The menopause is an important time in a woman’s life, as their bodies experience different symptoms at different stages. Menopause happens when a woman’s period stops due to low hormone levels and their ovaries are not able to produce oestrogen, progesterone or testosterone. Menopause can occur between the ages of 45 and 55 with the average age of women developing menopause in the UK at 51.
Many factors can contribute to menopause such as chemotherapy or radiotherapy, which can damage the ovaries during treatment. Menopause can also happen when the ovaries are removed during a surgical procedure called an oophorectomy or the removal of the uterus known as a hysterectomy. Genetic reasons can also contribute to the menopause or sometimes there may not be a reason for why menopause occurs at all.
Women can experience a perimenopausal stage, developing symptoms before their periods have stopped, usually around the age of 49. Early perimenopausal symptoms can happen due to infrequent periods when their menstrual cycles become longer. Late perimenopause can cause a worsening of menopausal symptoms when a woman’s menstrual cycle becomes less frequent with periods happening months apart. This usually can happen to women around 49 years of age.
As mentioned earlier, menopause and perimenopause can happen to all women at different stages in their lives. Around 80-90% of women will experience menopausal symptoms with around 25% of women describing them as severe and debilitating. Menopause symptoms can have big impacts on women’s daily lives including their relationships, social life, family life and their work. On average, symptoms can last for more than 7 years with women experiencing long term menopausal symptoms that may continue beyond that period.
There are many symptoms of menopause, which can affect women physically. They may develop hot flushes throughout the day and experience the sweats at night (vasomotor symptoms). Their sleeping patterns can be disturbed, causing women to suffer with insomnia, develop low energy levels, feel aches and pains in their joints, suffer with headaches and experience palpitations. Women may also go through vaginal dryness and suffer with urinary tract infections.
Menopause can also affect women’s mental health, causing symptoms of low mood, anxiety and depression. They may experience low libido or low sex drive, impaired memory, which can affects their concentration and cause brain fog.
The important thing for healthcare professionals to consider is that all women will experience different aspects of menopause and can react differently when responding to treatments. When supporting women going through menopause, decisions have to made with them, taking into account their symptoms, past medical history, their family history, diet and lifestyle and most importantly their preferences and concerns.
When diagnosing menopause and perimenopause, blood tests for FSH (Follicle stimulating hormone) are rarely required in women over the age of 45 for a diagnosis. The measurement of FSH levels can fluctuate and are not consistent with the severity or duration of symptoms. Therefore, it can cause a delay in starting treatment, can add further time to consultations and increases costs.
Providing diet and lifestyle advice, talking about symptoms and discussing treatment options with women experiencing menopause is very important. Educating women about making healthy changes to their lives while living with menopause can be extremely beneficial. It allows them to understand their symptoms and feel supported by their healthcare professional.
There are many positive lifestyle changes women can do to help relieve and manage their menopause symptoms. Getting plenty of rest and ensuring to keep to a regular sleeping pattern is a great way to boost energy levels. Talking about how to maintain a healthy diet is also detrimental. Eating calcium-rich foods like yogurt, drinking milk and taking vitamin D supplements can help keep bones strong and healthy. To help with this, women should be referred to a dietician, where they can be advised on a food diary and get advice on eating the right types of foods.
Exercising regularly during menopause is important to improve low energy levels and can help ease aches and pains in women’s joints. Other forms of exercise can be yoga, tai chi or meditation if they are experiencing depression and anxiety. Cognitive behaviour therapy (CBT) is a great way to manage mental health conditions and can help with sleeping problems and management of hot flushes.
Smoking cessation should also be considered to help women stop smoking, as smoking can increase the risk of earlier menopause, can trigger hot flushes and increases osteoporosis and heart disease. Alcohol can also exacerbate hot flushes and increase the risk of breast cancer therefore women should be advised to drink in moderation.
If women are experiencing vaginal dryness, there are moisturisers or lubricants that they can buy without needing a prescription at a pharmacy. When having sex using condoms, it is always a good idea to use a water-based lubrication rather than oil-based. HRT (hormone replacement therapy) can also help along with creams, pessaries, gel and vaginal rings. If the woman experiences a low sex drive, testosterone can be considered if HRT is not sufficient. Progesterone will help protect the lining of the womb from the effects of oestrogen. However, it is important to note that progesterone can only be given to women who have not had a hysterectomy.
HRT is a treatment commonly used for managing menopause symptoms. The main component of HRT is the hormone oestrogen. Oestrogen can be given in tablet (oral) form or delivered through the skin via patches, sprays or gel. If women are at an increased risk of blood clots either due to an underlying health condition or has a past medical history of blood clots, they should be informed about having oestrogen via the skin due to the neutral effect on the way the body breaks it down, reducing the risk of blood clots.
When starting women on HRT, it is important to make them aware that the doses of HRT treatment may need to be adjusted over time depending on how effectively the dose is absorbed. According to the British Menopause Society (BMS), there are three questions that need to be assessed to determine the optimal HRT dose, which are:
As suggested earlier, HRT should be offered alongside cognitive behavioural therapy rather than antidepressants. This will help with symptoms such as flushes and sweats. The benefits and risks should be discussed with the women along with the type of HRT given. Factors will include if a woman is perimenopausal or post-menopausal. What is their past medical and family history? What types of medications are they taking? And most importantly, what are their preferences with HRT.
For more information on prescribing for GP’s and other healthcare professionals, please click on the link below to check out the BMS’s (British Menopause Society) creative tool to help with practical prescribing with HRT. 03-BMS-TfC-HRT-Practical-Prescribing-NOV2022-A.pdf (thebms.org.uk)
A review should be arranged with a healthcare professional three months after starting HRT to ensure women are asymptomatic on treatment and then if they are responding well, should be reviewed once a year. If there is concern surrounding a woman’s complex medical history, uncertainty about if HRT can be used, if the women is experiencing side effects or poor symptom control then they should always be referred to an experienced healthcare professional in menopause.
HRT is an effective treatment for menopause and can improve women’s quality of life. HRT has been proven to improve bone density and protects from osteoporosis related fractures. Women under the age of 60 or within 10 years of having the menopause, have shown a risk reduction of both heart disease and cardiovascular disease.
For more information on HRT, please refer to the links below:
Menopause - Things you can do - NHS (www.nhs.uk)
BMS Tools for Clinicians - British Menopause Society (thebms.org.uk)
Menopause - Treatment - NHS (www.nhs.uk)
Osteoporosis - Prevention - NHS (www.nhs.uk)
Menopause - What is the menopause? (healthtalk.org)
When a decision is being made, the benefits and risks should be discussed about breast cancer in relation to HRT. HRT treatment, which contains both oestrogen and progesterone, carries a small increase in the risk of breast cancer. However, the risk is low compared to other lifestyle risk factors such as obesity and high alcohol intake.
HRT, which contains only oestrogen (in women who have had a hysterectomy) has been shown to carry little or no increase of breast cancer. It is again important to note that the risk of breast cancer in people who are obese is significantly higher than the risk of breast cancer in people taking HRT. The benefits of HRT in women such as symptom control, improved quality of life and benefits to both bone and cardiovascular disease further outweigh the risk of breast cancer. However, women should always be given the chance to make an informed choice about whether or not to start HRT.
Educating, weighing up the benefits and risks of HRT and helping women to understand their symptoms is vitally important as it enables them to feel empowered in their decision making. Not only this but it also builds a trusting relationship between the healthcare professional and women and this is why menopause matters.
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