5 things you need to know about the menopause

In our latest Ask the Expert article, featured in West Essex Life Magazine, Ms Nandita Deo, a Consultant Gynaecologist at The Holly Private Hospital talks about what women can expect when their periods stop.

1) What is menopause and how can it affect you?

The menopause is when you stop having your periods. This can happen when your ovaries stop releasing eggs or have been removed causing low levels of estrogen hormone in the body. The average age of menopause is between the ages of 45 and 55 years (average 51 years). Perimenopause is the time before your last period, when the estrogen levels are falling. This can last from a few months to several years and can be associated with menopausal symptoms. Menopause before the age of 40 years is called premature ovarian failure (premature ovarian insufficiency) and requires hormone replacement until the average age of natural menopause.

Every woman’s experience of the menopause is different with some women experiencing no symptoms to others having more severe and distressing symptoms. The most common symptoms are:

• Hot flushes and night sweats
• Vaginal dryness
• Low mood and/or feeling anxious
• Joint and muscle pain
• Reduced interest in having sex

2) What can you do to reduce the symptoms of menopause?

Depending on the symptoms and preferences, women choose to either go through the menopause without any treatment whilst some prefer to take some form of treatment to manage symptoms. Treatment options include either hormone replacement therapy (HRT) or an alternative treatment. The choice of treatment depends on your personal preferences, your medical and family history.

3) The different types of HRT

HRT is found to be an effective form of treatment for menopausal symptoms. HRT replaces the estrogen, which decreases in your body around the menopause. It is available as oral tablets, skin patches, body gel, vaginal ring, cream or pessary. The type of HRT prescribed will depend on whether you have a uterus (womb). As estrogen can cause abnormal thickening of the lining of the womb, it is given in combination with progesterone (combined HRT) in women who have a uterus and this can be done as a coil, tablet or a patch.
Combined HRT can be offered before you have the menopause or within 12 months of your last period and can be taken as a ‘cyclical combined HRT’ and this would give you regular monthly withdrawal bleeds.

If HRT is started more than 12 months after your last period, a ‘continuous combined HRT’ is offered which is a bleed free HRT regime. You may have some unscheduled bleeding initially, but this should resolve within 3 months.

If you have had your womb removed (hysterectomy), then you will be offered estrogen only HRT.

4) The benefits and risks of HRT

HRT has been found to be effective in treating hot flushes, low mood, vaginal dryness, improving low sexual desire and improving bone strength by preventing osteoporosis. There is not enough evidence around whether it prevents the onset of dementia.

Depending on the type of HRT, risks associated would include breast cancer and thrombosis (blood clots). However, HRT with estrogen alone (used for women who have no womb) is associated with little or no increased risk of breast cancer. HRT with a combination of estrogen and progesterone can increase your risk of breast cancer and the risk is higher the longer you are on the HRT and reduces when you stop it. Overall, your individual risk of breast cancer also depends on your background risk, your weight, smoking and drinking habits.

HRT taken in tablet form can increase your risk of developing blood clots and can cause a very small increase in stroke, which is very unlikely in women under 60 years.
Women with diabetes and hypertension can also benefit from HRT taken in the form of a patch.
Women who are on low dose vaginal estrogen for vaginal dryness can use it for as long as need be and it can be used safely in conjunction with HRT. Vaginal estrogen also reduces bladder infections and helps with urinary symptoms.

HRT is not a contraceptive and you would need to continue using contraception for 1 year after your last periods if this happens after the age of 50 years or for 2 years if your last period happens before you are 50 years of age.

Once you start HRT, you should see your health professional after 3 months and then yearly afterwards have a discussion around when it can be stopped. Any bleeding after 3 months of starting/changing your HRT would necessitate an urgent visit to the health professional.

5) Alternative treatment options

Lifestyle changes, herbal remedies, alternative therapies, complementary therapies can help with some menopausal symptoms.
Regular aerobic exercise, low intensity exercise, and reducing consumption of caffeine and alcohol may help with menopausal symptoms. Herbal extracts such as St John’s wort, black cohosh and isoflavones (soya products) can help reduce hot flushes and night sweats. However, care must be taken as they can react with medicines taken for conditions such as breast cancer, epilepsy, heart disease or asthma.
Acupressure, acupuncture, homeopathy, aromatherapy, cognitive behavioural therapy (CBT) has also been tried for various menopausal symptoms however its role needs further research.

Ms Deo has a clinic every Wednesday afternoon at The Holly Private Hospital. Call 020 8936 1201 to make an appointment.