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Menopause (also see information for Hormone Replacement Therapy)

Menopause is an important time in a woman's life. Her body is going through changes that can affect her social life, her feelings about herself, and her functioning at work. In the past, menopause was often surrounded by misconceptions and myths. Now, it is recognized that menopause is a natural step in the process of aging. Contrary to the old-fashioned view that life is all downhill after menopause, many women today find that the years after menopause offer new discoveries and fresh challenges.

Today, medical advances have resulted in a wide range of health care choices that can enhance quality of life during menopause and the decades afterward. It is vital for women to know that menopause itself carries no serious health risks. However, the chance for heart disease and osteoporosis (thinning of the bone) rises after menopause. Understanding menopause and the range of treatment options can help women make the best health decisions.

Remember, menopause is a perfectly natural occurrence.

The Facts About Menopause

Menopause is the medical term for the end of a woman's menstrual periods. It is a natural part of aging, and occurs when the ovaries stop making hormones called estrogens. This causes estrogen levels to drop, and leads to the end of monthly menstual periods. This usually happens between the ages of 45 and 60, but it can happen earlier. Menopause can also occur when the ovaries are surgically removed or stop functioning for any other reason.

Low estrogen levels are linked to some uncomfortable symptoms in many women. The most common and easy to recognize symptom is hot flashes ÷ sudden intense waves of heat and sweating. Some women find that these hot flashes disrupt their sleep, and others report mood changes. Other symptoms may include irregular periods, vaginal or urinary tract infections, urinary incontinence (leakage of urine or inability to control urine flow), and inflammation of the vagina. Because of the changes in the urinary tract and vagina, some women may have discomfort or pain during sexual intercourse. Many women also notice changes in their skin, digestive tract, and hair during menopause.

In the long term, some women experience problems linked to the low levels of estrogen found after menopause. These may include osteoporosis and increased risk for heart disease.

Understanding Estrogen & Progesterone top

Estrogen is known as a 'female hormone' because it plays a key role in shaping the female body and preparing it for uniquely female functions such as pregnancy. For example, estrogen is vital for the development of breasts and hips. In addition, the vagina, uterus, and other female organs depend on the presence of estrogen in the body to mature.

Together with progesterone, another female hormone made by the ovaries, estrogen regulates the changes that occur with each monthly period and prepares the uterus for pregnancy. Prior to menopause, more than 90% of the estrogen in a woman's body is made by the ovaries. Other organs (including the adrenal glands, liver, and kidneys) also make small amounts of estrogen. That's why women continue to have low levels of estrogen after menopause. Because fat cells can also make small amounts of estrogen, women who are overweight when they are going through menopause may have fewer problems with hot flashes and osteoporosis (both of which are related to lack of estrogen).

Some of the other important benefits of estrogen become apparent when estrogen levels decline after menopause. For instance, estrogen stimulates skeletal growth and helps maintain healthy bones. It also helps protect the heart and veins by increasing 'good cholesterol' (HDL or high-density lipoprotein) and lowering 'bad cholesterol' (LDL or low-density lipoprotein). Estrogen may also affect a woman’s sexual desire.

Progesterone is the second most important female hormone. Like estrogen, most progesterone is made by the ovaries, with a smaller amount made by the adrenal glands. The job of progesterone is to:

  • Stimulate the growth of a cushiony lining in the uterus where the fertilized egg can grow and develop into a baby
  • Help the breast make milk 
  • Generally maintain pregnancy

Symptoms

About 75% of women report some troublesome symptoms during menopause, but the severity and frequency of symptoms varies from woman to woman. The most common symptoms are hot flashes and vaginal atrophy (this is, the tissue of the vagina becomes thinner, drier, and more delicate, and begins to shrink).

Irregular bleeding

The period of time leading up to menopause is often characterized by irregular periods. In fact, changes such as shorter or longer periods, heavier or lighter menstrual bleeding, and varying lengths of time between periods may be a sign that menopause is near.

You should talk to a physician if:

  • Bleeding occurs more often than 21 days
  • Your period lasts longer than 8 days or is very heavy 
  • Your period occurs after 6 months or more without a period

Hot flashes
Factors that may be linked to hot flashes

  • Hot, humid weather
  • Confining spaces
  • Drinks or food with caffeine or alcohol
  • Spicy foods

Hot flashes are the classic sign of menopause, as well as the most common reason for seeking treatment. A hot flash produces a sudden sensation of warmth or even intense heat that spreads over various parts of the body, especially the chest, face, and head. Flushing and sweating usually occur as well, followed by a chill. Some women feel their heart beating very fast or hard and feel anxious.

