Menopause is the gradual decline and then cessation of ovarian function. During menopause, levels of hormones released by the ovaries declines, your oestrogen and progesterone will reduce. These hormones are responsible for things such as ovulation. The age menopause occurs is typically anywhere from the mid-40s to mid-50’s, the changes to your body that occur as a result of menopause happen over a few years.
Menopause is often referred to as ” the change of life”, or simply ” the change” because it means the end of a women’s reproductive life.
Symptoms vary for all women enormously and have many variables. Some women are fortunate and notice no significant disturbance in how they feel, most women have some annoying symptoms, but they are things they can manage, while some women can find the process of menopause quite distressing physically and emotionally.
What symptoms might I experience?
Typical symptoms of menopause can include:
- Hot Flushes – an increase in body temperature, making you feel uncomfortably hot for 10-15 secs at a time. Some women may have as many as 10-15 hot flushes a day while others might have just two per month.
- Night Sweats – as a result of hot flushes overnight.
- Sleep Disturbance – disturbed sleep patterns due to hot flushes and feeling uncomfortable
- Vaginal Dryness – there is a decrease in vaginal blood flow which causes a decrease in the production of lubrication
- Reduction in or loss of libido – decrease in lubrication can lead to uncomfortable sex. The loss of oestrogen can lead to a change in sex drive making arousal more difficult and less sensitive to touching and stroking.
If the sleep disturbance persists for a significant length of time then deterioration in mood with anxiety and depression, and emotional lability can be very challenging.
There will be a disturbance in menstrual function. Due to the decline in oestrogen there are increasing episodes of ammenorhea until complete absence of menstural bleeding occurs – your final period.
What’s happening to me during Menopause?
Many women think of menopause as their last period occurring, and that will happen. Prior to your last period, you’ll notice other changes. Your period cycle may become more erratic. You might notice your period, which was once on a regular routine to now be closer together, or other times, further apart. Period bleeding may also change. Some cycles you might notice to be heavier, or lighter with different length of days each time.
Some women report aches and pains in the muscles and joints (arthralgias and myalgias), headaches (likely due to sleep disturbance). Many women report poor concentration, reduced short term memory and this can cause issues with work, personal and family life.
What’s changing in my body?
As your ovarian function slowly declines there is a reduction of oestrogen production and this uneven decline in your oestrogen levels is thought to be responsible for most menopausal symptoms.
You are likely to notice some changes in your body weight (typically a small gain of 1-2kg) and a change in body fat distribution, with more fat around the abdomen, a little less around the thighs and buttocks. Many women experience a reduction in sexual desire, and if vaginal dryness occurs, sex will be uncomfortable or even painful.
After menopause women tend to lose bone mass at a greater rate of 3% per year. This can lead to osteoporosis (thinning of bones and major fractures later in life. Exercise is so important in preventing osteoporosis, particularly strength training. Movement and weights or strength training builds up bone and muscle strength, burns fat and revs up your metabolism.
What health checks do I need during menopause?
It is worth seeing your doctor for a checkup if your symptoms are troublesome.
Your doctor will take a history, and an examination that includes blood pressure, breast check, and pap smear if due. Importantly, a family history of breast cancer, hypertension, osteoporosis/bone fractures and blood clots can be important in deciding management options.
If you are nearing or at 50 a mammogram is important and free through Breastscreen Australia. A simple x-ray of bone mass called a bone density scan may be useful as a baseline.
What simple things can I do?
Many women manage the changes by adopting a healthy lifestyle. Not smoking and reducing alcohol intake reduces flushes. Avoiding caffeinated drinks after 2 pm can help with sleep disturbance. Building regular modest exercise into the day also helps sleep patterns. Loose comfortable clothing is usually more comfortable. A seemingly endless array of supplements are marketed but if you have a healthy diet, then these probably don’t add much except by placebo effect. If your diet is not balanced a multivitamin, and some evening primrose oil capsules may be helpful.
What about HRT?
Hormone replacement therapy has been available for approximately 50 years. Used appropriately and with supervision, it is safe and very effective at alleviating symptoms. HRT is available as tablets, patches and topical creams. Oestrogen and Progesterone are the mainstays. Women who have had a hysterectomy only require oestrogen. Additionally, testosterone supplements as a topical cream can be helpful with low energy and libido. It may sound surprising, but ovaries also produce testosterone up until menopause.
Deciding on HRT?
If you or your doctor are unsure what to do and your symptoms are troublesome, please feel free to arrange a referral to see me and make an appointment. We will go over your history in some detail and I want to hear about how your life has changed with the onset of menopause. Depending on the symptoms, your family and personal history, and relevant examination findings, we will discuss options for treatment. This may or may not include HRT. Short term benefits, plus long-term risks and benefits will be discussed. This will allow you to make an informed decision and select treatment appropriate for you.
Will this go on forever?
Fortunately, the answer is no.
As I stated at the outset, menopause is highly variable, most women will experience their main symptoms for a period of 1-5 years. Some even less. A small group do notice symptoms lasting even into their 60’s.
For more information, you may find the following link helpful and reassuring: https://www.menopause.org.au/health-info/fact-sheets
To discuss any gynaecology issues, please give us a call and make an appointment.
This article has been written by Dr Peter England – Expert Obstetrician and Gynaecologist. Read more about Dr Peter England
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