First Steps through the Menopause

Catherine E Francis

• Publisher: Lion Books
• Year: 2012
• ISBN:
  9780745957050
• Topic: Medicine
• Subtopic: General Health

Every woman who reaches middle age faces the menopause, but many do so with only the minimal amount of information - as well as a lot of myths. Are we condemned to have the same kind of menopause as our mothers did? Is it always a grim experience? Do we have to put on weight? Will our sex lives be effectively over? In this accessible, clear and straightforward guide, Catherine Francis explains what the menopause is, how it may affect you, and what to do if it does. From diet to exercise, conventional medicine to alternative remedies, First Steps through the Menopause is a short but comprehensive introduction to this important stage in a woman's life.

1

What is the menopause?

The menopause is sometimes described as the reversal of puberty. Both processes are caused by major hormonal changes within your body. Puberty kick-starts sexual development, menstruation, and the beginning of the reproductive phase of your life. The menopause does the opposite – it brings about the end of ovulation and your periods, after which you’re no longer able to conceive.

Technically, the menopause is your last menstrual period. However, because periods tend to be irregular during this time, medics usually pinpoint the menopause at twelve months after your final period.

The few years running up to your last period, when you may experience some of the symptoms described in this chapter, is officially known as the “perimenopause”. The stage after your last period, when you may continue to experience symptoms for several years, is “post-menopause”. However, most people use the term “menopause” fairly loosely to describe all three stages.

The menopause usually occurs between the ages of 45 and 55, with the average age being 52. However, it can be considerably later – up to the age of 60. Before the age of 40, it’s classed as a “premature menopause” (you can read more about that in Chapter 9).

Mythbuster

The menopause is a medical condition.

The menopause isn’t an illness or disorder requiring medical treatment. It’s a perfectly natural stage in every woman’s life, and many people sail through it without any problems. However, some of the symptoms caused by your hormones being in flux can be debilitating, and medical treatments or self-help measures can alleviate them. The menopause also increases your risk of other serious health problems, such as osteoporosis (brittle bones). You’ll learn how to lower those risks in Chapter 8.

What people say…

I started experiencing menopausal symptoms at 41. My periods stopped at 46, and I’m nearly through it now. Some of what you read about the menopause is so depressing, especially concerning things like your sex life. However, my only real symptom has been hot flushes, which have been quite manageable. It’s great not having periods or having to worry about pregnancy any more. And I’m glad to report that my husband and I still enjoy a good sex life.

Sabina, 49

What’s happening in your body?

Just as puberty is caused by increasing levels of the female hormones oestrogen and progesterone in your body, the menopause is caused by these hormones declining.

The main hormone at work is oestrogen, which is actually the collective term for three hormones: oestradiol, oestrone, and oestriol. Oestrogen is produced mainly in the ovaries, and in small amounts by the adrenal glands. As well as many other bodily functions, it regulates your menstrual cycle, causing you to have periods and release an egg every month.

As levels of oestrogen in your body slowly drop during your 40s and 50s, your ability to conceive diminishes, and you can experience a variety of symptoms. These can last for up to ten years, but for most women they last between two and six years. Eventually, your ovaries stop producing eggs, your periods stop, and the menopause has occurred.

Diminishing levels of other sex hormones, including progesterone and testosterone (yes, women’s bodies produce some “male” hormones too), also play their part in menopausal symptoms. However, oestrogen is the main culprit.

Mythbuster

My mother had a tough menopause, so I will too.

The age at which your mother had her menopause can give an indication as to when you’re likely to have yours. However, when it comes to symptoms, there’s no evidence of a genetic link. Just because your mother had a difficult time, it doesn’t mean you will. Every woman’s experience is different.

What symptoms might you experience?

The main sign that your menopause is approaching is that your periods become further apart or irregular. They may also be lighter and shorter, or they may be heavier and last longer – everyone is different. In some women, periods stop altogether without warning. However, you should remember that heavy or irregular periods can also be an indicator of medical conditions such as fibroids or polyps, so you should always mention them to your doctor.

As well as irregular periods, there are a number of other symptoms you may experience. Don’t panic – you’re unlikely to have all of them.

Hot flushes

Hot flushes are one of the most common symptoms of the menopause, experienced by three out of four women. They involve feeling hot and sweaty, usually in your upper body, often starting in your face, neck, or chest. They usually last for a few minutes, and are sometimes followed by feeling cold. Your skin may go red and patchy, and some women experience a “crawling” sensation on the skin. You may also have palpitations (increased heart rate). Hot flushes can occur several times a day.

Night sweats

These are hot flushes that occur at night, often with severe sweating that can leave your nightwear and bedclothes drenched.

