What is the menopause?
Strictly speaking, the menopause is the last menstrual period. However, most women think of the menopause as the time of life leading up to, and after, their last period. It is often called the 'change of life'. It occurs because as you get older your ovaries make less oestrogen (the main female hormone). The average age of the menopause in the UK is 51. However, it may be sooner or later than this. For example, you may have an early menopause if you have a hysterectomy.
What are the possible symptoms and problems of the menopause?
The menopause is a natural event. You may have no problems. However, it is common to develop one or more symptoms which are due to the low level of oestrogen.
Short term symptoms
- Hot flushes occur in about 3 in 4 women. A typical hot flush lasts a few minutes and causes flushing of your face, neck, and chest. You may also perspire (sweat) during a hot flush. Some women become giddy, weak, faint, or feel sick during a hot flush. The number of hot flushes can vary from every now and then, to fifteen or more times a day. Hot flushes tend to start just before the menopause, and typically persist for 2-3 years.
- Sweats commonly occur when you are in bed at night. In some cases they are so severe that sleep is disturbed and you need to change your bedding and night clothes.
- Other symptoms may develop such as headaches, tiredness, palpitations, being irritable, difficulty sleeping, depression, anxiety, aches and pains, loss of libido (sex drive), and feelings of not coping as well as before. It can be difficult to say whether these symptoms are due to the hormone changes of the menopause. For example, you may not sleep well or become irritable because you have frequent hot flushes, and not directly because of a low oestrogen level. Also, there may be other reasons why these other symptoms develop. For example, depression is common in women in their 'middle years' for various reasons.
Long term changes and problems
- Skin and Hair. You tend to lose some skin protein (collagen) after the menopause. This makes the skin drier, thinner, and more likely to itch. You may have less underarm and pubic hair. Some women have an increase in facial hair.
- Genital area. Lack of oestrogen tends to cause the tissues in and around the vagina to become thinner and drier. These changes can take months or years to develop.
- Osteoporosis ('brittle bones') may develop after the menopause. As you become older, you gradually lose bone tissue. Oestrogen helps to protect against bone loss. When the oestrogen level falls, the rate of bone loss increases. If you lose a lot of bone tissue, then this is called osteoporosis. It may cause no symptoms. However, if you have osteoporosis the bones are 'thinner' and are more likely to break. You may break a hip or wrist quite easily after a fall or minor injury. Not all women develop osteoporosis after the menopause. See separate page called 'Osteoporosis'.
What is HRT (hormone replacement therapy)?
All types of HRT contain an oestrogen hormone. If you take HRT it replaces the oestrogen that your ovaries no longer make after the menopause. HRT is good at preventing hot flushes, vaginal dryness and related vaginal symptoms, and may help to improve sleep if your sleeping pattern is affected by the menopause. Long-term use of HRT also has a small benefit in helping to prevent osteoporosis and bowel cancer.
However, there are risks in taking HRT. See the separate page called 'Menopause and HRT'. The rest of this page discusses some other treatment options for menopause symptoms.
Non-HRT treatments for hot flushes and night sweats
Lifestyle
Some women find that regular exercise, lighter clothing, sleeping in a cooler room, and reducing stress reduce the number of hot flushes. Some women find that things such as spicy foods, caffeine (in tea, coffee, cola, etc), smoking, and alcohol may trigger hot flushes. Avoiding these things may help in some cases.
Progestogen tablets
HRT usually refers to replacing the oestrogen hormone. Progestogen hormone has also been shown to reduce flushing in some women, although to a lesser extent than oestrogen-based HRT. The risk of taking a progestogen hormone is less than taking an oestrogen hormone.
Selective serotonin reuptake inhibitor (SSRIs)
SSRIs are a class of antidepressant. It had been noticed as a 'side-effect' that menopausal women who take these medicines had fewer hot flushes. A recent clinical trial of an SSRI called paroxetine showed that it did seem to reduce hot flushes. Some women in the trial had no hot flushes whilst taking paroxetine. Many women in the trial had some hot flushes, but much less often than before. Venlafaxine is another SSRI which has been shown to reduce hot flushes.
