Dr Caitlin O’Connor of Tralee Medical Centre at St Brendan’s Park on the menopause…
What is the menopause?
The menopause, also known as the ‘change of life’, simply means the end of menstruation.
The term is also used to refer to the months and years in a woman’s life before and after her final period — a time that is likely to bring with it some physical and emotional changes.
The menopause is usually a gradual process. The ovaries begin to produce lower amounts of hormones, which cause menstrual periods to become irregular and eventually to stop completely.
The fluctuating levels of hormones also contribute to other symptoms that may occur at this time, such as hot flushes and night sweats.
When does it happen?
Most women menstruate for the last time at about 50 years of age, although a few do so as early as 40 and a very small percentage as late as 60.
With the average life expectancy of Irish women now at around 80 years of age, this means that one-third of an Irish woman’s life may take place after their menopause. Women who smoke undergo menopause about two years earlier than non-smokers.
Most women notice some menstrual changes — such as shortening of cycle length (periods occurring closer together), skipped menstrual periods and occasional heavy periods — up to a few years before menstruation ceases.
Menopause can often occur at a time in life when other dramatic changes are taking place, such as the loss of parents, adjustment to children growing up and leaving home, or retirement.
These changes, in addition to the changes in your body, may result in psychological or emotional stress.
A premature menopause (before age 40) can sometimes occur and may be due to a number of different reasons, for example, surgical removal of the ovaries.
What are the symptoms?
You may have both physical and psychological symptoms during menopause. Most of the physical symptoms are due to the reduction in levels of the hormone oestrogen. Symptoms may occur for a few weeks, a few months, or sometimes over several years. Your symptoms may come and go, or they may occur regularly. Some common symptoms are:
• Hot flushes – the most common symptom of menopause, these can cause flushing in the face and neck.
• Night sweats – the night-time version of hot flushes – they may result in a disturbed sleep pattern.
• Changes in menstrual cycles – more than three-quarters of all menopausal women experience changes in their menstrual cycle before periods cease. Cycles can be longer, shorter or irregular.
They may also be lighter or heavier than they were before. The reason for the irregularities is changes in the body’s production of hormones, which occurs as the ovaries run out of eggs.
Slight changes in the length of your menstrual cycle may be a sign that menopause is beginning.
• Worsening PMS symptoms – unfortunately, menopause doesn’t mean the end of unpleasant PMS symptoms, such as bloating and extreme irritability.
In fact, worsening PMS may be one of the first signs that you’re entering the menopausal years. It is important to take dietary measures and to exercise regularly to help control those symptoms.
• Mood changes, irritability, depression, difficulty concentrating — fluctuating hormone levels may contribute to mood swings.
Some studies have linked oestrogen production with the production of a brain chemical called serotonin, which is needed to regulate moods. Lack of serotonin can lead to depression.
Other possible causes of emotional distress around the time of the menopause are PMS or the discomfort of physical symptoms.
Many menopausal women have stressful lives that may contribute to psychological symptoms. If a depression is severe or persistent, consult your doctor as depression can be treated.
• Fatigue and/or insomnia – many women complain of reduced energy levels at this time and a disrupted sleeping pattern may be a contributing factor.
• Vaginal dryness, painful sex and/or lack of sexual interest – with dropping oestrogen levels, the vagina becomes drier and the walls thinner.
Intercourse may become uncomfortable or even painful, so it’s not surprising that some women become less interested in sex during the menopausal years. Don’t be embarrassed about talking to your doctor or pharmacist.
The solution may be as simple as using an over-the-counter lubricant to overcome vaginal dryness or it may involve hormone replacement therapy (HRT) or other medical treatments. Regular sexual activity also improves natural lubrication.
• Stress incontinence – during menopause, decreasing levels of oestrogen can weaken the muscles that have control over the urethra (the tube carrying urine from the bladder to the outside of the body). This can cause leakage of urine.
Are there any long-term health problems associated with menopause?
The drop in oestrogen levels that occurs in the menopause can have a number of long-term effects. Before the menopause, oestrogen protects women against the condition atherosclerosis (hardening of the arteries) – a major cause of heart attacks and strokes. The menopause is therefore associated with a rise in incidence of these diseases.
Oestrogen deficiency is also associated with osteoporosis – a condition in which there is a gradual thinning of the bone, leading to increased risk of fractures. Lack of oestrogen accelerates the loss of bone that occurs in this condition.
Women may also find that they suffer from more infections of the bladder (cystitis) after the menopause. This is due to a reduction in acidity in the vagina, which can make it easier to contract infections.
How is it diagnosed?
Menopause is most commonly diagnosed on the basis of your symptoms and medical history. Your doctor may conduct tests to eliminate other causes of your symptoms if necessary, for instance, with blood or urine tests.
How is it treated?
Menopause is a natural part of a woman’s life cycle. It is not a disease and does not necessarily require any treatment. However, many women choose to take medications, such as Hormone Replacement Therapy (HRT) in order to relieve their symptoms.
HRT may contain either oestrogen only or a combination of oestrogen and progesterone. It may be prescribed in the form of tablets to be swallowed, patches to be applied to the skin, or a cream to be inserted into the vagina.
There has been concern in recent years about a possible connection between the use of HRT and an increased risk of heart disease and breast cancer. Because of this, HRT is now only recommended for short-term treatment of menopausal symptoms, when the benefits are considered to outweigh any risks. It is not considered to be suitable for long-term use, e.g. for the prevention of osteoporosis. You should discuss the pros and cons of HRT with your GP.
There are other medications that may help to relieve the individual symptoms of the menopause – e.g., the hot flushes, vaginal dryness and stress incontinence.
There are also other ways to help prevent osteoporosis — for example, you can take calcium supplements and exercise regularly, and there are a number of different medications that can be used in its treatment.
Exercise and eating healthy foods may also help with some of the unpleasant side-effects of menopause. Eating foods high in plant oestrogens, such as soya beans and lima beans, may alleviate symptoms. Other sources include nuts and seeds, fennel, celery, parsley and flax-seed oil.
What can I do?
Improve your diet
Eat more foods that are high in calcium, such as dark green vegetables and non-fat (skimmed) milk and dairy products.
Eat fruits, vegetables, and whole grain cereal products, especially those high in vitamin C and carotene — these include oranges, grapefruit, carrots, tomatoes, broccoli, cauliflower and green leafy vegetables.
Reduce saturated fats in your diet — these are found mainly in meat and dairy products. Also remember to check labels for product contents before you buy them.
Avoid sugar as much as you can — it may cause hot flushes and other menopausal symptoms.
You may find that eliminating or limiting caffeine and alcohol intake also helps with symptoms.
For people who cannot eat an adequate diet, supplements may be necessary. Speak to your doctor about your individual nutritional needs — using supplements without supervision can be risky because large doses of some vitamins may have serious side-effects.
Regular physical exercise will help you fight depression and maintain good circulation, mobility, bone density and a sense of wellbeing.
Resistance exercises (lifting weights) and other weight-bearing exercise (dancing, walking and climbing stairs) are important for preventing osteoporosis. Regular aerobic exercise (swimming, walking, cycling) helps you control your weight and blood pressure and lowers heart disease risk.
An exercise programme should start slowly and build up to more strenuous activities.
Women who smoke begin their menopause on average two years earlier than non-smokers.
Smoking decreases the amount of oestrogen in the body, and can trigger and worsen hot flushes.
Smoking is a risk factor for osteoporosis because it can decrease bone mass. It also increases the risk of heart disease, lung cancer and other cancers.
Look for support
Talk to a friend or family member who understands what you are experiencing. Discuss the problems with your doctor or practice nurse.