menopause, you may experience vaginal dryness, itching or discomfort. This can make sex difficult or painful (known as dyspareunia). These symptoms combined are known as vaginal atrophy.

Approximately one-third of women experience the symptoms of vaginal atrophy shortly after the menopause, and slightly more women have them later on. It is possible to experience vaginal atrophy more than 10 years after your final period.

If you experience vaginal symptoms, it is likely that they will persist or worsen over time unless they are treated.

Urinary symptoms

During the menopause, you may become prone to recurrent lower urinary tract infections, such as cystitis. You may also experience an urgent need to pass urine and need to pass it more often than normal.

Protecting your bones from osteoporosis

Loss of bone bulk and osteoporosis are natural features of ageing, but loss of oestrogen accelerates the process in women who have gone through the menopause.

You can reduce your risk of osteoporosis by doing short, frequent sessions of weight-bearing exercise, eating plenty of calcium, giving up smoking and moderating alcohol consumption. If you cannot get enough calcium from your diet, it may be worth trying calcium supplements. See your doctor before you start taking these.

Self Care Tips

If your menopausal symptoms are not severe, it may not be necessary to treat them using medication. Many women who experience menopausal symptoms find they can ease them by making changes to their lifestyle and diet.

Some of the various menopausal symptoms and how they can be improved by lifestyle changes are outlined below.

To improve hot flushes and night sweats:

  • take regular exercise
  • wear light clothing
  • keep your bedroom cool at night
  • try to reduce your stress levels
  • avoid potential triggers, such as spicy food, caffeine, smoking and alcohol

To improve sleep disturbance:

  • avoid exercise late in the day
  • go to bed at the same time every night

To improve mood disorders:

  • get plenty of rest
  • take regular exercise
  • try relaxation techniques such as mindfulness or yoga

Only 1 in 10 women seek medical advice when they go through the menopause and many do not need any treatment. However, if your menopausal symptoms are severe enough to interfere with your daily life, there are treatments that can help.

Treatment options include:

  • Hormone replacement therapy
  • tibolone (similar to HRT)
  • clonidine
  • vaginal lubricants
  • antidepressants

The kind of treatment you can take depends on your symptoms, medical history and your own preferences.

HRT and tibolone do not provide contraceptive protection, and although your fertility decreases during the menopause, it may still be possible for you to conceive. Therefore, continue to use contraception if you want to avoid becoming pregnant:

  • for one year after your last period if you are over 50 years of age
  • for two years after your last period if you are under 50 years of age

The treatments for menopause are detailed below.

Hormone replacement therapy (HRT)

Hormone replacement therapy (HRT) is effective in treating several of the most common menopausal symptoms, including hot flushes and night sweats, vaginal symptoms and cystitis.

As the name suggests, HRT works by replacing oestrogen, which naturally begins to fall in the approach to menopause, causing menopausal symptoms. There are three main types:

  • oestrogen-only HRT, for women who have had their womb and ovaries removed
  • cyclical HRT, for women who are experiencing menopausal symptoms but are still having periods (you take both oestrogen and progestogen)
  • continuous HRT, for women who are post-menopausal

HRT can be taken as a cream or gel, a tablet, a skin patch or an implant.

For more information on HRT, including how it is taken, who can use it, how it works, side effects and risks, go to https://www2.hse.ie/conditions/hrt/

Further information and support is available at:

Early Menopause

Post Menopausal Bleeding 

Menopause Matters - this is an independent UK website which also has information for Irish Healthcare Professionals - but the site is open to all