All women who live long enough will experience the menopause. For such an inevitable life event, it is surprising how little many women know about it and how, until very recently, it has been such a taboo subject for discussion.
Menopause is defined as the date of your final menstrual period. Transition from the reproductive phase of your life to menopause can start years before. The average age of menopause in the UK is 51. Many women experience symptoms during their forties. For some, it can be even earlier. Menopause before the age of 40 is defined as premature ovarian insufficiency. Between the ages of 40 and 45 it is an early menopause.
Changes in periods may be one of the first symptoms. Subtle changes in flow and duration may precede larger fluctuations along with variability in the length of consecutive cycles. Longer intervals between periods may eventually culminate in the menopause.
Over the same time women may start to notice flushes and sweats. They may occur for no apparent reason whatsoever but can be exacerbated by alcohol, hot drinks, stress and changes in temperature.
Sleep disturbance may be partially due to night sweats, but can occur independent of them. Joint aches and pains, often of small joints such as in the hand, are a feature which often goes unrecognised.
Psychological symptoms such as mood swings, irritability, anxiety, difficulty coping, forgetfulness and difficulty concentrating may be related to hormonal changes, either directly or indirectly, for example due to sleep disturbance. Other factors at the same time in a woman’s life may also be important. Unhappy children, elderly dependent relatives, work or financial pressures and the emotional challenge of growing older in a society which values youthfulness may be contributory.
Genitourinary symptoms are often the most embarrassing to talk about. Vaginal symptoms include vaginal dryness, soreness, burning, discomfort during and after sex and prolapse. Urinary symptoms include urgency, frequency, pain during urination, incontinence and recurrent urinary infections. The symptoms are directly attributable to oestrogen deficiency in the lower urinary and genital tracts. Unlike other menopausal symptoms they do not improve with the passage of time and are likely to worsen. Relationships may be impacted as women may avoid intimacy and intercourse. Symptoms affect 50% of postmenopausal women including 25% of women who are on systemic HRT (oral, patches and gels). One survey demonstrated that a staggering 40% of women aged 50-65 will have recently experienced some symptoms. Another study revealed that less than 20% of women had sought help for their urinary or vaginal symptoms from a healthcare professional. This may be for many reasons, such as acceptance of symptoms as a consequence of ageing, embarrassment and lack of knowledge about treatment options. Treatment is usually easy and effective and can transform a woman’s quality of life.
Other changes can include ones to the skin, which can become drier, thinner, less elastic and more prone to bruising. Hair can also become thinner and drier while unwanted hairs can also appear.
In addition to the genitourinary symptoms, long term oestrogen deprivation also affects the cardiovascular system and bone health.
As oestrogen levels decline, the protective effect on the heart is lost and the risk of heart disease is increased. This is important as heart disease is the leading cause of death for postmenopausal women, who are nine times more likely to die of heart disease than of breast cancer. There have been many studies on HRT and the heart. Current thinking is that there is no increased risk if HRT is initiated between the ages of 50 and 60 or within 10 years of the menopause. Oral HRT (but not patches or gel) may result in a small increased risk of stroke.
Oestrogen also protects against bone thinning which causes osteoporosis. The risk of fracture with this condition increases significantly beyond the age of 70. It is an important, preventable condition. Hip fractures carry a 20% mortality rate, with 25% of survivors needing long term care and 50% suffering long term loss of motility. Other common osteoporotic fractures are vertebral (spine), wrist, humerus, pelvis and ribs.
You may be at increased risk of osteoporosis if you have a history of early menopause, smoking, being underweight or anorexic, long or repeated courses of steroids, other types of medication including anastrozole for breast cancer, gastrointestinal diseases causing malabsorption, excessive alcohol, lack of physical activity or a family history, particularly of hip fracture . It is an important condition to consider, diagnose and treat. HRT can be used to prevent and treat osteoporosis. There are other non hormonal treatments which may be more appropriate in older women or those with contraindications to HRT, such as breast cancer.
It is particularly important to consider the consequences of an early menopause or premature ovarian insufficiency on long term health. These women should see a healthcare practitioner with sufficient skills to advise them appropriately, especially if they have complex medical conditions which will need due consideration. These particularly include women with breast cancer and those who have had a surgical menopause for conditions such as endometriosis.
Most women who wish to avoid an unplanned pregnancy in their forties or fifties will need to use contraception. If your menopause occurs before the age of 50, you should uses contraception for 2 years after your last period. Beyond fifty, you should use contraception for a year after your last period. Women using forms of contraception which render them period-free need to seek extra advice and may benefit from blood tests to diagnose the menopause.
Menopause in the workplace
Menopause in the workplace is a real occupational health issue. Over half of the workforce is now women and a significant number of these will be of an age where they may be experiencing menopausal symptoms which may significantly impact their performance at work. Work places and working practices are not designed with menopausal women in mind and women find it difficult and embarrassing to talk to their managers about their symptoms and adaptations which may help.
Guidance for employers and managers exists. There is increased awareness and support for this significant group of employees which will aid productivity and limit the loss of valued expertise from the workforce.
Seek advice from a professional with experience in menopause management to see how your workplace symptoms might be improved with HRT or other approaches.
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