These flashes last anywhere from a few seconds to several minutes. How often they occur varies from woman to woman. Women who have had a hysterectomy are more likely to have hot flashes. Many women experience most of their hot flashes in the first 2 years after menopause, and find that the hot flashes gradually lessen. However, some women have hot flashes for several years before menopause, and some have them for 10, 20, or even 40 years or longer after menopause.

Hot flashes can affect a woman's social life and work. Also, hot flashes that occur during the night can disrupt sleep. In fact, some women report that their bedsheets become dampened or even soaked with sweat when they have a hot flash during the night.

Vaginal thinning/Vaginal dryness

Estrogen plays a key role in maintaining the function of a woman’s vagina and surrounding tissues, uterus, urinary bladder, and urethra (the organ through which urine is passed from the bladder). After menopause, all of these organs may weaken or shrink. When these changes occur in the bladder and urethra, they can lead to the involuntary leakage of urine, infection, or painful urination.

A thinning of the tissue lining the vagina may lead to pain during intercourse. Vaginal dryness can also occur, as may itching or irritation. Although few women experience serious problems with vaginal dryness and thinning right after menopause, both dryness and thinning continue to occur over time. Some doctors estimate that at least half of all women older than 60 years have some degree of vaginal dryness. Regular sexual intercourse can help to keep the vagina moist and toned.

If you experience vaginal dryness, your GP can prescribe a vaginal lubricant or moisturiser. Vaginal lube & moisturiser can also be purchased over the counter. There are various different types such as water-based silicone-based and oil-based. Some women can sensitive to certain lubes so you may have to experiment with different ones. These can be used for as long as you like.

Links between mood, menopause, and sexual function

The brain also responds to estrogen. In fact, estrogen is now thought to be important in memory and the healthy functioning of nerve cells in the brain. Some studies have shown that estrogen replacement therapy can preserve brain activity and even improve memory.

Depression may also be more likely in the years right before menopause. However, it is unclear whether depression is linked to low levels of estrogen or to the many changes women face during their 40s and 50s (such as career or marriage pressures, or care of children or aging parents).

Diagnosis

Menopause is usually diagnosed after the doctor reviews a woman's medical history and performs a physical examination. The doctor may also order blood tests to make sure the symptoms are related to menopause and to decide what therapy, if any, might be most appropriate.

Health Changes After Menopause

Osteoporosis

Factors that increase the risk for osteoporosis

  • Caucasian or Asian race
  • Slim build
  • Cigarette smoking
  • Family history (a mother, sister, or aunt with osteoporosis)
  • Early menopause

Osteoporosis is the medical term for thinning of the bones. Thin bones become weaker and break easily, with the bones of the spine, wrists, and hips most prone to fracture. Although bones naturally weaken with age in both men and women starting at about age 40, women lose bone more rapidly after menopause.

Using estrogen after menopause can slow the rate of bone thinning and may prevent bones from breaking. Because estrogen use has some risks, only women who are likely to develop osteoporosis should use estrogens for prevention. If you have some of the factors that are listed below, or are concerned about your risk for osteoporosis, talk to your doctor. He or she can help you to evaluate your risk and decide whether estrogen therapy is right for you.

Making sure to get enough calcium in your diet can help strengthen your bones. Calcium is naturally found in many foods, including dairy products, and may also be added to a food (for instance, some orange juices now have calcium added). Calcium tablets are another good way to add to calcium to your diet. The goal should be to reach a total daily intake of 1000 milligrams per day before menopause or 1500 milligrams per day after menopause. Regular weight-bearing exercise, like walking, may also help prevent osteoporosis.

Heart disease

The rate of heart disease rises considerably in women after menopause. Because many people think of heart disease as a "man’s problem," it may be surprising to know that heart disease is the leading cause of death among women.

Risk factors for heart disease in women (as well as men) include:

  • Being overweight (obesity)
  • High blood pressure 
  • Diabetes 
  • Cigarette smoking 
  • High levels of "bad" cholesterol 
  • A low level of activity (sedentary lifestyle)

The use of estrogen replacement therapy has been shown to dramatically reduce the risk for heart disease. Estrogen can lower high levels of "bad" cholesterol and helps maintain healthy veins. It may also help lower blood pressure and play a role in keeping blood sugar close to normal levels. Some experts believe that estrogen replacement therapy may be the single most important factor in preventing heart disease in women.

Frequently Asked Questions

Will these symptoms last for the rest of my life?

For most women, the symptoms of menopause last for a relatively short time. However, a woman's level of estrogen naturally remains low after menopause. This can affect many parts of the body, including the sexual and urinary organs, the heart, and the bones. So in that sense, the changes of menopause will be lifelong. But eating right, exercising, and making other positive lifestyle changes can help a woman feel great and live a long, healthy life after menopause.

Is a change in sexual desire normal after menopause?

