Menopause

The peri-menopause is the period beginning with the first symptom, eg. a hot flush, change in the menstrual cycle, and it ends 12 months after the last menstrual period.

The average age of menopause onset is 51 and women are now living up to a 1/3^rd of their lives in the post-menopausal period. The long term consequences usually begin approximately 10 years after the the onset of the menopause and are a major sourse of morbidity and mortality. There is a a major opportunity at the onset of the Menopause to identify an individual’s baseline risks and initiate a management plan – to both treat any symptoms and prevent long-term consequences.

A menopause before the age of 45 is called an early menopause. A menopause before the age of 40 is considered premature, whether occurring naturally or due to medical intervention, and treatment is usually considered essential to prevent more serious long-term consequences.

Symptoms of the Menopause

Menopausal symptoms are well known and they usually develop in the peri-menopausal period. They can last for up to 3 – 5 years but the severity and duration of symptoms varies from one individual to another. Some women experience very few menopausal symptoms such as a hot flush or a night sweat with little affect on their everyday activities. Other women suffer from a number of symptoms which have a huge effect on their quality of life. There are so many symptoms of the Menopause, not every woman will experience all these changes and some are very unique to individuals.

Short Term Symptoms / Consequences

Hot Flushes: this is a sudden feeling of being very warm, as if your body temperature increases rapidly. Some describe it as the sensation of a wave of heat travelling up from your chest to your neck and face. Women can sometimes sweat profusely during these episodes, eg “sweat dripping down my face” and some women will also experience anxiety associated with these hot flushes.

Night Sweats: the severity varies dramatically between individuals, with some women waking up to 4-5 times a night, feeling like they are overheating, nightwear or blankets may be damp and, once it passes, one can feel very cold very quickly. The more severe sweats or frequency of the sweating can cause significant sleep disturbance.

Sleep Disturbance: This is a very common symptom. Women often describe being so tired due to disturbed sleep. Many report being able to get to sleep ok but usually wake after 3 or 4 hours and it is then difficult to get back to sleep. Being woken by frequent or severe night sweats can add to the problem leading to chronic fatique.

Changes in Menstrual Cycle: Women often describe a change in the length of their cycle, often shorter or missing a period. Also periods can get heavier. It can have a huge affect on women who also have a history of PMS . Some women in the peri-menopausal period will have no change in their cycle but may have other menopausal symptoms. It is not normal to have bleeding between periods.

Change in Mood: Women often describe feeling “low”. Some describe feeling overwhelmed easily and often very emotional over things that would not have bothered them before. Others describe feeling very irritable and can develop a rage “going from 0 to 90 in seconds”. The feeling of lack of control can be very scary. This can also be a difficult time for family members .

Vaginal Dryness: This is a common symptom. It can cause discomfort during sexual intercourse.

Poor Concentration: Also called “brain fog”, women often describe difficulty concentrating or difficulty reading a book, the newspaper, following a TV programme. It can also affect work performance leading to a negative impact on confidence levels.

Tingling/Numbess: Often in the hands and feet but can be throughout the body.

Fatigue: A very common symptom due to changes in hormone levels but often exacerbated by a combination of sleep disturbance, emotional changes and the presence of other menopausal symptoms.

Worsening PMS: Many women suffer from PMS during their reproductive life. Symptoms can vary from mild to severe and last from 2 -13 days before the start of their period. These symptoms are often worst around the time of the menopause and can have a hugh affect on a woman’s quality of life.

Headaches: Some women experience headaches or migraine at the time of their periods and these can get worse during the menopause. The headaches can often be more severe in the years and months before the menopause due to fluctuating hormone levels, not just related to low Oestrogen levels.

Loss of Libido: This is a very common and upsetting symptom which has an affect on relationships. The presence of other menopausal symptoms including flushes and sweats, chronic fatique and vaginal dryness can exacerbate this even further.

Palpitations / Heart Flutterings: Patients can often complain of the sensation that their heart is racing. This can be unsettling for some.

Increased Anxiety Levels: Excessive worrying over things / actions that would not have bothered them before. Feeling “overwhelmed” easily.

Weight Gain: It is more central weight gain in the “male distribution”. Weight gain is approximately .5 kg per year or 10 kg between the ages of 40-60. Several other factors are also thought to be involved including sleep deprivation, chronic fatigue, reduced physical activity and increased calorie intake.

Arthralgia: It is joint pain and is a common presenting complaint. It is often associated with a history of troublesome hot flushes and depressed mood.

There are many effective treatment options available to help deal with Menopause symptoms and women should not have to suffer. Treatment options depend on an individual’s symptoms, medical history, lifestyle, family history and, most importantly, the patient’s choice.

Medium Term Symptoms / Consequences

Urinary and bladder symptoms – collectively known as the Genito-urinary Syndrome of the menopause.

These changes usually happen 4 to 5 years after the Menopause and symptoms often include:

• vaginal dryness,
• vulval itch, burning or discomfort,
• discomfort during intercourse,
• passing urine frequently with sense of urgency and
• recurrent urinary tract infections.

Up to 50% of women have symptoms and they can have a hugh affect on some women’s quality of life including relationships. These symptoms can usually be treated easily .

Long Term Symptoms / Consequences

These usually occur approx. 10 years after the menopause. The severity depends on the individual’s underlying risk factors and the age at which their menopause began.

1) Osteoporosis

There is a natural gradual loss of bone density with age but there is an increased rate of loss during the menopausal years. This loss results in reduced bone strength leading to Osteoporosis and potential fractures. Osteoporosis does not usually cause symptoms until a fracture occurs. 1 in 2 women will get an Osteoporotic fracture in comparison to 1 in 4 men. 90% of hip fractures are due to Osteoporosis and they are a major cause of morbidity and mortality.

2) Cardiovascular disease (heart disease)

This is the leading cause of death in post-menopausal women in the developed world. There is a very low incidence in cardiovascular disease in the pre-menopausal woman versus the post-menopausal and this is thought to be due to the protective action of Oestrogen on the cardiovascular system. Women with a premature menopause have increased risk of cardiovascular disease and the risk increases the earlier the age of menopause onset.

3) Cognitive Decline

Cognitive decline occurs naturally with age. However, the earlier the age of menopause onset, the higher the risk of early cognitive impairment including dementia and Parkinson’s Disease.