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Menopause and Me

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This booklet has been written by Dr Louise Newson, GP, menopause specialist and founder of the

Newson Health and Wellbeing Centre in Stratford-upon-Avon, England.

For more information on Dr Newson visit www.menopausedoctor.co.uk

Contents

What is the menopause? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Long-term health problems that

can arise from your menopause . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Treatments: hormone replacement therapy (HRT) . . . . . . . . . . . . 7-8

Other treatments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-10

Lifestyle changes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Common HRT myths busted . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

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Menopause and me

Did you know? About three in four women will experience symptomsduring their menopause

Your menopause is a not an illness or medical condition: it is a completely normal life eventfor women.

However, this means that the troublesome symptoms it can bring are all too often underrecognised, undervalued and not taken seriously.

Symptoms such as hot flushes, fatigue, mood changes and brain fog can affect all aspectsof life, including home life, relationships and careers.

This guide looks at what your menopause actually is and the symptoms you mayexperience, as well as the treatments and lifestyle changes that make a real difference.

The information in this guide is aimed at women aged 45 and over. If you are under 45,you should refer to the Menopause and Me for Younger Women guide.

Did you know? Women spend on average a third of their life postmenopausal

If you are over 45, have irregular periodsand other typical symptoms, then a health

professional should be able to diagnoseyour menopause without the need for tests.

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What is the menopause?

How and when does your menopause happen?

Early Menopause

Did you know? The average age of the menopause is 51

Your menopause is when you stop havingperiods. It occurs when your ovaries stop producing eggs and as a result, levels of hormones called estrogen andprogesterone fall.

There are four key stages to be aware of:

Pre-menopause: the time in your lifebefore any menopausal symptoms occur.

Perimenopause: when you experiencemenopausal symptoms due to hormonechanges, but still have your period.

Menopause: when you do not have aperiod for 12 consecutive months.

Postmenopause: the time in your life afteryou have not had a period for 12consecutive months.

The average age of the menopause is 51, and although symptoms of theperimenopause can often start at around 45 years of age.

If the menopause occurs when a womanis under 45 then it is called an earlymenopause. If it occurs before the age of40 it is classed as premature ovarianinsufficiency (POI).

Hormones estrogen and progesterone

work together to regulate the menstrualcycle and production of eggs. Estrogen also plays an important role throughout a woman’s body, including bones, memory,mood and even hair and skin.

During your perimenopause andmenopause, hormone levels fluctuategreatly and this imbalance can result in arange of symptoms, from hot flushes toaches, pains and mood changes.

If your menopause occurs when you areunder 45 it is known as an earlymenopause. Menopause in women under40 years is usually referred to asPremature Ovarian Insufficiency (POI).

Certain circumstances can trigger an earlymenopause or POI. These include surgery

involving the ovaries, having radiotherapyto the pelvic area as a treatment forcancer, or certain types of chemotherapydrugs to treat cancer (for moreinformation on early menopause and POI,read the Menopause and Me for YoungerWomen booklet).

How is the menopause diagnosed?

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Did you know? Changes to periods can often be the first sign of your menopause

Menopause symptoms

The majority of women will experiencesymptoms during their menopause, which canaffect both their home and work lives.

The severity of symptoms variestremendously between women. Some will only experience them for a few months,others can continue to suffer for years – evendecades.

Common symptoms can include:

Period changes: This is often the first sign.You can experience a change in flow andyour periods will become less frequent,before stopping completely.

Hot flushes: This is the most commonsymptom of all, affecting three out of fourwomen. Hot flushes can come on suddenlyat any time of day, spreading throughout yourface, chest and body. For some women theymay last for moments, for others severalminutes. Hot flushes can have associatedsymptoms such as sweating, dizziness or evenheart palpitations.

Night sweats: Many women find they wakeup drenched in sweat and have to changetheir pyjamas or bed clothes. This can also bea disruptive symptom for partners too.

Mood changes: Some women who sufferfrom mood changes find they are verydisruptive to work and home life. You mayfind mood changes more common if youhave had premenstrual syndrome in the past.

Fatigue and poor sleep: Poor sleep can berelated to night sweats, but you may find youare more tired during the day even if yoursleep is not affected.

Brain fog: This is a collective term forsymptoms such as memory slips, poorconcentration, difficultly absorbinginformation and a feeling your brain is like

‘cotton wool’. Brain fog can not only presenta challenge while at work, it can also affectthe simplest of tasks like reading a book orlistening to the radio.