These are relatively new findings from small clinical trials. So, the exact role of SSRIs in the treatment of the menopause is yet to be clarified. It may become a more common treatment if these effects are confirmed with further research.
Clonidine
This medicine may reduce flushing symptoms. However, it frequently causes side-effects such as dry mouth, drowsiness, dizziness, and feeling sick. It is therefore not commonly used, but may be worth a try if all else fails.
Complementary treatments
Because of the recent concerns regarding HRT, complementary treatments have become more widely used. The most commonly used for menopausal symptoms are: black cohosh, red clover, dong quai, evening primrose oil, ginseng, vitamin E, and kava. Some small clinical studies have concluded that:
- Black cohosh is the most promising and seems to ease hot flushes in some women. However, the long-term effects are unknown.
- Red clover may be of benefit but different studies gave conflicting results. In addition, some species contain coumarins, which makes them unsuitable for women who take anticoagulants such as warfarin.
- Dong quai, evening primrose oil, vitamin E and ginseng are no better than placebo (dummy tablets). So, they are unlikely to help.
- You should avoid kava as it has been linked to cases of serious liver damage.
Soy foods have been studied and seem to have a modest benefit to reduce hot flushes. However, the studies are not conclusive. Soy foods have been a staple part of the diet in parts of the world for thousands of years and are presumed to be safe. So, it may be worth trying to increase the amount of soy foods that you eat.
In general, for other complementary therapies there is not much evidence to say that they reduce menopausal symptoms.
Non-HRT treatments for vaginal dryness
You can buy vaginal lubricants and vaginal moisturizers from pharmacies which can help ease vaginal dryness. Some women only notice the dryness when they have sex. In this situation, if you place a small dose of lubricant inside the vagina before having sex it will usually help.
(Note: you may not be aware that there are oestrogen creams which ease the vaginal symptoms of the menopause. Strictly speaking, they are a form of HRT, but have less risk than taking HRT tablets. See the page 'Menopause and HRT' for details.)
Non-HRT treatments for preventing osteoporosis
In the past, HRT was heavily marketed as a preventer of osteoporosis. The results of the recent large trials of HRT showed that the protective effect of HRT on bones is actually quite small. You can probably do more to prevent osteoporosis by:
- Doing regular weight-bearing exercise. This means exercise such as brisk walking, aerobics, dancing, running, etc. For older people, a regular walk is a good start. Exercise helps because the pulling and tugging on the bones by the muscles helps to stimulate bone-making cells and strengthens the bones.
- Eating a diet that includes foods rich in calcium and vitamin D. If you eat 1000 mg of calcium each day you have a reduced risk of hip fractures. Ask your practice nurse for advice about diet. Briefly, you can eat 1000 mg calcium most easily by:
- drinking a pint of milk a day, plus
- eating 60 g (2 oz) hard cheese such as Cheddar or Edam, or one pot of yoghurt (125 g), or 60 g of sardines.
- Taking dietary supplements of calcium and/or vitamin D tablets if you do not get enough in your diet and you are at increased risk of developing osteoporosis. A dietary supplement of vitamin D is recommended for all people over the age of 65.
- Stopping smoking if you smoke.
- Cut down on alcohol if you drink heavily.
If you develop osteoporosis, there are medicines which can help to restore some lost bone, and help to prevent further bone loss.
See separate page called 'Osteoporosis' for more details.
Treating other symptoms
Various other symptoms may occur around the menopause (depression, anxiety, loss of libido, etc). As mentioned above, these are not likely to be directly related to a low level of oestrogen. If any of these symptoms persist, it is best to see your doctor. Treatment for these symptoms is much the same for women going through te menopause as for any other age group.
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