Menopause – in a nutshell

Inevitably, all women will face menopause, also called the change of life. I had thought periods were tough enough, but every woman I’ve seen who’s experienced it has said to me “Wait till you get to menopause”. So, what’s to expect?

Let’s start with defining menopause… 

Perimenopause (peri – around) is essentially the transition stage into menopause and can occur several years before menopause. Menopause is the absence of periods for at least a year. In the UK, the average age to reach menopause is 50-52, 2 years earlier for an Afro-Caribbean woman. (1,2)

What changes occur inside my body?

• • The hormone oestrogen drives the development of the female reproductive system, which creates your period.
  • Once you reach around 40, the number of unmatured eggs in your ovaries becomes depleted.
  • And so, the ovaries spontaneously fail to produce all the important hormones such as oestrogen and progesterone. As a result, your fertility is decreasing. (3)
  • Other hormones in the body initially try to fight this off, but eventually give up, which is why periods still occur before they completely stop, but become more erratic and irregular.

How does menopause begin?

Just like many other conditions and life changes, it affects every woman differently. Hence it is important to approach each woman individually. 

Here are the 5 key features of menopause that you may experience: 

1. 1. 1. Erratic Periods – in quantity, duration, and intervals. 
         • • It’s usually the first thing that you may notice.
           • You may also experience some spotting or heavy bleedings.
      2. Hot flushes 
         • • We don’t really know what causes this, but it is the most common symptom. 
           • There’s no pattern to it and occurs several times a day and lasts for a few minutes. 
      3. Sleep disturbance – this may happen due to restlessness or night sweats from hot flushes.
      4. Psychological disturbance – like headache, depression, mood swings, lower sex drive.
      5. Physical changes such as dry/itching/shrinking vagina, painful sexual intercourse, weak bones, more bad cholesterol in your blood, urge to go to the toilet more often.

What can you do about menopause?

The diagnosis of menopause is clinical, and the management is symptom-based. Here are a few evidence-based tips:

• • • Maintain a healthy diet and exercise. A healthy lifestyle has many benefits such as reducing stress levels, increasing bone strength, and reducing bad cholesterol. Weight-bearing exercises such as aerobics are particularly good for bone health. It also reduces the risk of cardiovascular disease such as heart attack/stroke.

   

  • • Oestrogen hormone therapy is the most effective treatment for hot flushes (80- 90%). This may be offered by your doctor if conservative measures do not help e.g., relaxation techniques, avoiding triggers such as alcohol/hot drinks, keeping cool, etc. If unable to take oestrogen, then Selective Serotonin Reuptake Inhibitors (SSRI) are also effective. 

   

  • • Ensure you have enough calcium and Vitamin D in your diet to reduce the risk of bone weakening. Food high in calcium includes sesame seeds, broccoli, dates, fish, and tofu. Supplements may be recommended by your doctor.

   

  • • Keep hydrated – Water is a natural body cleanser and can help with dryness and headaches.

   

  • • Stop smoking! Smoking can cause early menopause. It also increases the risk of bone weakening and vaginal spotting. (4)

   

  • • Topical oestrogen therapy for the vagina – can help with dryness, painful sexual intercourse, and urinary problems. (5)

   

Figure 1 – Diagram of body with Symptoms/Signs of Menopause   

Can we prevent menopause?

• • Menopause is the normal physiological process that occurs as we age.
  • Certain risk factors can make you go into menopause early – some of which you can modify like smoking and some which you can’t like age, cancer treatment such as chemotherapy, ovarian surgery, etc. 
  • If you have your womb removed (hysterectomy) your ovaries will stop working too. (3)

Menopause can be a daunting period of your life, so please do not hesitate to seek help from healthcare professionals when you need it. Join our community of women to support you through the journey. 

References:

1. 1. 1. Gold EB. Factors Associated with Age at Natural Menopause in a Multiethnic Sample of Midlife Women. American Journal of Epidemiology. 2001 May 1;153(9):865–74.
      2. ‌Bromberger JT, Matthews KA, Kuller LH, Wing RR, Meilahn EN, Plantinga P. Prospective Study of the Determinants of Age at Menopause. American Journal of Epidemiology. 1997 Jan 15;145(2):124–33.
      3. Currie H, Firm P. Menopause : answers at your fingertips. London: Class Publishing; 2006.
      4. ‌15. Malnick SD, Somin M, Attali M. Smoking, ageing, and oestrogen. The Lancet. 1999 Sep;354(9182):955.
      5. Biehl C, Plotsker O, Mirkin S. A systematic review of the efficacy and safety of vaginal estrogen products for the treatment of genitourinary syndrome of menopause. Menopause. 2019 Apr;26(4):431–53.

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