For women, the menopause is a natural biological process that causes periods to stop due to a reduction in hormone levels. It generally occurs between the ages of 45 and 55, but can sometimes happen earlier. The menopause comes with a number of symptoms; most notably vaginal dryness, hot flushes, mood swings and a reduced sex drive. These symptoms are normally treated using Hormone Replacement Therapy (HRT), which comes in a variety of forms including tablets, gels and patches.
What is the menopause?
The menopause occurs at the end of a woman’s monthly menstrual cycle, and is typically diagnosed 12 months after experiencing her last mentrual period. Most women will begin to experience the menopause during their early 50s, while for many others this will happen at some point in their 40s. A small percentage of women may even enter the menopausal phase in their 30s.
As a woman approaches menopause, the female hormones known as oestrogen and progesterone start to reduce, leading to a number of symptoms that can lower energy levels, disrupt sleep and impact emotional wellbeing. These symptoms typically include hot flushes, mood swings and vaginal dryness, among others that are covered in more detail further along in this article.
Oestrogen performs many key roles in a woman’s body. It helps to regulate her menstrual cycle, keep her vagina moist and even control her skin temperature. Oestrogen levels decrease during menopause, which causes many symptoms associated with the menopausal transition. These symptoms will last until oestrogen production returns to normal.
Symptoms of the menopause include:
- Hot flushes (a sudden warmth in the upper body, particularly in the face, neck and chest, which is often accompanied by skin redness)
- Vaginal dryness (which is occasionally accompanied by pain or irritation, particularly during sex)
- Reduced sex drive (libido)
- Night sweats (which can often lead to difficulty sleeping)
- Urinary incontinence (the involuntary leaking of urine, particularly when coughing or sneezing) and often recurrent urinary tract infections (UTIs)
- Changes in body shape, often including weight gain
- Joint pain and muscle aches
- Frequent headaches or migraines
- Osteoporosis (weakened bones)
- Changes in mood (sudden bouts of anxiety, mood swings or low self-esteem) and ‘brain fog’ (frequent problems with memory or concentration)
For most women, the majority of these symptoms will usually last between 2 and 5 years; however, vaginal dryness and incontinence often persist, and could even get worse if left untreated.
In most cases, a GP can diagnose menopause in women based on symptoms and medical history. Occasionally, a blood test may need to be carried out to assess the levels of oestrogen and follicle-stimulating hormone (FSH) — this is because oestrogen levels decrease and FSH levels increase during menopause.
Your GP will decide on the best course of action. There are a wide number of HRT treatments available, and the most appropriate treatment will be determined by the severity of symptoms, the patient’s medical history and the personal preference of the individual. There are risks associated with any type of HRT treatment, so you should always seek a professional diagnosis before attempting to self-treat any symptoms of the menopause.
The symptoms of the menopause are typically treated using Hormone Replacement Therapy (HRT), a treatment which replaces the hormones (oestrogen and progesterone) that decrease as a women enters the menopause.
There are over 50 different HRT preparations available, and finding the right treatment for you can take time. Generally, a low dose of HRT treatment will be administered at the beginning, to ensure there are no unexpected side effects and that the dose can be increased to maximise effectiveness. Your doctor will usually assess how effective the treatment has been after a few months, and decide on a different course of treatment if necessary.
The are generally 3 types of HRT treatments:
Taking oestrogen without progestogen (a synthetic form of progesterone) increases the risk of developing endometrial cancer (which affects the womb or uterus) and therefore oestrogen-only treatment is only offered to menopausal or postmenopausal women who have previously had a hysterectomy.
Examples of oestrogen-only HRT treatments include:
- Elleste Solo Tablets
- Premarin Tablets
- Progynova Tablets
- Zumenon Tablets
- Estradot Patches
- Evorel Patches
- FemSeven Patches
Continuous combined HRT
This type of treatment is generally administered to post-menopausal women (those who haven’t experienced a period for at least a year) and involves taking oestrogen and progestogen daily, without a break.
Women on long-term HRT treatments should consider the use of topical treatments like patches and gels, as these come with a lower risk over a long period.
Examples of continuous combined HRT treatments include:
- Elleste Duet Tablets
- Femoston Tablets
- Indivina Tablets
- Kliofem Tablets
- Kliovance Tablets
- Evorel Conti Patches
- Evorel Sequi Patches
- FemSeven Conti Patches
Sometimes called sequential HRT, this treatment is normally given to those experiencing the symptoms of the menopause while still having their periods.
Cyclical HRT comes in two types:
- Monthly cyclical HRT, where oestrogen is taken daily and progestogen is taken for up to 2 weeks after a period (recommended for women who have regular periods)
- Three-monthly cyclical HRT, where oestrogen is taken daily and progestogen is taken for up to 2 weeks, every 13 weeks (recommended for women who have irregular periods)
Other menopause treatments available include Ovestin Cream (a cream applied directly to the vagina to reduce dryness and irritiation) and Oestrogel (a gel applied to the skin that helps to relieve symptoms such as hot flushes and mood swings).
The menopause is a natural phase of a woman’s lifecycle and therefore it cannot be prevented. That said, there are a number of behavioural and lifestyle changes you can make to reduce the severity of the symptoms experienced during the menopause:
- Exercising regularly comes with a multitude of benefits (it can naturally improve mood and enhance sleep quality) but it has also been shown to lessen the symptoms of hot flushes.
- Maintaining a healthy diet is good for bone and heart health, while cutting down on spicy foods, alcohol and caffeine will help to reduce hot flushes (as these are common triggers).
- Staying cool at night (by wearing loose-fitting clothing, sleeping in a ventilated room or using a fan) can help to relieve night sweats and hot flushes.
- Having a cool shower before bed can also decrease the likelihood of night sweats and hot flushes disrupting sleep.
- If you are a smoker, quitting smoking is a way of reducing hot flushes, while also decreasing the risk of other serious health concerns.
- If you suffer from vaginal dryness, using a lubricant (especially during sex) will help to alleviate any pain or irritation as a result.
Some herbal remedies including ginseng, evening primrose oil, black cohosh and red clover could help to reduce menopausal symptoms like hot flushes, though clinical studies have provided no definitive evidence of their effectiveness. You should always consult your doctor before taking a herbal remedy.