Many women say that their sexual desire lessens during the time of menopause. In many cases, the cause is physical. For instance, because lower estrogen levels sometimes cause physical changes in a woman's sexual organs, having sex may become uncomfortable or painful so it is important to find out whether there is a physical cause for lack of desire. For some women, taking hormones called androgens can help restore sexual desire.

Some women find that sexual desire changes because of how they feel about themselves during menopause. Counseling and support groups can help women learn strategies for coping with the physical and emotional changes that occur during menopause.

What can be done to relieve pain during sex?

Intercourse may be painful when there is not enough moisture in the vagina or when the tissue lining the vagina becomes fragile because of lower estrogen levels in the body. Several methods are available to relieve pain during intercourse. It may sound surprising, but frequent sexual activity is one of the most effective remedies for vaginal dryness. Other remedies include taking a warm bath before intercourse or using lubricants. Short-acting, water-based lubricants, such as K-Y Jelly, supply moisture and are used immediately before intercourse. These products are readily available in grocery stores and pharmacies, usually at a low cost.

Long-acting vaginal moisturizers are also available, and can provide extended relief. Vaginal creams containing estrogen are very helpful in relieving the symptoms of menopause, including vaginal dryness.

Since I began menopause, I've had an embarrassing problem - urine leaks when I laugh or cough. What can be done to prevent this?

Some women have problems with bladder control after menopause begins. This happens because the muscles that surround the bladder and hold the urine inside become weaker when estrogen levels are low. Fortunately, simple exercises - known as Kegel exercises - can strengthen these muscles. To perform a Kegel, contract the pelvic muscles as if trying to tighten or close the vaginal opening. Hold the contraction for a count of three and then relax. Wait a couple of seconds and repeat. Fast Kegels (squeezing and relaxing muscles as quickly as possible) can also help. Performing several Kegels a day (try for a total of 50 per day) can markedly improve bladder control - and may even enhance sexual pleasure! Taking estrogen can also help maintain the tone or strength of pelvic muscles.

My doctor has recommended hormone replacement therapy, but I've heard that I'll have menstrual periods again if I take it. Is that true?

Estrogen therapy may cause vaginal bleeding in some women. This depends on the hormone that is selected and the dose taken each day, as well as each woman's own unique response to therapy. Often, estrogen is taken in a cyclic regimen - that is, estrogen is taken for 21 to 25 days of the month followed by several days without estrogen. After menopause, low estrogen levels result in a thinning of the uterine lining, which, in turn, stops the monthly period. Taking estrogen after menopause thickens the uterine lining. This lining is shed on the days when estrogen is not being taken, resulting in vaginal bleeding similar to a period. About two-thirds of women who still have a uterus will have a period on the days when they are not taking estrogen. Similarly, most women who take continuous estrogen (that is, estrogen every day) plus progestin pills on some days of the month will have a period.

If I have a period on estrogen therapy, will I also have PMS again?

Some women do experience PMS-like symptoms, including swollen or tender breasts, bloating, nausea, and sometimes even a blue mood. Some of these symptoms are linked to mild water retention, and may be relieved by a mild diuretic. Other things that can help include:

  • Reducing salt intake
  • Increasing exercise and activity 
  • Avoiding caffeine and chocolate 
  • Taking vitamin B6 or B complex

Even though my eating habits have not changed, I've gained weight recently. Is that linked to menopause?

It may be. The body's metabolism changes during and after menopause. Everyone's metabolism begins to slow during the early to mid-30s. This change occurs slowly, so it may take a while for the impact of eating habits to affect weight. It is important to make a sensible, nutritious diet and healthy behaviors, such as getting enough exercise, a goal for life.

I seem to be very forgetful lately and I'm worried. What's happening?

Many menopausal women have problems with short-term memory - like forgetting the location of car keys or eyeglasses, skipping appointments they didn't remember, or losing the end of a thought when speaking or writing. These may be due to a busy lifestyle and/or stress at home or work. Notably, several medical studies have shown distinct differences in memory in women who have active ovaries producing estrogen or are taking estrogen replacement therapy compared to women with low levels of estrogen due to menopause.

How will menopause affect my daily activities and lifestyle?

That all depends on you. Menopause is a natural part of life, not a disease or a health crisis. However, menopause may occur when many other changes are happening in your. For instance, your children may be marrying or leaving home, your parents may be ill or dying, or you may be wondering what you'll do when you retire from work. That's why it is probably more helpful to think of how your daily activities and lifestyle will affect menopause. For instance, making sure that you exercise and eat right can make a real difference in how you feel and can even help prevent some of the long-term effects that are linked to estrogen deficiency (like heart disease or osteoporosis).

Physical changes do occur with menopause and with aging. But the changes that happen during this period can be minimized by healthy living and a sense of purpose in life.

If you would like more information on the Menopause, please contact the Brunswick offices.