Gynaecology
Menopause
The natural process marking the end of a woman’s reproductive life, where no eggs remain in the ovaries to ovulate and hormone levels begin to fall.
What is Menopause?
Menopause is the term given for the final menstrual period and marks the end of a woman’s natural reproductive life.
Menopause can be diagnosed based on symptoms and changes in the menstrual cycle. Most women become menopausal between the age of 45 and 55 years, with the average age being 51. Early menopause occurs in women before the age of 45 and premature menopause affects women under the age of 40.
What are the symptoms of Menopause?
Around 4 in 5 women experience symptoms of menopause, these include:
- Hot Flushes +/- nights sweats (vasomotor symptoms)
- Vaginal dryness
- Joint and muscle pains
- Mood and sleep disturbance
The severity and duration of symptoms can vary greatly between individuals and no two people will experience menopause the same way.
Why does Menopause occur?
Menopause occurs when there are changes in reproductive hormone levels as the body begins to run out of eggs. Menopause can occur as a result of the natural passage of time, but may also be induced by primary ovarian insufficiency, cancer or surgery. In these instances, symptoms may be more sudden and severe and are more likely to require intervention.
Prior to menopause, individuals usually go through “peri-menopause”, during which time normal menstrual hormones begin to change and the symptoms of menopause can begin. Peri-menopause can precede menopause by up to 5 years.
What are the treatment options for Menopause?
There are a number of different options available for treating the symptoms of menopause. These range from simple lifestyle modifications, to hormone therapy, to medications and complementary remedies.
Lifestyle Modification
Many people cope well with the symptoms of menopause and find that simple lifestyle changes offer sufficient relief without the need for medication or therapies. These include:
- Regular weight-bearing exercise
- Increased Vitamin D and Calcium intake
- Following a healthy, balanced diet
- Maintaining a healthy body mass
- Reduction in alcohol and caffeine consumption
- Avoidance of smoking*
*People who smoke tend to undergo menopause an average of 4 years earlier than their non-smoking counterparts and are more likely to suffer symptoms of menopause.
Menopausal Hormone Therapy (MHT)
Previously known as Hormone Replacement Therapy (HRT), MHT is the most effective treatment for vasomotor symptoms, which are the most common symptoms that affect quality of life.
MHT treatment should be started with a clear understanding of the aims of treatment, following a comprehensive assessment by a specialist about the risks, contraindications and benefits.
MHT treatment should be regularly monitored and there should be a regular re-assessment of the need for treatment against ongoing risks and benefits of continuation of treatment.
Non-hormonal Medication
For those who are unable or choose not to consider MHT treatment, there are some non-hormonal prescription medications that may prove useful. These include:
- Low-dose antidepressants:
- Selective serotonin reuptake inhibitors (SSRIs) (escitalopram and paroxetine)
- Serotonin-norepinephrine reuptake inhibitors (SNRIs) (venlafaxine)
- Gabapentin
- Clonidine
Your doctor can only prescribe these after considering risks and side effects.
Complementary Therapies
Many women also find relief from complementary therapies and herbal remedies. These may be effective for some patients, but have inconsistent results.
- Over-the-counter remedies such as phytoestrogens and black cohosh may assist with vasomotor and vaginal symptoms
- St John’s Wort may help with mood changes
- Acupuncture
- Hypnotherapy
You can find out more about these options here.