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Womens Health

Menopause

Doctor Balfour has a special interest in menopausal health and runs a menopause clinic at the surgery for our patients

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Common questions about the menopause:-

What is the menopause?

Defined as when you have not had a period for one year (as long as you are not on medication that could affect your periods).  The average age for this in the UK is 51 but any time after 45 is considered normal.  You are then described as postmenopausal.

Perimenopause - the period of time when you develop menopausal symptoms but are still having periods although they may be more frequent, irregular, lighter, or heavier.  This phase can last up to 10 years.

Postmenopausal bleeding - a vaginal bleed when your last proper period was at least one year ago.  THIS NEEDS URGENT ASSESSMENT BY YOUR GP.

Surgical menopause - your ovaries are removed during a surgical operation (bilateral oophorectomy).

Medical menopause - can be caused by chemotherapy, radiotherapy, and some other drugs

Early menopause - the menopause occurs before the age of 45

Premature ovarian insufficiency - the menopause occurs before the age of 40 (about 1 in 100 women)

If you have been diagnosed with an early or premature menopause it is very important that you take HRT until at least your early 50s unless there is a specific contraindication.  Many women in this age group have been put off HRT by media scares but they do need to replace the natural hormones they have lost to protect their heart and bones for the future.

What symptoms may I get around the time of the menopause

We have oestrogen receptors all over our bodies, including our bones, brains, heart, skin, and vagina.  There are many possible symptoms related to the menopause, some more commonly talked about than others.  Symptoms vary a great deal between women and can change with time.  They can be brief or last for decades.

Physical symptoms can include irregular periods, hot flushes, night sweats, difficulty sleeping, migraines and other headaches, palpitations, lack of energy, feeling faint or dizzy, aching muscles, painful joints, vaginal dryness or burning, urinary frequency, pain and incontinence, loss of libido, breast pain, dry eyes, dry or burning mouth, indigestion, altered sense of smell, tinnitus, restless legs, weight gain around the abdomen, thinning and drier hair, brittle nails, increased facial hair, spots, and dry itchy skin.

Psychological symptoms can include brain fog, loss of confidence, anxiety, low mood, depression, mood swings, irritability, crying easily, poor concentration, lack of motivation, poor memory, loss of joy, and low self-esteem.

Many women are given antidepressants at this stage of life when they really need HRT.  When you consider that many of us are also coping with at least one of the stresses of looking after a partner, children, elderly relatives, or work issues, it is amazing that we manage to keep going at all!

What type of HRT can I have?

If you have had your uterus (womb) removed you only need oestrogen HRT.

If you still have your uterus you need both oestrogen and a progestogen (combined HRT) to stop the lining of the uterus building up and in rare cases developing endometrial cancer.  This is divided into continuous combined or sequential combined HRT and we can discuss which is best for you.

Some women may also benefit from testosterone.

HRT can be delivered by tablets, patches, gels or spray, and we can discuss the most suitable option for you.

What are the side-effects and risks of HRT?

There are so many myths about HRT that are still being perpetuated and many doctors are still very cautious about prescribing it despite the proven benefits.  Typical misconceptions are that it makes you put on weight, that you can't have it if you get migraine or blood clots or have a family history of breast cancer, that it just delays your menopause and that you should only be on it it for the shortest possible time.

The biggest worry for most women is the risk of breast cancer but this does not apply to all types of HRT and for the types it does apply to the risk is much smaller than we had been led to believe.  I can discuss the research and look at this risk in relation to other factors for breast cancer and how you can reduce your personal risk.

There is a small increased risk of blood clots and ischaemic strokes with the tablet forms of oestrogen but not with the patch and gel forms of HRT.

What are the long term benefits of HRT?

If you started before the age of 60 and within 10 years (but ideally within 6 years) of your last period, women have a significantly reduced risk of heart disease in the future.  Long-term HRT can also protect against osteoporosis.  Women on continuous combined HRT have a lower risk of endometrial cancer than those on no HRT at all.

What about testosterone?

I am able to prescribe this if indicated.  Many people don't realise that testosterone is a really important hormone for women as well as men.  We produce it both in our ovaries and via our adrenal glands and production naturally declines with age.  Our levels reduce more dramatically if our ovaries are removed or stop functioning at a young age.  I can prescribe testosterone if indicated, mainly to help with libido but in some women it can also improve motivation, mood, energy levels, concentration, muscle strength and stamina.  You woudl normally have a trial of an adequate dose of oestrogen (with progestogen if you still have a uterus) for at least 6 months before considering whether testosterone is also needed to help with your symptoms.  Younger women with a surgical menopause are most likely to need testosterone supplementation.

How can I improve my virginal or urinary symptoms?

As we lose oestrogen we all develop thinning of the tissues of the vagina, vulva and bladder.  This is not something that settles after the menopause but steadily gets worse, often leading to vaginal burning and itching, painful sex, urinary frequency and recurrent urinary tract infections.  It can easily be prevented by the regular, long term use of vaginal oestrogen which is very safe and effective.  It does not increase the risk of breast cancer and those still with their uterus do not need to have a progestogen as well.

Most women on HRT find their vaginal symptoms are greatly improved but about 20% find they need to add in long term vaginal oestrogen.

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Useful resources

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Websites

www.womens-health-concern.org includes an information leaflet and chart on understanding the risk factors for breast cancer

www.menopausedoctor.co.uk

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Books

Me & My Menopausal Vagina by Jane Lewis

The Pelvic Floor Bible by Jane Simpson Continence Specialist

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Products

YES lubricants www.yesyesyes.org



 
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