The menopause (the word literally means “last period”) happens when your ovaries stop functioning – no more eggs mature each month and no more oestrogen and progesterone hormones are produced.
Your body senses the changing levels of oestrogen giving you the symptoms – this group of symptoms is called the climacteric. Perhaps only 10% of women have no climacteric symptoms. The perimenopause, which may last for several years, is the phase of life leading up to the menopause. During the perimenopause, ovary function reduces gradually and often fluctuates, giving rise to erratic symptoms.
The mean age for the menopause is 51. In 1% of women it occurs before the age of 40 and it is unusual to happen after 57.
There is no magic to relieve symptoms, but reducing the triggers can make life a little more tolerable. Reduced caffeine intake and avoiding alcohol combined with increased regular gentle exercise should help.
Red clover contains isoflavins, which are precursors of oestrogen, and can relieve some symptoms for some women. Black cohosh is also effective, but do not take more than the suggested dose, as it is liver toxic in high levels. Other measures including acupuncture and homeopathy will help some women.
Hormone replacement is a treatment which replaces the oestrogen which your ovaries were producing before the menopause. All forms of HRT contain oestrogen. Progesterone is also given if you have not had a hysterectomy, in order to keep the lining of the uterus thin, and prevent the development of endometrial cancer. There is an option of adding male hormone testosterone which can improve “Joi de vivre”. HRT may not be advised if there is s a strong family history of breast cancer.
I will discuss the benefits including relief of climacteric symptoms, prevention of osteoporosis and possible reduction in the heart conditions, together with the possible risks, including your individual risk of breast cancer and thrombosis. Almost always start with natural body identical preparations, which can be given with or without a cycle.
Vaginal oestrogen, in low dose, is used to relieve vaginal dryness. Because the treatment is locally in the vagina, there is no increased risk of breast cancer and no need for you to take progesterone.
For women who are not able to take oestrogen due to side effects or because they have a history of a hormone dependant cancer, then treatment with gabapentin or venlafaxine can improve symptoms.
Vaginal laser treatment of the genitourinary symptoms of the menopause is a new treatment which is not yet fully scrutinised in studies.
Bleeding irregularly can happen in the first three months after starting or changing HRT. Any change in the bleeding pattern after that should be investigated.
Prescribed HRT and Bioidentical HRT are both body identical hormones – ie the same as the oestrogen and the progesterone your ovary was producing before the menopause. Bioidentical hormones are not regulated by the Medicines and Healthcare products Regulatory Agency – MHRA.
There is no national guideline – it has to be an individual assessment. Many women continue past the age of 70 if they feel the benefit and have regular screening including a mammogram.