Menopause Care

Learn about the perimenopause, menopause, monitoring your symptoms including using the Balance app and website to learn more, alternatives to hormone replacement therapy (HRT) as well as the risks and benefits of HRT. This is useful information to help you make an informed decision about what is best for you in conjunction with your doctor, nurse or other health clinician.

Menopause

Menopause is when your periods stop due to lower hormone levels. This usually happens between the ages of 45 and 55.

It can sometimes happen earlier naturally. Or for reasons such as surgery to remove the ovaries (oophorectomy) or the uterus (hysterectomy), cancer treatments like chemotherapy, or a genetic reason. Sometimes the reason is unknown.

Perimenopause is when you have symptoms before your periods have stopped. You reach menopause when you have not had a period for 12 months.

As healthcare professionals, we often use the term menopause as a “catch-all” whether you’re going through perimenopause or menopause.

Perimenopause

Perimenopause is the period before the menopause.

Perimenopause starts when the amount of oestrogen made by the ovaries begins to decline. It usually begins in your 40s, although it can start earlier.

Symptoms

Menopause and perimenopause symptoms can have a big impact on your life, including relationships and work.

It is thought that there are at least 35 symptoms of the menopause including:

1. Hot flushes and night sweats

2. Fatigue

3. Dizziness

4. Loss of libido

5. Mood swings

6. Irritability

7. Hair loss

8. Weight gain

9. Palpitations

10. Bloating

11. Headaches

12. Tinnitus

13. Bladder weakness

14. Memory lapses

15. Irregular periods

16. Itchy skin

17. Nausea

18. Joint pain

19. Anxiety

20. Brittle nails

21. Digestive problems

22. Incontinence

23. Low mood

24. Cystitis

25. Vaginal dryness

26. Difficulty concentrating

27. Osteoporosis

28. Emotional changes

29. Depression

30. Insomnia

31. Aching muscles

32. Tender breasts

33. Heavy periods

34. Skin changes

35. Panic attacks

It can be really helpful to keep a symptom tracker so you can talk to your GP or nurse about the symptoms you’re experiencing. Here are two good ones we recommend to our patients:

Things you should know

As life expectancy has increased, you can expect to be post-menopausal for at least one third of your life. This is why it’s important to think of the menopause as a long-term female hormone deficiency.

Like any other deficiency, this is associated with several health risks.

• Osteoporosis: This is a condition that weakens the bones and makes them likely to break much more easily. Bone is a living tissue which regenerates throughout our lives, and oestrogen helps to keep your bones strong and healthy. The risk of osteoporosis increases during menopause, when bones begin to break down more quickly than they can be rebuilt. Women can lose up to 10% of their bone strength in the five years after menopause, as a direct result of the drop in oestrogen.
• Cardiovascular disease: Oestrogen helps to keep your blood vessels healthy, and can also help to control cholesterol levels. This is why low oestrogen can affect the heart and blood vessels, increasing the risk of coronary heart disease, stroke and vascular dementia.
• Diabetes: Oestrogen is important at maintaining blood sugar levels and low levels of oestrogen can lead to metabolic changes occurring in the body. This can lead to an increased risk of developing type 2 diabetes
• Dementia and clinical depression: Oestrogen and testosterone are really important to maintain the function of your brain. The cells in the brain need these hormones to process information and work properly. After the menopause, women are more likely to develop dementia and also clinical depression when the levels of these protective hormones reduce.
• Other diseases: Research has shown that women who have an early menopause also have an increased risk of lung diseases including asthma, kidney diseases, bowel cancer and irritable bowel syndrome, osteoarthritis and also some auto-immune conditions. These risks increase if you have an early menopause, but it’s important to know that these risks can be reduced if you take hormone treatment such as HRT.

There are things you can do to help with symptoms. There are also medicines that can replace the missing hormones and help relieve your symptoms.

Things you can do

Lifestyle changes can really help reduce perimenopause and menopause symptoms:

• A healthy balanced diet is good for general health.
• Spicy foods, alcohol, caffeine (tea and coffee as well as chocolate and cola drinks) can make hot flushes worse so avoiding these may help.
• Up your intake of vitamins B, C, D and E.
• Drink lots of water, this could be infused with fruit, or sugar free squash, anything which helps you to remain hydrated.
• Take up regular exercise that you enjoy. It needn’t be a chore to move your body, take a walk with a friend, join a class, try relaxing activities like yoga or Pilates. Regular exercise may improve hot flushes and night sweats and improve sleep as well as helping you maintain or lose weight. Weight bearing exercise such as walking, running and dancing can improve bone strength.
• Take up meditation, breathing exercises or mindfulness.
• Get a good night’s sleep of seven to eight hours a night if you can and if night sweats or insomnia keep you awake, speak to your doctor.

Treatment

The main medicine treatment for perimenopause and menopause symptoms is hormone replacement therapy (HRT), which replaces the hormones that are at low levels. There are other treatments if you cannot, or choose not to, have HRT.