Loss of sexual desire: It is common to loseinterest in and pleasure from sex around thetime of the menopause; feeling tired, having alow mood and experiencing night sweats canall be contributing factors. There is also ahormonal reason why your libido may feelrock-bottom. Women have testosterone, aswell as men, and this hormone can influenceour sex-drive. Testosterone levels tend todecline in women during the menopausewhich may lead to less interest in sex.

Joint pains and muscle aches: Estrogen is veryimportant in providing lubrication for yourjoints and preventing inflammation, so lowlevels can leave your joints sore and aching.

Hair and skin changes: Estrogen helps tobuild collagen - the protein that protects thestructure of our skin. Lower levels of estrogencan lead to reduced elasticity, fine lines anddryness. Some women find their skinbecomes itchier, or they develop acne.Changing hormones can also make your hairthinner and less glossy, and you may noticeincreased facial hair growth.

Worsening migraines: If you suffer frommigraines, you may find they become moresevere and closer together.

Vaginal and urinary symptoms: Low estrogencan cause the tissues around the vagina tobecome thinner, dry, itchy and inflamed-known as vaginal atrophy or atrophic vaginitis.Your vagina also expands less easily duringsex, making sex uncomfortable or painful.Low estrogen also thins the lining of thebladder, leading to the urge to urinate morefrequently. Some women find they haverecurrent urinary tract infections.

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Vaginal dryness and urinary symptoms

As mentioned, one of the symptoms ofthe menopause is vaginal dryness andother urinary complications due toreduced estrogen in the body.

These symptoms can occur during the

perimenopause or menopause but tendto get more noticeable after themenopause – during the postmenopausalphase – and can get quite troublesome formany women.

Long term health problems which can arise from your menopause

Osteoporosis

Osteoporosis is a condition that weakensthe bones and makes them more likely tobreak.

People with osteoporosis have anincreased risk of fractures, even with littleor no trauma – meaning that normalstresses on the bones from standing,coughing or even hugging, can result infractures.

Estrogen helps keep our bones strong

and healthy but as this hormone reducesduring the menopause women are atgreater risk of developing osteoporosisthan men. Women can lose up to 10% oftheir bone density in the five years afterthe menopause.

Other factors that increase the risk of bone-weakening are a family history of osteoporosis, smoking and heavydrinking.

Cardiovascular disease

This refers to conditions affecting theheart and blood vessels, such as coronaryheart disease, congenital heart disease,stroke and vascular dementia. Estrogenhelps keep our blood vessels healthy andhelps control cholesterol, so fluctuatinglevels of estrogen can increase your

chances of getting cardiovascular disease.

Other factors that increase your risk ofgetting cardiovascular disease include highblood pressure, smoking, being overweightand a family history of cardiovasculardisease.

Did you know? Women lose up to 10% of their bone-strength in thefirst five years after menopause

Did you know? Symptoms of vaginal dryness can get worseas you get older

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Treatments: Hormone Replacement Therapy (HRT)

Hormone Replacement Therapy (HRT)

There are a range of treatments availableto help manage your menopausesymptoms and, in many cases, vastlyimprove your quality of life.

Your first step should be talking to a healthprofessional about the options available toyou, so you can make an informeddecision about the potential benefits andrisks. Don’t wait until symptoms becomeunmanageable before you seek advice.

A trusted source of information is the2015 guidelines on menopause bymedicines regulator the National Institutefor Health and Care Excellence (NICE). It contains information on treatments thatcan help your symptoms, what sort of information you should expect during an appointment with a health professional, and questions you can ask(www.nice.org.uk/guidance/ng23).

HRT is a treatment that relievessymptoms by replacing the estrogen yourbody stops making after the menopause.The type of estrogen most commonlyused these days is 17 beta-estradiol. Manywomen also need to take a progestogenalongside estrogen – known as combinedHRT. Some women also take testosteroneas part of their HRT.

Estrogen available as a skin patch, gelapplied to the skin or as a tablet, HRTremains the most effective treatment torelieve symptoms. Yet it is thought thatin some parts of the UK only one in tenwomen who would benefit from HRTactually take it.

HRT benefits

Your symptoms will improve Many women find their symptomsimprove within a few months of startingHRT and feel like they have their ‘old life’back, improving their overall quality of life.

Hot flushes and night sweats usually stopwithin a few weeks of starting HRT. Manyof the vaginal and urinary symptomsusually resolve within three months, but itcan take up to a year in some cases.

