There is increasing interest in menopause within the workplace and how it affects women’s careers and mental health.
I see women in their 40s and 50s all the time who have been suffering for years and not known how to get help from their GP or what to ask for, or not realised that their symptoms could be due to hormone changes.
Here are some facts which readers might find useful.
What is the menopause?
The menopause is when women’s periods stop. From puberty onwards women’s bodies start releasing an egg every month to prepare for possible pregnancy.
If the egg is not fertilised a period occurs. Eventually the ovaries stop producing eggs and, after a year of no periods, a woman reaches the menopause.
The peri-menopause is the time leading up to the menopause in which hormone levels start to change.
This can last for several years during which the levels of the female hormones oestrogen and progesterone go up and down, then gradually drop as the periods stop.
This can cause distressing symptoms affecting the brain, skin, joints and genitals.
For many women the peri-menopause and menopause is a really difficult time.
We know from studies that 50 per cent of women feel it changes their life for the worse.
Women in their 40s and 50s are often balancing multiple demands such as work, teenage children and elderly parents.
Feeling exhausted, anxious and unwell can make all of this seem impossible, and many struggle with work, sleep and relationships.
It is really common for women not to realise that these changes are caused by hormones, and to put them down to normal ageing or stress.
What are the symptoms?
The classic symptom of menopause is hot flushes and we know that 80 per cent of women will get these at some point.
The most distressing symptoms which I see, however, are those that affect the brain. Many women find themselves suffering from debilitating anxiety, even if they have never been anxious or low before.
Sleep is often disturbed and unsettled, either by hot flushes, anxiety or stress. Women often describe a ‘brain fog’; feeling increasingly forgetful or struggling with things which used to be simple before.
Overwhelming fatigue is also common, and this is made worse by lack of sleep.
There are a variety of common and annoying symptoms that are also affected by hormones.
Women often notice that they cannot exercise or train like they used to, or that their joints are achy or stiff.
Skin and hair changes and itchy skin often improves with hormone treatment, as can palpitations. Another distressing symptom is pain or dryness in the vulva and vagina, which can make sex uncomfortable and painful.
Treatment without hormones
Keeping yourself healthy during peri-menopause and menopause can help the symptoms. We know that being overweight makes hot flushes and joint pains worse. Research shows that a diet rich in whole grains, vegetables and unprocessed food helps sleep, anxiety and hot flushes.
It is really tempting to drink alcohol to help with anxiety and poor sleep but we know that this makes both those symptoms worse. Exercise helps mental and physical health and reduces your risk of many cancers.
There are a number of herbal supplements which people try during the peri-menopause but there is little evidence that any of them help. CBT is a psychological intervention which can work for hot flushes and poor sleep. There are some prescribable drugs like venlafaxine and gabapentin which can be used for hot flushes in women who cannot have, or do not want, HRT.
Hormone Replacement Therapy
Hormone Replacement Therapy (HRT) works by giving back oestrogen, which is one of the hormones which drops during the menopause. It is oestrogen treatment which makes the distressing symptoms disappear.
If oestrogen is given on its own it will make the womb lining grow abnormally. We also, therefore, need to give an artificial form of progesterone (a ‘progestogen’) to protect the womb lining.
There are lots of ways in which HRT can be given including patch, tablets and gel.
I prescribe the ‘body-identical’ HRT which is an oestrogen gel and an oral progesterone tablet.
Both are made from yams and are identical in structure to the ‘normal’ hormones produced by the body.
Another popular form of progestogen is the Mirena coil which protects the womb lining, controls heavy periods and provides contraception.
Pain or dryness of the vulva can be treated with an oestrogen cream or pessary.
Some women find that they still have low libido or energy levels even if their hot flushes are back to normal.
In this case treatment with testosterone can sometimes help. Testosterone is not licensed for women so is not usually prescribed by NHS GPs.
It is, however, commonly used by specialist menopause clinics.
HRT has an almost immediate effect. Women go back to feeling like themselves again, often in a matter of days.
Every woman is different, and what might suit one woman will not necessarily suit another.
It can sometimes take a bit of time to get the dose and preparation right but do not give up. A combination that is right for you can usually be found.
HRT has many other advantages too. We know that the oestrogen helps strengthen bones and protects against osteoporosis.
It also helps prevent the changes in blood vessels that occur after the menopause and that can lead to heart attacks and strokes.
What about the risk of breast cancer?
There have been several scares about HRT over the last two decades, which have resulted in a lot of women abandoning their treatment and suffering unnecessarily. We do know that there is a very small increased risk of getting breast cancer resulting from taking HRT which contains any type of progestogen.
We know that this increased risk is low, and that there is no increased risk of dying from the breast cancer.
To put it into context; the increased risk of breast cancer from taking HRT over 5 years is about the same as the increased risk of having a glass of wine a night, and is much less than the increased risk of being overweight.
I always tell patients that if HRT makes you feel well enough to exercise more, eat more healthily and drink less alcohol, then the risks are balanced out.
Where can I get help?
GPs are beginning to know more and more about menopause and HRT as more training is available.
Dr Olivia Hum is an NHS GP in Lewes, and has just started a menopause serivce called Women’s Health Sussex, based in Haywards Heath at the Nuffield Hospital.
To find out more, visit her website www.womenshealthsussex.com
She is also speaking at a free public online event at the Nuffield Health Hospital on January 20; see their website for details.