Menopause in a nutshell

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Puberty gets a lot of attention in our life education and until recently, menopause has largely been ignored. However, menopause is just as normal, just as natural, and (just like puberty) having knowledge on what is happening to your body can ease the transition through this stage of life.

Thankfully, more women are speaking up and there are a multitude of new books, resources, media and social media features that discuss menopause; the options can even be a little overwhelming.  So here is a quick summary of what menopause is – what to expect and the options if your symptoms are troublesome – written by your friendly ERH endocrinologists.

What is the difference between perimenopause and menopause?

Perimenopause is the transition time when ovarian function starts to fluctuate and winds down.  Periods can be very irregular, sometimes closer together and heavier than usual.  Eventually periods usually become lighter and less frequent before stopping altogether. 

Natural menopause (when ovulation ceases, and oestrogen levels drop permanently) occurs at the end of perimenopause when periods have stopped for 1 year or more.  

Very early perimenopause/menopause, under the age of 40, is called “primary ovarian insufficiency” and should be investigated and managed by a specialist for hormone replacement and monitoring of bone health. Hormone replacement is usually continued until approximately the age of 50 years. 

Surgical menopause (menopause as a result of removal of the ovaries) effects a more sudden withdrawal of oestrogen than natural menopause. If there are no contraindications (or reasons not to prescribe) hormone replacement is often initiated at the time of surgery to minimise symptoms, and then this can either be continued if needed for symptoms and/or if the surgical menopause has been undertaken below the age of 50.

What age will it happen?

The average age for menopause is around 50.  Anything from 45-55 years of age  is normal and expected.  

Will I get symptoms and how long will they last?

Symptoms vary from  person to person.  About 20% of people won’t have any troublesome symptoms, about 20% will have severe symptoms that can go on for more than ten 10 years or more,  and most will fall somewhere in the middle.  Common symptoms include hot flushes, sweats (also known as vasomotor symptoms), fatigue, irritability, low mood, low libido, difficulty concentrating, aches and pains, insomnia, urinary frequency and vaginal dryness and weight gain.

What are the options for managing my symptoms?

Lifestyle approaches that can be helpful and include stress reduction, sleep optimisation (look up “sleep hygiene” tips on the internet), minimising caffeine and alcohol. 

MHT (Menopausal Hormone Therapy), formerly known as Hormone Replacement Therapy (HRT), is the most effective treatment available for the symptoms of menopause. In the early 2000s, there was much controversy surrounding the use of MHT, but reanalysis of trials and safety data suggests for most women under the age of 60 and within six 6 years of menopause (more on this in a future post. Caution should be exercised and the risks and benefits careful weighed in high risk circumstances, which include a history of a blood clot or high risk for a blood clot, previous breast cancer/high risk of breast cancer and vascular disease or high risk for vascular disease. 

Non-hormonal options for hot flushes and sweats (where the risks of MHT are thought to outweigh the benefits) include medications that act on the nervous system, such as selective seratonin reuptake inhibitor (SSRI) antidepressants or a medication called Gabapentin that reduce the flushes by suppress by reducing the response of the nervous system to the drop in oestrogen occurring at menopause.  There is also now a procedure available called a stellate ganglion block, where anaesthetic is injected, under ultrasound guidance, into the nerve bundle situated in the neck responsible for triggering facial hot flushes. 

Oestrogen cream can be used for vaginal symptoms. The genitourinary symptoms of menopause such as of vaginal dryness and increased frequency of urination (which can often disturb sleep) respond well to topical oestrogen cream, and this is safe for most women , and is sometimes even considered in those women with a who have had a history of breast cancer if the benefits are thought to outweigh the risks.  Importantly, there is no age limit for the use of vaginal oestrogen cream (we will be writing more about this in a future post).

Hopefully this has given you a starting point in learning about what to expect in perimenopause and menopause and what to do about symptoms.  See your GP if your symptoms are affecting your quality of life, and if needed they may refer you to an endocrinologist.  

In summary, no matter what age, there are options for optimising your quality of life as you transition through menopause.

PS We are also developing an app-based program to deliver more detailed information and guidance on menopause -subscribe to the newsletter to hear when it launches. 

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