Menopause

Menopause is a natural life event. The majority of women will have mild menopausal changes which can be easily managed. For some, however, the changes will be severe enough to interfere with their quality of life.

What is menopause?

Menopause is the time of a woman’s last menstrual period. After this time a woman is no longer able to become pregnant.

Most women reach menopause between the ages of 45 and 55. Menopause can occur before the age of 40 and is then known as premature menopause, though this is uncommon.

As a woman approaches menopause the production of her normal female hormones, oestrogen and progesterone, slows down. Eventually the ovaries no longer release eggs and periods stop.

During this transition time, a woman may notice physical and emotional changes as her body adjusts to the lower level of oestrogen. These changes often begin to occur a few years before a woman’s last period, and last 2-6 years on average. This time when changes are occurring is called perimenopause, though women often refer to it as ‘going through the menopause’.

Women’s experiences of menopause

Women’s experiences differ greatly. The majority of women will have mild menopausal changes which can be easily managed. For some, however, the changes will be severe enough to disrupt their lifestyle. Many women find it useful to seek medical advice, whatever changes they are experiencing.

Changes can be physical or emotional. A woman may experience a few or many of the following:

• Unpredictable menstrual bleeding (lighter or heavier than usual)
• Irregular menstrual cycles
• Hot flushes or night sweats
• Mood swings
• Sleep disturbances
• Anxiety, depression or loss of self-confidence
• Dryness of the vagina, which can lead to painful sexual intercourse
• Loss of sex drive
• Tiredness, light headedness, forgetfulness
• Heart palpitations
• Dry or itchy skin
• Feelings of being unloved
• Urinary problems, such as an increase in frequency or urgency
• Joint aches and muscle pains

After menopause, many changes are less noticeable or may stop completely. There is however a change in the body’s metabolism after menopause, and this may result in weight gain and redistribution of body fat.

Managing menopause

Life stresses, such as children leaving home, ageing or death of parents and changes in employment, health or relationships often have an emotional impact around the time of menopause. It’s important to talk to your family and partner about any changes you are experiencing. This may help them to understand how you are feeling and what they can do to support you.

Symptoms of stress are often intertwined with menopausal changes. It is important to consider the changes you are experiencing and if they may be related to other things happening in your life. Look at ways of dealing with or reducing stress, such as learning relaxation techniques or doing yoga or other types of exercise. Exercise can be of benefit in helping to manage menopausal changes, as well as managing stress.

Some women find hormone therapy (HT) helps make menopausal changes more tolerable. See the FPWA HT information sheet for more details. Non-hormonal therapy (eg low doses of antidepressants) may also help some symptoms.

Natural therapies may also be of benefit to some women in managing menopausal changes. If you are considering using natural therapies for the treatment of menopause, it is important to see a trained natural therapist as some therapies can have side effects. Make sure you tell your doctor if you are taking any other medications, natural or otherwise, as some products can react with one another.

Feelings about sex can sometimes change after menopause, including having a lower libido. If physical changes such as vaginal dryness are a problem during sex, products such as vaginal lubricants and oestrogen creams and pessaries can be useful.

Health considerations around menopause

Osteoporosis
Loss of calcium from bones starts around the age of 30 but accelerates after menopause. This can lead to bone thinning and the possibility of fracture. Hip and spinal fractures can cause significant disability and are sometimes life-threatening. Women can reduce the risk of osteoporosis with lifestyle adjustments like increased exercise and changes in diet.

Factors which increase the risk of osteoporosis are:

• A family history of osteoporosis
• Thin build
• Few menstrual periods
• Little weight bearing exercise
• Smoking
• Excessive alcohol consumption
• Excessive caffeine consumption
• Poor calcium intake in the diet
• Cortisone (steroid) therapy

HT may help prevent osteoporosis, but women should discuss the risks and benefits of HT with a doctor.

Heart disease
After menopause a woman’s risk of heart disease increases (this has been linked with the decline of oestrogen production at this time). Again, a woman may reduce her risk by addressing lifestyle issues such as exercise and smoking.

Factors that contribute to the risk of heart disease are:

• Hypertension (high blood pressure)
• Family history of heart disease before the age of 60
• Smoking
• Obesity
• Lack of regular exercise
• Diabetes
• High cholesterol

Many women are surprised to learn that heart disease is the number one cause of death in women in Australia.

Promoting good health
A healthy lifestyle is important for all women throughout life, including during menopause. This should include:

• A diet high in fresh fruit and vegetables. Current recommendations are to have at least 5 serves of vegetables and 2 serves of fruit per day to obtain enough fibre and other nutrients
• A diet rich in calcium. Approximately 3-4 cups per day of milk or milk products (including calcium enriched soy products) provides enough calcium (calcium tablets may be used to supplement the diet to reach the recommended daily intake of 1,000mg)
• Eating small portions of lean meat, fish, chicken or other protein foods several times a week to ensure enough protein is being absorbed
• Reducing fats in the diet
• Regular weightbearing exercise such as walking or dancing, at least 3 times each week for 30 minutes
• Pelvic floor exercises
• Keeping alcohol consumption to 2 or fewer standards drinks per day
• Stopping smoking
• Limiting caffeine intake (by having less coffee, tea, cola drinks, chocolate, and cocoa)

Contraception is still an important consideration at this time. While fertility is diminishing, becoming pregnant is still a possibility. FPWA or a doctor can provide you with further information about your contraceptive needs.

Health checks
A woman may choose to visit her doctor for management of distressing symptoms of menopause or to discuss health risks as she gets older, such as heart disease, high blood pressure, osteoporosis and diabetes.

Pap smears are recommended every two years from the age of 20-70 years. It’s also important to be aware of your breasts – know their look and feel, get any changes checked promptly and have a mammogram every two years from the age of 50. For women with an increased risk of breast cancer, eg family history of breast cancer in a close relative such as a mother or sister, regular mammogram screening from the age of 40 is recommended.

For more information about menopause contact the Sexual Health Helpline on
9227 6178 or 1800 198 205 (country callers) or email.

Practising safe sex reduces the risk of contracting HIV and other sexually transmissible infections (STIs).

Page last updated Tue, 17 Aug 2010 09:16