Managing the Menopause Informed Choices An Information Leaflet April 2011 Every Patient Matters
MAT142 2 Introduction This information booklet has been written to give you, the woman, basic information about the menopause. As you near the menopause, you may have symptoms from the changes your body is making. Many women wonder if these changes are normal, and many are confused about how to treat their symptoms. If your symptoms are causing you discomfort or concern this leaflet sets out options for your management and can help to make your treatment choice. If after reading this booklet you need more help, you can talk to your doctor, health visitor or practice nurse. In some cases you may be referred to a menopause clinic at your local hospital. Menopause is the time in a woman s life when her periods stop. It is a normal change in a woman s body. This change often happens between the ages of 45 and 55 years. Since the average age of menopause is around 50 years and the female life expectancy is 78 years, it is not unusual for a woman to spend more than one-third of her life in the post-menopause period. Menopause causes uncomfortable symptoms, and the risk for hypertension, diabetes and osteoporosis are greater after the onset of menopause. Therapies that may ameliorate the symptoms and consequences of menopause are available, but different treatments have different advantages and disadvantages. Each menopausal woman should be involved in the choice of treatment that works best for her. What is the menopause? Menopause is defined as the permanent cessation of periods. This is caused when the ovaries stop producing eggs which causes a large fall in the amount of hormone secreted from the ovary. This hormone, oestrogen, makes the lining of the womb (the endometrium) grow, so after the menopause the when level of oestrogen becomes very low the lining of the womb becomes thin and your periods stop. If you think you have reached the menopause but are not sure, you can have a blood hormone test to confirm that you have reached the menopause, as occasionally there may be another reason why your periods may have stopped.
MAT142 3 Will I have symptoms if I am menopausal? About 70 per cent of all women will experience irregular periods and hot flushes. This signals the beginning of the menopause. The transitional period can last over several years, and often begins with variations in the menstrual cycle (irregular periods). It can be described as three stages:- Pre-menopause: the time up to the beginning of the perimenopause, but is also used to define the time up to the last menstrual period. Peri-menopause: the time around menopause during which the menstrual cycle (periods) and hormone changes are occurring, but before 12 months without periods has elapsed. Post-menopause: begins at the time of the last menstrual period, although not recognised until 12 months after the last menstrual period. What are the short term problems? Hot flushes and sweats: Many women sail through the menopause without a lot of trouble. When symptoms occur, the main ones are hot flushes and sweats. These do not cause harm, but they can make life a misery. Night sweats are hot flushes occurring at night, often while sleeping, these can often cause tiredness as you may not be able to sleep well because of them. Most women remain symptomatic for at least one year, but up to a half of all women remain symptomatic for longer than five years. Other symptoms are lack of concentration, poor memory and aching joints. Some of this is just part of getting older, but an under active thyroid gland can cause similar problems, so you will need to discuss this with your doctor. Mood changes: Some women have mood changes such as depression. Mood swings are not the same as depression; often mood swings go away with time. How much of this is due to the menopause needs to be assessed in each individual case. If you feel you have these problems, it may be best to discuss these with your doctor.
MAT142 4 A variety of psychological effects may occur during the menopause transition, including mild anxiety and decreased sexual motivation. Getting enough sleep and rest and staying physically active will help you feel your best. Vaginal changes: The skin of the vagina is sensitive to the amount of hormone oestrogen. After the menopause because of the lack of oestrogen the skin of the vagina can become thin and sore, leading to discomfort, and problems with intercourse. A variety of changes occur in the lower urinary tract during the menopause, leading to an increased incidence of pain on passing urine, urgency, frequency and pain in the suprapubic area, as well as stress and urge incontinence. Though really bad vaginal dryness may need HRT if vaginal dryness is the only reason for considering HRT then administration of very low dose vaginal creams, pessaries or vaginal rings may reverse many vaginal problems and help urinary changes. What are the long term effects of the menopause? Osteoporosis: The main long term problem is osteoporosis. Our bones become thinner with age. This process gets a bit faster after the menopause because when oestrogen levels fall at menopause, bones become thinner more quickly. This can lead to bones breaking more easily, and bones in the spine can become compressed, making the woman lose inches in height. There are various treatments that can help prevent osteoporosis. You can help keep a healthy life style; eating a good diet, taking exercise, not smoking. Many doctors recommend calcium and vitamin D. Calcium is used in the body to make bone and your diet may not contain enough. Vitamin D is necessary for making bone too. It is important with all vitamins and supplements like calcium to take no more than recommended doses. Taking too much can be harmful. Your chemist, practice nurse or GP will advise you about suitable preparations. Heart disease and strokes: Heart disease and strokes are the leading cause of death among women, and the chances of cardiovascular disease increases after the menopause. Follow general advice such as
MAT142 5 stopping smoking, avoiding being overweight, taking regular exercise, and eating the recommended daily amount of fruit and vegetables. Women need to consult their GPs to have blood pressure and cholesterol levels checked. You may be advised to take certain medications that can help prevent cardiovascular disease, such as tablets to lower your blood pressure or tablets to lower your cholesterol. How do I manage menopause? What are my options? Eating a healthy diet and exercising at menopause and beyond are important to feel your best. Stop smoking if you smoke. Cut down on alcohol if you drink heavily. Most women do not need any special treatment for the menopause. But some women may have menopausal symptoms that need treatment. Several are available. It s a good idea to talk about the treatments with the doctor or nurse specialist, so you can choose what s best for you. There is no one treatment that is good for all women. Sometimes menopause symptoms go away in time without treatment. What about hormone replacement therapy? If used properly, hormone replacement therapy (HRT) is one way to deal with the more difficult symptoms of menopause. It is the only therapy that is approved by the government for treating more difficult hot flashes and vaginal dryness. HRT therapy should not be used solely to prevent heart disease or bone disease, stroke, memory loss or Alzheimer s disease. HRT can be administered orally (in pill form), vaginally (as a cream) and transdermally (in patch form). There are many kinds of HRT so your doctor can suggest what is best for you. As with all treatments, HRT has possible benefits and risks; it is important to talk about these issues with your doctor. If you decide to use HRT, use the lowest dose that helps and for the shortest time needed. You should check with your doctor every six months, to see if you still need HRT.
