Navigating Menopause
Menopause is a natural biological process that marks the end of menstruation and fertility in women. While menopause is a normal part of aging, it can bring about various physical and emotional changes that may impact a woman's quality of life. In this blog post, we'll explore menopause, including its symptoms, management strategies, and implications for women's health.
Understanding Menopause
Menopause typically occurs in women between the ages of 45 and 55, with the average age of onset around 51 years. It is defined as the cessation of menstrual periods for 12 consecutive months. Menopause occurs due to a decline in the production of oestrogen and progesterone hormones by the ovaries. For some, menopause can occur abruptly due to premature ovarian insufficiency, surgery or cancer treatment.
Understanding Perimenopause
Perimenopause is the beginning of the end of ovarian function. It is the stage that occurs before menopause and can last from 2 to even 10 years. Perimenopause is marked by irregular periods but can be challenging to diagnose given the wide range of ages you might start to experience a wide variety of symptoms and severity. Menstrual irregularity can also be varied, your period might be early or late, longer or shorter, heavier or lighter and more or less painful.
Common Symptoms
Menopause can be accompanied by a variety of symptoms, which may vary in severity and duration among women. Common symptoms of menopause include:
Hot Flashes: Sudden, intense feelings of heat that may cause flushing, sweating, and palpitations. It all starts in the brain at your internal temperature regulator which is disrupted when oestrogen levels decline. This causes vasomotor symptoms by triggering blood vessels to dilate spreading a hot flush sensation to rise up your chest to your face.
Night Sweats: Episodes of excessive sweating during sleep, often accompanied by hot flashes.
Vaginal Dryness: Reduced lubrication and moisture in the vaginal tissues, leading to discomfort or pain during sexual intercourse.
Mood Changes: Entering menopause increases the risk of experiencing mental health concerns including depression, anxiety and shift in mood, cognition and emotional wellbeing.
Sleep Disturbances: Difficulty falling asleep, staying asleep, or experiencing restful sleep may occur due to hormonal changes or night sweats.
Brain fog: Most likely to begin as oestrogen levels begin to fluctuate in perimenopause. This is because women have oestrogen receptors in the hippocampus and prefrontal cortex, which are areas of the brain responsible for memory and other cognitive functioning. This might cause you to feel forgetful, have difficulty concentrating, feel mentally slower and fatigued, inability to multitask and difficulty with word finding. For most these changes are short-lived and postmenopause your cognition should return.
Changes in Libido: Decreased interest in sexual activity or changes in sexual desire may occur due to hormonal changes or vaginal dryness.
Breast soreness, fullness, and swelling: may worsen during perimenopause when hormones surge and drop erratically.
Bone Health: Decreased oestrogen levels during menopause can increase the risk of osteoporosis, a condition characterised by weakened bones and increased fracture risk.
Metabolic disfunction: Change in body composition lowering muscle mass and increased visceral fat. Declining oestrogen levels increase the risk of developing insulin resistance, increased cholesterol and fatty liver disease.
Hair/ Skin/ Nail changes: Some women experience a relative increase in androgens during perimenopause. This can cause acne to emerge or re-emerge in part due to the androgens but there is also an overall skin sensitivity caused by loss of moisture, collagen and elastin. This can be worsened by sun exposure, smoking, lack of sleep and stress. These changes and excessive sweating can also lead to worsening body odour. It is possible to experience both hair loss and also excessive hair growth. Perimenopausal women are especially susceptible to weakened nails again due to hormonal changes.
Digestive issues: Oestrogen plays a vital role in maintaining the health and functioning of the intricate gastrointestinal system. Menopause causes changes to the microbiome, and increases the incidence of reflux and IBS.
Muscle/ joint pain: This is one of the most bothersome symptoms along the menopause journey. It can develop at any point in menopause but it is especially prevalent in perimenopause, occurring in up to 70% of women.
Tinnitus/ Vertigo: Tinnitus is an auditory condition marked by the sensation of ringing or buzzing sound in the ears. Vertigo is a sudden feeling of dizziness or spinning sensation often triggered by certain movements. Despite a lack of research we suspect hormones can influence the ear.
Palpitations: Around 50% of menopausal women experience palpitations. They can occur in response to diminishing levels of oestrogen which increases heart rate and frequency of palpitaitons.
It is an important and challenging time to rule out overlapping symptoms with other diagnoses not related to menopause. These include; thyroid disorders, anaemia, insulin resistance, major depressive disorder, autoimmune disease or even Alzheimers disease.
Management Strategies for Menopause Symptoms
While menopause symptoms can be challenging, several management strategies can help alleviate discomfort and improve quality of life:
Lifestyle Modifications: Healthy lifestyle habits, including regular exercise, balanced diet, stress management, and adequate sleep, can help alleviate menopause symptoms and promote overall well-being.
Cognitive behavioural therapy: has been demonstrated to improve sleep, mood and vasomotor symptoms. Hypnosis has been shown to reduce vasomotor symptoms severity and frequency, and has been useful for reducing anxiety and improving sleep.
