The menopause: An expert's guide

The menopause is a natural stage in a woman’s life that signifies the end of all menstrual cycles due to a decrease in hormone levels. Whilst all women will experience the menopause, the menopause will feel different for everyone.

Here, Dr Nicola Davies, renowned menopause doctor at the Medical Prime clinic, provides an expert insight into the menopause.

What is the menopause?

The menopause is the stage in life when a woman stops having menstrual periods. A natural menopause usually occurs between the ages of 45 and 55, with an average age of 51 in the UK, but it can vary depending on individual factors.

The menopause is diagnosed retrospectively after 12 months without a period. If it occurs before the age of 45, it is known as early menopause. If it occurs before the age of 40, it is diagnosed as premature ovarian insufficiency.

What symptoms will I experience with the menopause?

The menopause can cause various symptoms, including:

• Hot flushes: Sudden feelings of heat in the face, neck and chest, often accompanied by sweating and flushing.
• Night sweats: Hot flushes that occur at night and disrupt sleep.
• Vaginal dryness: Reduced moisture and elasticity in the vagina, leading to discomfort, itching and pain during sex.
• Mood changes: Irritability, anxiety, depression, or mood swings.
• Sleep problems: Difficulty falling or staying asleep, or waking up too early.
• Memory and concentration problems: Difficulty remembering things or focusing on tasks.
• Weight gain: Increased fat around the abdomen and hips.
• Reduced libido: Decreased interest or pleasure in sex.
• Urinary problems: Increased frequency or urgency of urination, or urinary tract infections.
• Joint and muscle pain: Stiffness, soreness, or inflammation in the joints and muscles.

What are the most effective and safe treatments for menopause symptoms?

The most effective and safe treatments for menopause symptoms depend on the type and severity of the symptoms, as well as a woman’s personal preferences and medical history. Some of the common treatments for menopause symptoms include:

Hormone replacement therapy (HRT)

HRT can be very effective at relieving hot flushes, brain fog, night sweats, vaginal dryness, urinary symptoms, mood changes, and bone loss. However, HRT also carries certain risks, such as a small increased risk of breast cancer, blood clots, stroke and endometrial cancer. These risks should always be discussed in consultation with a doctor before starting treatment.

Non-hormonal medications

Non-hormonal medications involve taking drugs that can help manage specific menopause symptoms. These drugs include antidepressants and other medications that can help to improve bladder problems and hot flushes.

Alternative therapies

Alternative therapies for menopause symptoms involve using natural or complementary methods for symptom relief, such as herbal remedies, dietary supplements, acupuncture, yoga, or clinical hypnosis. These therapies should always be used with caution under medical guidance.

When and why should I start HRT?

The decision to start HRT depends on several factors, such as a woman’s age, menopause symptoms, medical history, personal preferences, and time since the start of the menopause. Women should discuss the benefits and risks of HRT with their doctor to determine whether HRT is right for them.

Current guidelines recommend the use of HRT for women who:

• Have early menopause (before the age of 45) or premature ovarian insufficiency (when a woman’s ovaries stop functioning before the age of 40)
• Have moderate to severe hot flushes, night sweats, or vaginal dryness that affect their quality of life
• Have a high risk of osteoporosis and fractures

HRT can contain oestrogen alone (for women who have had a hysterectomy) or a combination of oestrogen and progestogen. Oestrogen is the main hormone that relieves many of the menopause symptoms and also protects against heart disease and osteoporosis. Progestogen is added to protect the lining of the uterus (endometrium) from the overgrowth of cells or from cancer in women who still have a uterus. In some cases, testosterone might be added to HRT to provide additional benefits, such as to improve libido, mood, and energy in women who have low levels of this hormone.

HRT can be taken continuously or cyclically, and it is available as a gel, patch, spray or tablets. The choice of route depends on a woman’s symptoms, preferences, and medical and family history.

The risks and benefits of HRT can vary depending on the type, dose, route, duration, and timing of use. For this reason, it’s important to consult with a doctor before starting treatment with HRT to figure out the most appropriate type and dose of HRT. For most women, however, the benefits of HRT will outweigh the potential risks.

Can lifestyle changes also help?

Lifestyle changes can certainly help with the management of the menopause, helping to reduce symptoms and to improve wellbeing.

Making healthy choices can involve:

• Eating a balanced diet rich in calcium and vitamin D
• Exercising regularly
• Quitting smoking
• Limiting alcohol and caffeine intake
• Managing stress levels
• Practising good sleep hygiene
• Seeking social support

If you require expert care for the management of your menopause symptoms, don’t hesitate to book an appointment with Dr Nicola Davies via her Top Doctors profile today.