Menopausal Health - Symptoms, Treatments and Recommendations
Menopause and the menopausal transition are a normal part of ageing for women, not a disease or disorder. This period in a woman's life can also be accompanied by other changes in addition to menopause: women may have children beginning to leave home, be caring for older relatives, or taking on more work.
Some women experience no or very little menopausal symptoms and can feel relieved not having to worry about periods or becoming pregnant. However, many women do experience symptoms during the menopausal transition including: trouble sleeping, hot flashes, mood changes, depression and pain during sex. You may be able to get help from one of our specialists
to treat your symptoms or recommend lifestyle changes.
What is the Menopausal Transition?
Menopause is classified as the point at which a woman has gone 12 months since her last period. In the years leading up to this point, women may experience changes in their periods, mood, hot flashes, and other symptoms. This period is called the menopausal transition or perimenopause.
This transition usually begins between the ages of 45 and 55, lasting on average 7 years, but potentially up to 14. The duration of the menopausal transition depends on factors such as smoking, ethnicity and the age when the transition began. The production of estrogen and progesterone, reproductive hormones, varies greatly during the perimenopause.
Different women are all affected in unique ways. You may find that you gain weight more easily, your bone and heart health changes, as well as your body shape, composition or physicality.
Symptoms of Menopause (Transition)
Common symptoms of menopause may not necessarily be caused by the menopausal transition. You may be recommended to have a blood test to determine your FSH and E2 levels and rule out other potential causes. Symptoms can include:
- Change to your periods - Your period may be longer or shorter than usual, no longer regular, or more heavy or lighter than usual. These are normal changes during menopause, but you should see a specialist if: your periods are very close together, you have heavy bleeding, you have spotting, your periods resume after no bleeding for a year, your periods last more than a week.
- Hot flashes - Hot flashes are a common symptom during menopause and can even last for many years after.
- Incontinence - You may have a sudden urges to urinate or stress incontinence during exercise, sneezing or laughing.
- Sleep issues - You may find it difficult to fall asleep, or you might wake up too early. You can also experience night sweats which wake you up during the night and struggle getting back to sleep.
- Sexual changes - The vagina may become drier, making sexual intercourse uncomfortable. You may also have a lower sex drive, or even feel more confident having sex without having to worry about periods or pregnancy. Please note, you will still be at risk of sexually transmitted diseases (STDs).
- Mood changes - You may feel more irritable or moody around the time of menopause.
- Changes to your body - You may find you gain weight more easily and your overall proportions change. Other issues can include memory problems, stiff joints and muscles. In some cases women can also experience headaches, heart palpitations and aches and pains.
Treatment for Menopause and Perimenopause
The most common medical treatment for menopause and the menopausal transition is hormone replacement therapy (HRT), which replaces hormones which are at low levels as a result of menopause.
Alternate treatment options will be provided if you are unable to or do not want to have HRT.
Hormone Replacement Therapy (HRT)
For most people going through menopause or the menopausal transition, HRT is a safe and effective treatment. Your specialist will discuss the risks with you.
HRT replaces your body's levels of oestrogen which drop around the time of menopause. HRT can be applied in different methods and doses depending on your specific circumstances. These can include:
- Skin patches
- A gel or spray to apply to the skin
If you still have a womb (uterus) you will need to take progesterone in combination with the oestrogen to protect your womb. This is called combined HRT.
Progesterone comes in these forms:
- A combined skin patch with oestrogen
- IUS (Intrauterine system, or coil)
You may be offered testosterone to improve your sex drive if HRT does not improve it.
Benefits of HRT
HRT can help to relieve the vast majority of menopausal and perimenopausal symptoms including:
- Hot flushes and night sweats often improve within a few weeks
- Mood changes can take a few months to improve
- Vaginal dryness can take a few months to improve
- Brain fog
- Joint pains
HRT can also reduce the risk of osteoporosis and heart disease.
Testosterone gel for reduced sex drive
If HRT does not restore your sex drive, you may be offered testosterone cream or gel to improve sex drive, mood and energy levels. Testosterone is naturally produced by the ovaries but your levels will usually drop with age. Testosterone is not licensed for use in women, but your specialist may prescribe this if they think it could help. It can be used safely with HRT and has uncommon side effects of acne and hair growth.
Oestrogen for vaginal dryness and discomfort
Menopause and perimenopause can cause your vagina to become dry, painful or itchy.
You can be prescribed oestrogen treatments in multiple forms: tablet, cream or ring to insert into your vagina. These can also improve issues with discomfort while you urinate.
These treatments do not enter the bloodstream and only act in the direct area where you applied them. These can be used for the rest of your life and symptoms will usually come back if you stop using them. You can use vaginal oestrogen with HRT safely.
Non-hormonal treatments are available if your symptoms are having a considerable impact and you cannot, or choose not to, have HRT. These include:
- Blood pressure medicine - Clonidine
- Epilepsy medicine - Gabapentine
- Antidepressants - these can help with mood symptoms if you are diagnosed with depression or anxiety
- Cognitive Behaviourly Therapy (CBT) - This talking therapy can help with low mood and anxiety as well as physical symptoms including hot flushes and joint pain