Mood swings

These include tearfulness, irritability, anxiety, panic attacks, and depression. You’re more likely to experience emotional changes if you’ve had similar symptoms with pre-menstrual syndrome (PMS). Depression and anxiety can be made worse by oestrogen deficiency – but don’t discount the events or stresses in your life that may be contributing to your emotional distress.

Vaginal dryness

This is caused by the body producing less natural lubricant and by the thinning of the vaginal walls, which can also lead to loss of elasticity. It’s experienced by around a third of women after the menopause, and it can make sex uncomfortable or painful. However, there are ways around this, which you can read more about in Chapter 5. Dryness can also lead to itching and general discomfort in the vulval area.

Lower libido

As oestrogen and other sex hormones drop, this can lead to a decrease in sexual desire (not helped by the discomfort of vaginal dryness). However, some women enjoy sex more after the menopause, so don’t assume it’s the end of your sex life.

Interrupted sleep

Lower levels of oestrogen can affect the quality of your sleep and lead to insomnia. Night sweats can also disturb your sleep (and your partner’s), as can depression and anxiety.

Poor concentration and memory

Oestrogen contributes to the functioning of brain cells, so a drop in oestrogen may result in lower concentration levels and memory lapses. This may be made worse by fatigue from disturbed sleep.

Dry skin

Lower levels of oestrogen make it harder for your skin to retain moisture. Skin also becomes thinner with age, which can lead to dryness and itching.

Urinary problems

Around one in six women develops a urinary tract problem during the menopause. Stress incontinence (leaking urine when coughing or laughing) can become an issue, due to thinning of the tissue and loss of elasticity. This can also lead to reduced bladder capacity, which means you may need to pass urine more often. There’s also an increased risk of urinary tract infections.

General aches and pains

Lower levels of oestrogen can contribute to joint pains, muscular pains, and headaches.

Mythbuster

Women always go through hell with the menopause.

Most women experience some symptoms during the menopause. However, for many, these are relatively mild – and some feel no effects at all. If you experience unpleasant symptoms, there are plenty of measures you can take to reduce or eliminate them. So don’t be discouraged – read on to learn how you can start taking control of your body.

How is the menopause diagnosed?

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Your doctor will be able to confirm that you’re probably approaching the menopause, based on your age, the pattern of your periods, and your symptoms. However, it’s not always possible to be certain, especially if you’re taking the contraceptive pill or other hormonal treatments. There’s no definitive medical test for the menopause. Measuring the levels of follicle-stimulating hormone (FSH) in your blood can help to confirm a diagnosis, as FSH rises in women who are approaching the menopause. However, the test isn’t always accurate and isn’t enough on its own to confirm that you’re menopausal.

What people say…

I started missing a few periods when I was 45, and when I did have them, my PMS was worse than before. After eight months, I started having hot flushes. My face and chest go red and feel like they’re on fire – it’s a bit embarrassing when I’m at work, although the women of my age are very supportive of each other. I spoke to my doctor and decided not to go down the HRT route yet, although I’m keeping an open mind about it. Improving my diet and exercising more have helped my symptoms somewhat. Having an understanding husband helps too.
Phillipa, 47

 

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Over to you!

If you’re experiencing one or more of the symptoms described in this chapter, make an appointment with your doctor. Many of these symptoms can have other medical causes, such as fibroids, so it’s best to get them checked out. Alternatively, your doctor may be able to confirm that you’re probably approaching the menopause, and you can discuss your options. However, you may want to read the next few chapters first, so you’re informed about the options available to you and know what to ask.

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2

Hormone replacement therapy (HRT)

The most common medical treatment offered to alleviate unpleasant menopausal symptoms is hormone replacement therapy (HRT). This boosts your levels of the female hormones your body is naturally producing less of.

HRT can be very effective at relieving symptoms caused by oestrogen deficiency, such as hot flushes, vaginal dryness, and sleep disturbances. It can also help protect you against more serious health conditions, such as osteoporosis, particularly in women who’ve had an early menopause. However, not everyone is suitable for HRT, and there are some risks attached to it, so it’s a good idea to consider all the options before making a decision.

How does HRT work?

There are over sixty different types of HRT on the market. Some are oestrogen-only, and some are “combined”, containing oestrogen and progestogen (a synthetic replacement for progesterone).

Oestrogen plays an important role in many body functions, so if your natural levels are waning, a replacement can alleviate many unpleasant symptoms. The oestrogen in HRT is usually extracted from plants or from the urine of pregnant horses.

Declining levels of progesterone don’t have such a dramatic effect on your body, but progesterone offers protection against cancer of the lining of the womb (the endometrium), so a replacement progestogen is used in some forms of HRT.

There are three main types of HRT:

Continuous combined HRT

This is usually prescribed for women whose periods have stopped. It contains b...