Menopause Management

The most common cause of menopause is a natural decline in a woman’s oestrogen levels that result in her ovaries stopping the production of eggs.

Underlying medical conditions such as Turner’s syndrome can cause menopause as well as medical treatments such as radiotherapy, chemotherapy, or oophorectomies (surgical removal of the ovaries). Early menopause can be linked to genetics and often runs in families.

There are three stages of menopause:

• Perimenopause – typically starts in your 40s. Your oestrogen levels begin to decrease and you may experience irregular menstrual cycles and menopause symptoms.
• Menopause – when you’ve not had a period for 12 straight months.
• Postmenopause – starts 12 months after your last period. Menopause symptoms may lesson but other health concerns may become a risk due to reduced oestrogen.

Perimenopause, also known as menopause transition, begins several years before menopause and ends when 12 months have passed without a period that is not due to other causes, such as illness, medication, pregnancy or breastfeeding.

Perimenopause in the UK usually starts in a woman’s 40s, but it can be earlier. It can last from a few months to many years. On average perimenopause lasts for four years.

During perimenopause, your ovaries gradually make less oestrogen. In the later stage of perimenopause, this decrease in oestrogen speeds up and can cause menopause symptoms.

There is a wide range of symptoms for menopause and they can often be confused for other medical conditions. With all of these symptoms, certain lifestyle changes or medication can help to alleviate them. The most common ones are:

• Night sweats – often women wake up drenched in sweat in sodden bedding, even if the room is cool. The medical term for the condition is nocturnal hyperhidrosis. It is usually harmless but it can feel uncomfortable, be disruptive for sleeping and be embarrassing. If you are losing out on sleep due to night sweats, we offer sleep studies to help work out a way to improve the quality of your sleep.
• Hot flushes - most women who go through the menopause will experience hot flushes. They cause a sudden feeling of heat to surge through the body and can induce sweating, palpitations, and blushing. Just how many a woman will experience a day, how severe they are, and how long they last vary between each individual with some claiming that they are a mild annoyance, to others who find they disrupt their normal lives. Hot flushes can last for years after the menopause and most women learn to accommodate them into their everyday routine. If this isn’t achievable, however, there are medicinal and holistic treatment options available that some have found to help ease the discomfort.
• Vaginal dryness - can happen at any age but is most common during the menopause due to the decrease of oestrogen levels. It is characterised by irritation and a burning or itchy sensation. You may find sex uncomfortable. You may have a reduced sex drive and find it hard to become aroused or reach orgasm. Vaginal dryness can also increase the likelihood of getting urinary tract infections (UTIs). One simple treatment that could help alleviate the symptoms is to apply a lubricant or vaginal moisturiser. If this doesn’t help, talk to your Consultant for more options.
• Insomnia - if you’re spending long periods of time trying to fall asleep, waking up multiple times in the night, not feeling refreshed from the sleep you do get or feel tired and irritated during the day and find it hard to concentrate. Some people may go through bouts of insomnia during their life without experiencing any issues whilst others find it causes a serious impact on themselves and their families.
If you’re struggling with insomnia, we have both sleep and psychological experts available for appointments.
• Menopause fatigue - a common menopause complaint is a persistent on-going feeling of exhaustion and lack of energy. Menopause fatigue is due to changing hormone levels and can cause a lowered attention span, mental fuzziness and memory lapses with decreased wakefulness and the feeling of irritability.
Lifestyle changes such as regular exercise, decreasing alcohol and caffeine consumption, good sleep hygiene and relaxation techniques can help.
• Low moods/anxiety - either as a direct result of the menopause or due to the other symptoms that may develop. If this occurs you are likely to feel tired or have little energy, lose your appetite or comfort eat, you may even come down with a feeling of hopelessness.
There are certain life changes you can make to help ease this such as reducing your alcohol intake, regular exercise, and eating a healthier diet, but should this become bad enough that you want to seek help there is medicinal aid or counselling available.

The menopause can start early in some women. Why this can happen to a woman earlier in life is still unknown as there are no clear causes.

Early menopause is when a woman's periods stop before the age of 45.

Premature menopause is when the menopause starts before the age of 40.

The main premature and early menopause symptom is infrequent periods or periods stopping altogether without any other reason. Women may also experience other symptoms of regular menopause.

Women who go through early or premature menopause may feel distressed or depressed over the early loss of their fertility, especially if they had hoped to have children, or the change in their bodies. They may experience more severe menopause symptoms and have a higher risk of health problems, such as heart disease and osteoporosis, as they have lower oestrogen levels.

If you think you are experiencing menopausal symptoms a simple blood test that measures your hormone levels will confirm this.

Testing for menopause is usually offered to women aged 40 to 45 but it can be done younger than 40 if premature menopause is suspected as the cause of your symptoms.

A Hormone Replacement Therapy (HRT)

HRT is the most common treatment for the menopause and involves taking oestrogen to replace the levels being lost. This relieves the symptoms that occur due to this.

The main two types of HRT treatment are:

• combined HRT (oestrogen and progestogen) - prescribed to women who still have their womb, as oestrogen taken on its own can increase the risk of womb cancer.
• oestrogen-only HRT - given to women who have had their womb removed by a hysterectomy.

Like all treatments, there are certain risks involved with HRT treatment and these will be discussed with your consultant. HRT can also help prevent the weakening of bones, a condition some women suffer from after menopause.

Other menopause treatments

The other treatments for menopause largely focus around tackling the individual symptom. These can be worked out with your Consultant who may want you to see one of our other specialists in the relevant field.

Postmenopause begins 12 months after your last period and continues until the end of your life.

After menopause, your hormones do not fluctuate as much as when you were in perimenopause and this often means that menopause symptoms ease. This is not always the case and some women can continue to experience menopause symptoms for many years after the menopause transition.

During postmenopause you will have lower levels of oestrogen and this causes an increased risk of a number of health symptoms and conditions including:

• osteoporosis – brittle and weak bones
• heart disease – oestrogen has a positive effect on the inner layer of your artery walls and helps regulate blood flow
• vaginal atrophy - thinning, drying and inflammation of the vaginal walls
• vaginal bleeding
• urinary incontinence - involuntary leakage of urine due to a thinning urethra lining or weaker pelvic muscles around the urethra
• weight gain
• insomnia

Every woman’s risk of these conditions is different and your doctor can discuss these with you, the steps you can take to reduce your individual risk, and treatment options. More information on Postmenopause can be found here.