You should also find that symptoms suchas mood changes, difficulty concentrating,aches and pains in your joints and theappearance of your skin will also improve.

Your risk of cardiovascular disease willreduceThere is some evidence that taking HRT,

particularly estrogen-only HRT, reducesyour risk of cardiovascular disease. Thebenefits are greatest in women who start HRT within ten years of theirmenopause.

Your risk of osteoporosis will reduceTaking HRT can help prevent and reversebone loss, even for women who takelower doses of HRT, so it can reduce yourrisk of bone fracture due to osteoporosis.

Your risk of other diseases will reduceStudies have shown that women whotake HRT also have a lower future risk oftype 2 diabetes, osteoarthritis, bowelcancer, depression and dementia.

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These days the NHS and private menopausespecialists offer a more modern type of HRTcontaining estrogen that is derived fromplants, such as yams. This is known as body-identical estrogen, as it has the same molecularstructure as the estrogen produced by ourbodies.

However, some private clinics offer a type ofHRT known as bioidentical HRT. Like body-identical estrogen, it is derived from plants. Butthe crucial difference is that some clinics offerbioidentical treatment that is ‘compounded’ orcustom-blended following hormone testing.

According to the British Menopause Society,

bioidentical HRT products are not authorisedby the Medicines and Healthcare ProductsRegulatory Agency (MHRA).

They are marketed as natural supplements anddo not require approval by the MHRA. As aresult, they have not been through therigorous process of drug development, whichconventional medicines and productsundergo.Compounded or bioidentical hormones havenot been scientifically evaluated in clinical trialsfor effectiveness and safety, and there is noevidence that they are more effective thanlicensed types of HRT.

HRT risks

For the majority of women who start takingHRT under 60, the benefits outweigh the risks.

The type of HRT that is suitable for you usuallydepends on 4 factors:- your medical history- any existing conditions- whether you still have your womb (uterus) or not- and if you are still having periods.

If you still have a uterus, then you will need totake a progestogen (a synthetic type of thehormone progesterone) or body identicalprogesterone alongside estrogen, known ascombined HRT. This is because takingestrogen on its own can increase the risk ofuterine cancer, but taking a progestogenreverses this risk.

There are two small risks for some womenwho take HRT - the risk of breast cancer andthe risk of a blood clot. The one that worriesmost women is breast cancer. Your actual riskdepends on many factors including age, familyhistory and your general health and not onwhether you take HRT alone. That is why it iscrucial you discuss your individualcircumstances with a health professional.

Studies have shown that women who takeestrogen-only HRT do not have an increasedrisk of breast cancer. Taking combined HRT (estrogen and progestogen) may be

associated with a small risk of developingbreast cancer. Some studies show this riskreduces if using a type of progestogen calledmicronised progesterone, which is derivedfrom plants. The risk of breast cancer withtaking combined HRT is very low. Womenwho are obese actually have far greater riskof developing breast cancer, than women ofa healthy weight taking combined HRT.

If you have a history of blood clots, liverdisease or migraine then you can still takeHRT but you may be recommended to usean estrogen patch or gel as this is associatedwith no risk of clots. If you need progestogenthen this is usually still given as a tablet or aMirena coil can be used instead.

Side effects of HRT The most common sideeffects include nausea, some breast discomfortor leg cramps. Side effects are most likely tooccur when you first start taking HRT andthen usually settle with time.

Different brands of HRT use differentestrogens and progestogens, so you may findthat changing brands helps with the sideeffects. Switching the delivery method of HRT– for example from tablets to patches – canalso help.

Some women find that HRT patches canirritate the skin, so talk to a health professionalabout switching brands.

Body-identical and bioidentical hormones: what you need to know

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Other treatments

As well as regulating sex drive,testosterone helps with your mood,memory and concentration. Not allwomen will need testosterone but talk to

your health professional if you find HRTalone is not helping with these symptoms.Testosterone is given as a cream or gel, orsometimes as an implant.

Did you know? Women produce three times as much testosteronethan estrogen before the menopause

Treatments for vaginal dryness and urinary symptoms

Testosterone

To ease these symptoms, estrogen can begiven directly to the vagina in the form ofa cream, a tablet (pessary) or a silicon ringinserted into the vagina.

Using estrogen in this way is not the sameas taking HRT, so it does not have thesame associated risks. Estrogen applieddirectly to the vagina can be safely usedby most women on a regular basis for along period of time, which is important assymptoms can continue when you arepostmenopausal and they often return

when you stop treatment.

