The menopause is the end of monthly periods. After this, a woman can no longer have children because no more eggs are released. The whole process usually lasts for a few years.
For many women, the timing of their periods becomes unpredictable and the amount of blood loss changes too. Most women (80%) experience hot flushes and/or sweating. Some notice vaginal dryness, which can make intercourse difficult. Others find their moods changeable. Much later on, maybe not until their 70s, up to 30% of women may have problems with osteoporosis (brittle bones) partly because of changes at the menopause.
The average woman is 50-51 years old when she finally stops having periods, but anywhere between 45 and 54 is common. Smokers are more likely to have an early menopause than non-smokers.
Often signs of the menopause (like erratic periods) appear three or four years before periods stop for good. In some cases, the lead up to the last period can take up to 10 years. Some symptoms (like hot flushes) can go on for a year or two after the last period.
Hot flushes and night sweats
What is a hot flush?
The skin becomes hot and red for about 15 seconds or one minute, then gradually calms down again. This flushing can happens on and off throughout the day and night, and may be very mild or very strong. Although it can be annoying, its not harmful.
What about night sweats?
Some women have bouts of sweating, especially at night, with or without flushes. The sweating can be so heavy that it can be quite frightening for those who dont realise what is happening.
Can I do anything to reduce hot flushes?
Try avoiding alcohol, tea or coffee and spicy foods.
Wear several layers of light clothing so you can quickly take them off and on as your temperature changes.
For night sweats, try lying on a large towel so that you dont have to change the sheets every time. Use cotton night clothes and cotton sheets.
Ask your doctor if any drugs you are using cause flushing or sweating, as it may be possible to change your prescription.
If the problem is really getting you down, there are helpful treatments from the doctor you can use, for example hormone replacement therapy.
Will I lose interest in sex?
If you enjoyed sex before the menopause, you should continue to enjoy it afterwards, but sex may become painful because of vaginal dryness.
To counteract this, you can use lubricating jelly, which is available over the counter in most chemist shops. Your doctor can also prescribe an estrogen cream or hormone replacement therapy.
As both men and women get older, interest in sex may decrease but this particularly affects women. Hormone replacement therapy can improve your sex drive by improving feelings of well-being and energy levels, e.g. by improving sleep through control of night sweats, as well as restoring hormone levels which can also improve sensation.There are other reasons for losing interest in sex such other health concerns, medications or relationship worries. If you are worried it is often helpful to talk to your GP or practice nurse.
When can I stop using contraception?
As a general guide, doctors advise women over 50 to wait until they haven’t had a spontaneous period for a year before stopping contraception. For women under 50, they advise waiting two years.
If you are taking hormonal contraception including the use of an intrauterine system you cannot rely on either the occurrence or absence of period like bleeds to help you decide whether you are still fertile or not. Please continue to use contraception and ask your doctor for advice. In some women over 50 a blood test may help determine whether the menopause has occurred.
Many women worry they might be pregnant when there are long gaps between periods which often happens during the menopause. If there is a chance you might be pregnant, ease your mind by getting a pregnancy test.
HRT - Hormone replacement therapy
HRT is designed to give women extra estrogen to keep the level of hormones in the blood fairly constant, topping up the body’s natural supply. It is usually taken in tablet form, though it can be applied as a patch or gel, inserted as an implant under the skin or applied as a cream to be absorbed through the skin of the vagina.
HRT can reduce flushing and sweats, prevent vaginal dryness and reduce the risk of osteoporosis (brittle bones) in later life.
If HRT is taken when the womb (uterus) is still present, then estrogen is taken with a progestogen which prevents estrogenic stimulation and thickening of the womb lining. It is usually taken in tablet form, though it can be applied as a patch or gel or, inserted as an implant under the skin.
In women who are not yet postmenopuasal i.e. have some periods due to continuing ovarian function the HRT products used contain daily estrogen and cyclical progestogen. This will mean you there will monthly bleeds when taking it.
"Period free" HRT can be used by women who are 54 year or older, or more than one year post menopausal at any age. These products contain both daily estrogen and progestogen. This daily combination keeps the womb lining thin. Although some bleeding in the first six months of therapy is common, there should not be bleeding after that.
If HRT is taken after a hysterectomy, usually estrogen alone is required.
Although menopausal symptoms are believed to be due to the changing hormone levels, particularly estrogen, but many factors such as diet and exercise, lifestyle and other medication can influence the symptoms. Therefore, for some people, life-style factors such as reducing/stopping smoking, reducing alcohol intake, reducing caffeine intake, reducing stress, eating healthily and taking regular exercise can considerably help the symptoms of menopause.
Keeping active with regular exercise is one of the key steps you can take to good health. Over a week activity should add up to at least 150 minutes (two and a half hours) of moderate intensity activity in bouts of ten minutes or more – one way to approach this is to do 30 minutes on at least five days a week.
Moderate intensity physical activity is anything that makes you warmer, breathe harder and your heart to beat faster but still be able to carry out a conversation for example brisk walking and cycling.
Comparable benefits can be achieved through 75 minutes of vigorous intensity exercise spread across the week, This will make you breathe much harder and your heart to beat rapidly making it more difficult to carry out a conversation for example running, swimming, playing football.
It is also recommended that adults undertake physical activity that involve using body weight or working against resistance to improve muscle strength. Examples include exercise with weights and carrying or moving heavy loads such as groceries.
Finally it is recommended the amount of time spent sitting should be minimised. For example reduce the time spent watching TV or swapping a bus or car journey with walking part of the way
Try to eat plenty of fibre-rich foods (wholemeal bread, pasta and rice, fruit and vegetables, potatoes and porridge) and less fat, especially the saturated kind. Calcium-rich foods are also important for keeping the bones strong before and after the menopause.
Good sources of calcium include milk, cheese and yoghurt, green leafy vegetables and fish complete with bones, like sardines.
Visit the excellent Menopause Matters website which features a popular and busy free forum. You can also contact the local menopause helpline on 01387 241121 on Thursday between 9am and 12 noon.