The menopause and HRT: what every woman needs to know.
Fact sheet one: The menopause
What is the menopause?
Many people use the word ‘menopause’ when speaking of the general changes, which mark the time when a woman changes from being fertile to no longer being able to bear children. You may be more familiar with terms ‘change’ or ‘change of life’; both are used to describe the years when you may experience menopausal symptoms.
The menopause actually refers to the last monthly period you will ever have. For some women, their periods stop without warning but in most cases, the first sign that your approaching the menopause is when your periods become less regular.
As the menopause approaches, production of the female hormone oestrogen and progesterone by the ovaries gradually slows down. This accounts for the change in the frequency of your periods. At first, periods may come more often but as the levels of both hormones fall, your periods will become less frequent until they stop altogether. For most women, this process takes months or in some cases, years.
It is these hormonal changes and in particular, the lack of oestrogen, which account for many of the physical and emotional symptoms women experience around the time of the menopause.
When does the menopause start?
Women can go through a natural menopause at any age between 40 and 58, during which their periods will become irregular and then stop entirely. A few women will have an early menopause in their 30’s or even 20’s because their ovaries stop working for no clear reason or as a result of certain types of medical treatment which can affect ovaries.
If you have had an operation to remove your womb (a hysterectomy), this tends to lead to an earlier menopause known as surgical menopause. Removal of the womb and the ovaries together will cause immediate menopause. If you have had a hysterectomy, you will find helpful information in fact sheet 4: having a hysterectomy.
How will I know what to expect?
It is not unusual for women approaching the menopause to wonder about how they will feel at this time. The menopause itself is a period of biological change and adjustment; it should not be thought of as an illness. Most women will experience mild to moderate menopausal symptoms. However, some will find the physical and emotional symptoms so distressing that they may feel overwhelmed and unable to enjoy life at this time.
Your experience of your own menopause is very personal and can depend on a number of things. What is certain is that the more information, advice and support you seek from your family doctor, nurse, family and friends, the better you will feel about yourself and your ability to deal with the changes around the time of the menopause. You will also be in a better position to consider whether you should ask your doctor about oestrogen replacement or hormone replacement therapy. (see fact sheet 2: HRT)
How will I feel?
As the levels of oestrogen in your body fall, you may begin to experience some of the following symptoms:
Skin and vaginal dryness
Mood swings / depression
Poor memory and concentration
Loss of sex drive
Many women can find themselves having to cope with these symptoms at a time when there may be difficulties with teenage children, elderly parents, upheavals at work, or perhaps changes in personal relationships.
Dealing with these situations is a strain at the best of times so it’s important to remember that the menopause does not cause them.
What can Ido?
There are a number of ways in which you can help yourself and relieve the effect of your menopausal symptoms; by talking to your family doctor about hormone replacement therapy (see fact sheet 2) and by taking some simple steps to make life easier (see fact sheet 5: on you and your health).
For the majority of patients, symptoms last no more than a few months but for some women they may persist for a number of years, until the oestrogen levels settle down.
What are the long term effects?
In recent years it has been recognised that low oestrogen levels may be responsible for long term health problems in women who have been through the menopause. These health problems could affect some women for the rest of their lives.
Before the menopause oestrogen seems to protect the blood vessels and have a beneficial effect on blood cholesterol. This protective effect is lost after the menopause. The lack of oestrogen after the menopause puts some women at greater risk of heart disease.
Low oestrogen levels also account for your bones becoming thinner, putting you at greater risk of bone fractures, especially the hip, wrist and spine- this can be prevented by oestrogen replacement therapy if initiated early in the menopause.
Bearing in mind that most women can now expect to live, on average, to the age of about 78. This means that roughly 30 years of a woman’s life is spent in the menopause. Therefore women are at greater risk of long term health risks for at least one third of their natural lives.
A family history of heart disease and bone thinning are important areas to discuss with your family doctor at this time. It is likely that if you are at risk from heart disease or osteoporosis, you will benefit especially from the protection given by hormone replacement therapy or HRT, as it is more commonly known.
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