Another option for dryness is vaginalmoisturisers and lubricants during sex.These products can be bought over thecounter and can be used either alongsidevaginal estrogen treatments or on theirown.

Your symptoms should improve within afew weeks of treatment. See a healthprofessional if symptoms do not improve,as these can be due to other conditions.

Cognitive Behavioural Therapy (CBT)

CBT is a talking therapy recommended byNICE as a treatment for low moodassociated with menopause. It focuses onchanging the way you think and behave,

with sessions either in groups or one-to-one with a therapist. You can be referredvia your GP, but many women find it isquicker to organise privately.

Other treatments

There are some alternative prescriptionmedications that can be used forsymptoms if HRT cannot be given or is not preferred. These include

antidepressants such as citalopram orvenlafaxine - which can improve hotflushes but often have side effects, such as nausea.

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Herbal medicines

Some women consider taking herbalmedicines alongside or instead ofconventional medicines.

There is a huge market out there formenopausal symptoms, including St John’swort, red clover and black cohosh. Herbalmedicines though natural, are notnecessarily safer. There is much variety intheir effectiveness and potency. In addition,some come with side effects and caninterfere with other medicines you maybe taking.

It is also worth remembering thatalthough herbal medicines might helpsome of your symptoms, they won’taddress your hormone levels and in turnwon’t protect your bones or reduce yourrisk of cardiovascular disease.

If you are considering herbal medicines,speak to a health professional.

Traditional Herbal Registration (THR)certification mark.

The MHRA oversees a scheme called theTHR certification mark. If you are thinkingof using herbal medicines, you should lookout for this logo, as it means it has beendeemed safe when used as intended,manufactured to set quality standards andhas reliable and accurate productinformation. The authorised usage anddosage of the medicine is based onevidence of its traditional use, but theeffectiveness of the product has not beenassessed by the MHRA.

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Lifestyle changes

Common HRT myths busted

Maintaining a healthy lifestyle is importantfor women of all ages, but particularlyduring your menopause. You should beaiming to:

Eat a healthy, balanced diet: a diet rich incalcium helps protect your bones andreduce the risk of osteoporosis.

Exercise regularly: NHS guidelines stateyou should try and aim for 30 minutes ofmoderate exercise five times a week.Weight-bearing exercises, such as walkingor running, are also important to maintainbone strength.

Limit alcohol and cigarettes: alcohol can

interrupt sleep and exacerbate hotflushes. If you do smoke, cut down withthe aim of quitting altogether.

Get enough vitamin D: vitamin D alsoplays a part in keeping your bones strongand healthy. You should get all the vitaminD you need from sunlight and the smallamounts found in food, but you may alsowant to take a supplement.

Relax: If work is proving stressful, taketime out for yourself. Do something youenjoy that lifts your mood, such as yoga,having an aromatherapy massage or justspending time with loved ones.

Did you know? Alcohol, caffeine and spicy foods can alltrigger hot flushes

Myth: You should wait for your symptomsto be unbearable before seeing a healthprofessional about HRTFalse. You can start taking HRT fromwhen symptoms start, even when youare perimenopausal.

Myth: HRT delays the menopauseFalse. If you experience menopausalsymptoms after stopping HRT, you wouldhave experienced them even if you hadnever taken HRT.

Myth: You should stop taking HRT afterfive years

False. There is no maximum amount oftime you should take HRT for. It dependson your individual circumstances, risksand benefits and personal choice.

Myth: HRT is not suitable if you sufferfrom migraines False. If you have a history of migraine,you should opt for HRT in the form of apatch or gel rather than a tablet. Womenwho have migraines with aura (visualdisturbances such as flashing or seeingspots) have a small increased risk ofstroke when taking estrogen in tabletform, but not as a patch or gel.

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Email: info@newsonhealth.co.uk | Web: www.newsonhealth.co.uk

The team at Newson Health are passionate about improving awareness of safeprescribing of HRT to ladies at all stages of the perimenopause and menopause

and also offering holistic treatments for the menopause.

Dr Louise Newson has written and developed the websitewww.menopausedoctor.co.uk

This website contains evidence-based, non-biased information about theperimenopause and the menopause. She created this website to empower women withinformation about their perimenopause and menopause, and to inform them about the

treatments available.

Her aim is for women to have more knowledge and confidence to approach their ownGP to ask for help.

Louise also wants healthcare professionals to access this website and read importantguidelines and articles so that their experience and knowledge of the menopause

improves and they can, in turn, help many more women.