MAT142 6 HRT can help with menopause by: Reducing hot flashes/flushes Treating vaginal dryness Slowing bone density loss Improving sleep (thus decreasing mood swings) There is evidence that HRT reduces the risk of bowel cancer. Alzheimer s disease leads to loss of brain power. At its worst, patients who have it loose their ability to remember and may not recognise members of their families. There is evidence that HRT reduces the risk of Alzheimer s disease, but more research needs to be completed to be certain. For some women, HRT may increase their chance of: Blood clots Heart attack Stroke Breast cancer Gall bladder disease Who should not take HRT for menopause? Women who: Think they are pregnant Have problems with vaginal bleeding Have certain type of cancers (such as breast and uterine cancer) Have had a stroke or heart attack Have liver disease Have heart disease HRT can also cause side effects: Vaginal bleeding Bloating Breast tenderness or swelling Headaches Mood changes Nausea
MAT142 7 What about natural treatments for the menopause? Some women decide to take herbal or other plant-based products to help relieve symptoms of the menopause. For most women who wish to take them, it is a matter of trial and error to see which seem effective. The list of herbal remedies is as long as your arm, Evening primrose, Dong Quai, Red clover to name a few. Vitamins and elements: calcium and vitamin D have already been mentioned. Vitamin C and vitamin E have also been recommended by some, but there is really no evidence to support their use. If you do try them, make sure that you do not exceed the recommended dosage. Although their efficacy in alleviating menopausal symptoms has been debated, some believe that the following herbal treatments can be effective: Black cohosh: An herb that is purported to alleviate depression, night sweats, anxiety and irritability. Black cohosh is part of the buttercup family and has oestrogen activity. Though side effects include nausea, dizziness and headaches. Phytoestrogens: natural compounds similar to oestrogen that help to alleviate menopausal symptoms. Phytoestrogens are found in foods such as fruits, clover, yogurt, lentils, soy and spinach. Chasteberry: used for pre-menstrual syndrome and for menopause symptoms such as hot flushes. Ginkgo: can be used for memory problems, dizziness, headaches, anxiety. Ginseng: has been used for centuries as a tonic and aphrodisiac. Can be used for treating tiredness, but it should be used with caution as it is linked with side effects such as high blood pressure. Products that come from plants may sound like they are safe, but there is no proof they really are. There also is no proof that they are better at helping symptoms of menopause. Make sure you discuss these types of products with your doctor before taking them. You should also tell your doctor about other medicines you are taking, since some plant products can be harmful when combined with other drugs.
MAT142 8 What about sexuality during the menopause Some women experience decreased libido when they reach menopause, while others increase enjoyment of sex, due to the fact they no longer need to worry about pregnancy. Decreased sex drive during menopause is caused by a variety of physiological changes: Hot flushes, which lead to discomfort during intercourse Vaginal dryness which can lead to discomfort during intercourse Night sweats, which lead to insomnia Decreases in androgen (male hormone) including levels of testosterone Menopause also affects sexuality through the physical changes: Decreased blood flow to the pelvis, which leads to a smaller and less elastic vagina The thinning of the vaginal walls, which also become tender, making intercourse painful Urinary leakage due to decreased pelvic muscle support Maintaining a healthy sex life is important, as it will promote vaginal health. Our smoke free policy As per the smoke free law, smoking is not allowed by anyone anywhere on the hospital site. For further information, please read the patient information leaflet 'Policy on Smoke Free NHS Premises'.
MAT142 9 Produced by Stockport NHS Foundation Trust Review Date: November 2013 If you would like this leaflet in a different format, e.g. in large print, or on audiotape, or for people with learning disabilities, please contact PCS. Your local contact for more information is Patient and Customer Services at Poplar Suite, SHH, Tel: 0161 419 5678 or www.stockport.nhs.uk