Keeping cool (e.g. dressing in layers, air conditioning, drinking cool liquids) may help some women’s hot flushes. And avoiding known triggers like stress, spicy foods, and excessive caffeine and alcohol.
Vaginal Moisturisers and Lubricants: Over-the-counter vaginal moisturisers (Such as YES Vaginal moisturiser or Olive & Bee Intimate Cream) and lubricants can help relieve vaginal dryness and discomfort during sexual intercourse.
Bone Health Measures: Adequate calcium and vitamin D intake, weight-bearing exercise, and bone density screenings can help maintain bone health and reduce the risk of osteoporosis.
Non-Hormonal Therapies:
Selective serotonin reuptake inhibitors (SSRIs) and serotonin noradrenalin reuptake inhibitors have been shown to reduce hot flashes.
Gabapentin improves the frequency and severity of hot flashes and night sweats as it promotes sleepiness.
Oxybutynin is used for urinary incontinence but can also help with hot flashes.
Clonidine is a medication that lowers blood pressure and may be used to prevent migraines. It can be used for menopause to reduce hot flashes although it is less effective than other options.
Fezolinant (brand name Veozah) is a new nonhormonal pill for hot flashes, it is a selective neurokinin-3 receptor agonist that targets the brain temperature regulator (hypothalamus) to alleviate severity and frequency of hot flashes.
Menopause hormone therapy (MHT) also referred to as HRT: Involves the use of oestrogen or oestrogen-progestin combinations to replace declining hormone levels and alleviate menopausal symptoms. MHT can be administered in various forms, including pills, patches, creams/ gels.
Hormonal contraceptives can be used in perimenopause for symptoms of irreguar/ heavy menstrual bleeding and may also help with symptoms of menopause. The options include combined oral contraceptive pill or the progesterone only pill. The Mirena IUD Can also be used to control menstrual bleeding in perimenopause and can remain through menopause to protect the uterine lining whilst using oestrogen therapy.
Benefits of MHT include; Reduction in vasomotor symptoms, improved quality of life, improvements in sleep, libido, headaches, aches and pains, skin and hair and decreased risk of; osteoporosis and fracture, cardiovascular disease, colorectal cancer, endometrial cancer, diabetes, cataracts.
MHT unfortunately cannot be used if you have a history of oestrogen dependent cancer, blood clots, unexplained abnormal uterine bleeding and liver disease or cardiovascular disease.
If you have a uterus then MHT must be combined with both oestrogen and progesterone - which protects the uterine lining
Perimenopausal women who are symptomatic should consider using cyclical therapy to allow for ongoing regular menstrual bleeding and contraception should be considered. An example of this could be a Mirena IUD to protect the uterus with Topical oestrogen gel to treat symptoms like hot flushes. Alternatively a progesterone oral pill could be taken cyclically in addition to daily oestrogen gel.
Postmenopausal women can use continuous oestrogen and progesterone therapy if desired, to treat their symptoms.
Women without a uterus (those who have had a hysterectomy) can use just oestrogen alone to control symptoms of menopause
Testosterone cream might be used in menopausal women to treat low libido.
SERMs (Selective oestrogen receptor modulator) such as tibolone have oestrogenic progestogenic and testosterone like effects. It can be used in menopausal women for symptoms of menopause.
Local hormones might be needed to treat genitourinary symptoms. This could be vaginal oestrogen in a cream or pessary or a pessary of DHEA which can be applied locally to the vagina to reduce dryness.
What about the risks? It is generally considered safe for women to continue MHT for up to 10 years if they are less than 60 or within 10 years of menopause. Breast cancer risks start to rise with combined therapy after 5years and cardiovascular risk as you age. New generations of medications which are more body identical include micronised progesterone and have a much safer risk profile for breast cancer and transdermal oestrogen by gel or patch reduces the risk of blood clots.
Health Implications of Menopause
Beyond symptom management, menopause also has important implications for women's health and wellbeing. Oestrogen is an incredible protective hormone and as it decreases in menopause, women loose that protection. Decreasing oestrogen levels after menopause can increase the risk of cardiovascular disease, dementia, metabolic disease, osteoporosis and fractures. Menopause-related hormonal changes may contribute to mood disturbances or depression in some women, underscoring the importance of mental health awareness and support. If you are not able to or choose to avoid menopause hormone therapy and actually even if you are replacing your hormones it is imperative that you maintain a healthy lifestyle, continue regular exercise, healthy diet and stress management.
Conclusion
Menopause is a major transition in a woman's life that can bring about various physical, emotional, and health changes. By understanding the symptoms of menopause, exploring management strategies, and addressing potential health implications, women can navigate this life stage with confidence and maintain their overall health and wellbeing. If you have questions or concerns about menopause or symptoms, don't hesitate to consult with your healthcare provider for guidance and support.
Resources
Books:
The Menopause Brain by Dr Lisa Mosconi
The New Menopause by Dr Mary Claire Haver
Websites: