Sunday 12 March 2017

All You Need To Know About Menopause


Many women dread the thought of the menopause and what it might bring. Although some women sail through “the change” and only notice they no longer have periods, they are sadly in the minority. For many women the menopause is a time of huge physical and emotional change. Here, S Magazine’s Dr Rosemary Leonard explains all you need to know about the dreaded change of life.

What is the menopause?

The medical profession defines the menopause as the date of your last ever period. If only it was as simple as that.

The reality is that the menopause, like puberty, isn’t a single event, it’s something that happens gradually over a period of many months.

What is actually happening is your ovaries are winding down and ceasing to produce both eggs and hormones. For some, the events surrounding the menopause can go on for years and many women describe themselves during this time as being menopausal.

However, strictly speaking, according to gynaecologists you can be menopausal while you are still having periods – even if they are all over the place. In this situation you are perimenopausal, which means you have not started the menopause.

Once your periods have stopped, according to doctors you are postmenopausal. However, there is of course a grey area here when you don’t know whether your periods have finished or not.

How do I know if I’m menopausal?

The main sign, which happens to every woman, is that their periods stop. Sometimes this is very sudden, but a more common scenario is for periods to become erratic and totally unpredictable. You may have a gap of six or eight weeks then have two in a row.

This pattern may go on for six months or more – there’s just no way of knowing when your periods are going to stop.

A lot of women get other symptoms, too, such as hot flushes and sweats, as well as mood swings, but some very lucky women just realise their periods have come to an end. Nothing else. It’s not necessarily a nightmare for everyone.

What exactly is happening to your body?

The ovaries have stopped working; they are no longer releasing eggs nor producing hormones.

What are the symptoms?

There are some lucky women who go through the menopause without ever having a flush or producing an extra bead of sweat, others find their life is made a complete misery by their body thermostat seeming to be completely out of control – feeling hot and dripping in sweat one minute, then freezing the next.

How to tackle flushes and sweats

Flushes and sweats are often the most troubling symptoms of the menopause. Not all women get them, but in some they are so severe that they make life a misery.

The exact cause isn’t known, but it is thought that the fall in oestrogen levels at the menopause affects the centre of the brain that controls body temperature. This effect is in part controlled by the chemical messengers serotonin and noradrenaline.

Wearing several layers of lighter clothing, rather than one thick layer, can be very helpful. When you feel hot, just shed a layer then put it back on again when you cool down.

Get to know your clothing fibres and read labels carefully. Items made from natural fibres are much better at allowing sweat to evaporate than man-made ones such as polyester.

Switch to bed linen and nightwear made of 100 per cent cotton, rather than a polycotton mix. It can really make a difference to night-time comfort.

If you find yourself constantly throwing off the duvet, switch to one with a lower tog value and have an extra blanket at hand in case you need one. If you sleep with a partner, having two single duvets can solve the problem of disturbing their sleep.

If you smoke, consider quitting as studies suggests it increases the likelihood of having hot flushes.

Being overweight also means you are more prone to hot flushes, so this could be another stimulus to shedding excess pounds.

Exercise is likely to help flushes if you are already fit, but it can make them worse initially if you are a couch potato. Also consider yoga, relaxation and paced respiration. there’s no conclusive evidence that they will help sweats and flushes, but each will contribute to general wellbeing.

Diet and medication

Making changes to your diet can help to reduce flushes and sweats, though the effects vary between women. If you are having really bad symptoms you may not notice much difference, but it’s worth a try.

Alcohol and caffeine can make sweats worse, you’re also likely to look more flushed. Don’t stop drinking caffeine suddenly as this can cause awful caffeine-withdrawal headaches. Instead, cut down slowly and gradually switch to decaf.

Eating really hot or spicy food can trigger a really bad hot flush. Stick to milder curries and let food cool down a little before eating.

Eating a diet rich in isoflavones can take the edge off hot flushes in some women. You can also boost your phytoestrogen intake by eating more pulses (chickpeas and lentils) as well as bean sprouts, linseeds, green leafy veg and soya products.

Prescribing antidepressants is a relatively new approach to treating flushes and sweats but it is becoming increasingly popular.

A wide range of alternative remedies are available, though they may have very little effect. the best are those containing phytoestrogens, and black cohosh can be helpful, too, but should not be taken for more than six months.

It is important to only use registered herbal products and not take any labelled as food supplements, which have no guarantee of the purity of their ingredients.

Hormone replacement therapy (HRT)

As its name suggests, hormone replacement therapy – HRT – replaces the hormones that are no longer being produced by the ovaries.

The main ingredient is oestrogen, the hormone that the body misses so much, and the aim of HRT is to restore oestrogen levels, allowing the body to function as it did before the menopause.

It can be wonderful for women with menopausal symptoms and give you back a normal life, stopping flushes and sweats within days.

It has lots of other benefits, too, including helping to prevent osteoporosis and to stop the mood changes that can occur around the menopause, as well as helping to maintain your libido and skin and hair quality.

The main disadvantage of HRT is that it can increase the risk of breast cancer, but for most women this increased risk is very small – drinking 14 units a week of alcohol increases the risk by just as much.

HRT taken by the mouth can also very slightly increase the risk of blood clots.

Other side-effects can include bloating, weight gain and headaches. Some women also find they get erratic bleeding on HRT.

The main hormone in HRT is oestrogen, but this can cause thickening of the lining of the womb and, over time, increase the risk of a cancer in the womb. this effect can be counteracted by adding a second hormone, progesterone.

Is it right for every woman?

No. there are some women who should not have HRT, such as those who have had breast cancer, or a history of blood clots, and if you have high blood pressure it should be back to its normal level before you start HRT. But it’s fine for most women – and it’s not the baddy it is often made out to be.

There are lots of different HRT regimes available and finding the one that suits you can take time. It’s best to try each new method for three months, to give your body time to adapt to it. Don’t chop and change too quickly.

The longer HRT is taken, the greater the beneficial effect on bones, but unfortunately the risk of breast cancer also rises, especially after 10 years of use.

Menopausal madness

Any woman can suffer from emotional issues at any age, but the time when they become really troublesome is the years around the menopause. Those who have had problems in the past with anxiety or depression find that what they thought was under control suddenly reappears, and women who have previously never had any problems with their moods find themselves irritable, angry, anxious or depressed for no apparent reason other than the menopause.

Mood changes are common around the time of the menopause due to changing hormones. And during the perimenopause premenstrual syndrome (PMS) often becomes a lot worse.

Anxiety and depression are common in women of menopausal age and are often at their worst just after periods stop. At this stage women often drive themselves hard to make everyone else a priority. Not surprisingly, this can lead to stress – which makes anxiety and depression worse.

Self-help measures – taking more care of yourself, making time for relaxation and exercise and eating a balanced diet – should be top of every woman’s list when tackling mental health issues.

Don’t be afraid to speak to your doctor. You will not be labelled as being weak or mad and the most effective treatments – either tablets or talking therapy – are usually only accessible from your GP.

If you want to avoid antidepressants, herbal remedies, especially St John’s Wort, can be helpful for some women.

Waistline worries

It is normal for a woman’s shape to change after the menopause. The lack of oestrogen means that fat tends to be laid down more around the tummy – hence that awful phrase “middle-aged spread”.

But having a little fat around your middle is not only normal, it’s healthy. If you still have a 24 inch waist in your fifties, the chances are you are underweight and not only look a little gaunt but have an increased risk of osteoporosis.

Your metabolic rate falls as you get older, mainly because your muscles shrink. This means that if you eat the same at 50 as you did at 20, you will put on weight. To stop yourself piling on the pounds, you need to reduce your daily calorie intake.

The best way to control your weight is not only to watch your diet, but to take much more exercise. This should involve not only cardiovascular exercise but also doing exercises that help you maintain your muscles. Weight-bearing exercise is important, too, to help maintain strong bones.

The scales don’t always tell the story about how healthy you are. The amount of body fat you have, and especially your waist measurement, are also important. It is possible not to be “overweight” but still be carrying too much fat around your middle for good health.

Looking after your bones

Most of us take our bones for granted and don’t think about them at all unless something happens to one of them, such as a broken arm or a creaky knee.

But the reason all women should think about their bones is because of osteoporosis. It’s a condition that weakens bones, making them fragile and more likely to break. But unlike osteoarthritis it does not cause joint pain.

No symptoms may appear until you are in your seventies, but you really need to be aware of osteoporosis around the age of the menopause, because that is when you can best do something about it. It’s a condition that affects one in three women, so it’s not something you should ignore. Osteoporosis can also cause a curved spine and loss of height, but only when bones are already very weak.

Oestrogen helps to maintain bones, so bones suddenly start becoming weaker after the menopause. Once this starts happening there is no cure to build them up again, the available treatments just aim to stop further bone loss.

Some women are more at risk than others, this includes those with a small build or who have had an early menopause, or whose periods stopped because of low weight or excessive exercise or who have a family history of the condition.

Prevention is all important, and that means eating at least 800mg of calcium a day, making sure your vitamin D levels are adequate and doing regular weight-bearing exercise.

Menstrual mayhem

The menstrual cycle always changes in the approach to the menopause, but exactly what happens can vary enormously.

Some women find that their periods just become more irregular and lighter. Others are not nearly so lucky and have very erratic bleeds, which may be incredibly heavy.

It can be difficult to predict how long the “menstrual chaos” that can occur at the menopause will last and though an occasional heavy period may be nothing to worry about, if it happens repeatedly it can, and often does, lead to iron-deficiency anaemia.

Other gynaecological problems often occur in women in their forties, such as fibroids. It is important not to assume all changes in bleeding are just due to the approach of the menopause. Effective treatments are available that can help with heavy erratic periods, so don’t hesitate to get medical advice.

Sex and contraception

Up until a year after you’ve had your last period it is still possible to ovulate and have a surprise pregnancy, so women should continue to use contraception. There is a wide choice suitable for women in their forties, including the combined pill, though this will mask any signs of the menopause. Women of all ages can and do get sexually transmitted infections.

After the menopause you are no longer at risk of an unwanted pregnancy but it’s still very important to protect yourself against infections, especially when you are with a new partner.

The fall in hormone levels, especially oestrogen and testosterone, can lead to a dramatic decline in libido after the menopause. this can be improved with HRT or testosterone replacement, but both of these can carry other health risks.

Skin and hair

The loss of oestrogen that occurs at the menopause usually makes the skin much more dry (especially around the vagina area).

Dry skin is also more prone to irritation from perfumes and other chemicals, such as biological detergents, and also from slightly itchy fabrics. You may find it impossible to wear wool next to your skin, especially around your neck.

Hormone changes also mean that the skin loses some of its deep support, making it a little more saggy and prone to lines and wrinkles. though the skin inevitably changes with age, far more damage is done by sunlight and smoking.

Hair also becomes a little thinner after the menopause and does not grow as long. It is also more fragile, so needs to be treated gently and hair in the armpits and groin can become more sparse.

Feeling and looking good after the menopause can take a little more effort and the words “high maintenance” take on a whole new meaning. But we all know older women from their fifties onwards who not only look fabulous but are reaching the peaks of their careers or taking on new roles and are clearly happy and fulfilled.

However, though many do have excellent health, this is a time when you shouldn’t take your body for granted and looking after yourself should be a priority.



Etiam at libero iaculis, mollis justo non, blandit augue. Vestibulum sit amet sodales est, a lacinia ex. Suspendisse vel enim sagittis, volutpat sem eget, condimentum sem.