THE MENOPAUSE

Sooner or later every woman comes to the time of her life known as the menopause. All too often it's thought of as being an illness or a sign of old age but, just like pregnancy and puberty, it's a natural stage in life that brings with it certain biological changes.

Every woman's experience of the menopause is different, and each one will find different ways of managing the changes which can happen in the body.

Understanding the menopause

The word 'menopause' literally means the end of menstruation. This happens when a woman's ovaries cease to produce the female hormones oestrogen and progesterone.

The production of these hormones doesn't stop overnight. It is reduced gradually until the levels of hormones are too low to bring on the monthly period and the release of an egg. This signals the end of the woman's fertile years.

The changes that women experience during the menopause are caused by this reduction in hormones. As the production of these hormones diminishes, the body becomes used to the much lower amounts of oestrogen and progesterone.

At what age does it happen?

It's impossible to predict at what age the menopause will occur. The average age is 48 but it usually occurs between the ages of 43-58. Common beliefs are that those who start to menstruate early will experience the menopause later, and that mothers and daughters will have it at a similar age. Neither of these theories is correct. Only one thing is certain - smokers often experience the menopause earlier than non-smokers.

How do you know that the menopause has started?

The only true sign of the menopause is the end of your periods. However, many women experience changes which are related to the menopause before their periods have completely stopped and these can continue for some time after the end of the menopause. Because the menopause does not happen overnight, most women find that their periods do not suddenly come to a halt. Some women find that the time between each period becomes longer and longer (though their menstruation is normal) until the periods stop. For other women there is no change in menstrual rhythm but there is a scantier flow each time until it dwindles to nothing.

Changes associated with the menopause

Many women are led to believe that the menopause is a time of misery when they will feel ill, be overcome by crying fits and suffer chronic depression - all of this is highly unlikely. The menopause has a bad name which is quite unjustified. About thirty per cent of women have a trouble free menopause. Fifty per cent of women experience slight problems which are manageable and a further twenty per cent have problems which may need some sort of medical help.

Some women tend to blame any ailment they experience around the age of fifty on the menopause! In reality there are usually three major physical changes which are related to it.

These are osteoporosis (brittleness of the bones), changes in the vagina and hot flushes.

All these can vary in severity and most can be managed either through self help or by medical intervention.

Hormone replacement therapy (hrt)

Hormone Replacement Therapy (HRT) has become an increasingly popular alternative for women suffering from menopausal symptoms. It's by no means ideal for every woman but it has been found to be a great help to some.

HRT is designed to make up the loss of oestrogen which causes osteoporosis (a calcium deficiency which leads to a weakness in the bones), dry vagina and hot flushes. Some women find that problems such as headaches, tiredness and depression are also helped by HRT.

HRT can be taken in different forms - tablets, creams and implants and for varying lengths of time. Your doctor will advise what is best for you.

Osteoporosis

Osteoporosis can be a serious side effect of the menopause. It is the least common, but when it does occur it leads to an increased risk of fracture of the bones. Although the underlying causes for osteoporosis originate with menopause, the changes may not become apparent until a few years later.

The reduced levels of oestrogen present after the menopause lead to a decrease in the growth of bones and reduce the body's ability to absorb calcium from food.

What you can do?

As with severe episodes of hot flushes, hormone replacement therapy may be advised by a doctor. But since it is very difficult to tell whether you are developing, or are going to develop, osteoporosis, perhaps the most sensible thing to do is to eat a calcium enriched diet. Foods which are high in calcium include milk, yoghurt, cheese, fish and green vegetables.

It has also been shown that women who take part in some regular form of exercise are less likely to develop osteoporosis, because exercise stimulates growth of bones. The best exercise is anything that is done standing or sitting up, such as cycling, running or walking, but any exercise is better than none at all. A recommended routine is one hour of exercise three times per week. You can start off with much less than an hour per week and gradually build up as you become fitter. Consult your doctor before you start off on any form of strenuous exercise.

Changes in the vagina

The decrease in the level of oestrogen can cause changes in the vagina. These changes can vary in severity but generally the decrease in oestrogen can lead to a lack of lubrication and in some cases a permanent thinning of the vaginal walls. This can mean that lovemaking becomes painful for some women as there is a loss of elasticity and lubrication. It has also been shown that there is a degree of shrinkage of the vagina in women who choose not to have sex after the menopause. The thinning of the vaginal walls also makes the vagina more prone to infection, in particular, thrush. Infection may spread to the bladder as wen, sometimes resulting in pain while passing urine.

What you can do?

Unhappy, some women feel the menopause signals the end to their years of femininity and means that sex is now out of the question. Vaginal discomfort during lovemaking can serve to compound these beliefs - which are by no means true. In fact, temporary vaginal discomfort can easily be overcome with the use of a lubricant such as Sensible which has been formulated specially for this purpose and is available from chemists. It has a consistency similar to that of the natural vaginal fluids and is odourless, non-greasy and non-staining.

If the discomfort persists, talk to your doctor who may recommend a specific course of treatment. Some women experience severe thinning of the vaginal walls and for them a doctor may prescribe hormone replacement therapy which in this case can be given in the form of a cream containing oestrogen which is applied locally to the vagina.

Don't be embarrassed about vaginal dryness. It is a very common problem and you have no need to feel uncomfortable talking to your doctor about it.

Hot flushes

The most common experience associated with the menopause is that of hot flushes. These are episodes of perspiration, flushing and increased pulse rate. They tend to start as a sensation of heat in the chest which moves upwards over the arms and face. They can last from one to three minutes and at their most severe can happen at an hourly frequency any time during the day or night.

Some women never experience a hot flush and the majority of women who do have them only occasionally. They can be as mild as sudden blushing or they can be so serious that they disturb sleep. They happen because an area of the brain which controls blood flow becomes temporarily unsettled by the decreased level of hormones.

Episodes of hot flushes can go on for up to two, or even five, years but they decrease in frequency and eventually stop as the body becomes accustomed to lower levels of hormones.

What you can do?

There are a number of practical steps which can be taken to make you feel more comfortable about hot flushes. Some women wear layers of clothing so that it becomes easier to cool off when a hot flush occurs, and some keep a spare set of nightclothes by the bed to change into if they have problems during the night. Hot fluids such as tea, coffee and soup can often bring on hot flushes and it is, therefore, sensible to avoid these. Alcohol, and in particular wine and sherry, can also act in this way.

Perhaps the most unsettling thing about hot flushes is the worry about how you look during an episode. The experience can be so intense that you feel you must look bright red all over. But, this is not necessarily the case and the best way to overcome this feeling of embarrassment is to look in the mirror during a hot flush, as you will see that it is usually unnoticeable to anyone else.

For some, hot flushes become a severe problem and if this is the case doctors may prescribe hormone replacement therapy.

Other common complaints

Depression:A number of women experience bouts of depression at the time of the menopause. Some doctors say that the depression can be caused by the reduction in the levels of hormones. Others say that depression at this time can be caused by external rather than internal factors. For example, women may feel unhappy about their children growing up and leaving home, or be disappointed about the lack of variety in their work or lack of excitement in their marriage.

However, whether the depression is caused by the menopause or through outside events, it should not be ignored. If you are experiencing severe depression it may be advisable to consult a doctor.

Headaches: It's difficult to know whether headaches are directly due to the menopause. Most menopausal headaches do not seem to be related to hormone levels, but may well result from tiredness due to hot flushes and general stress and anxiety which may occur at this time of fife. Pain killers, such as aspirin will help in the short term.

Migraine headaches have been linked with changing oestrogen levels. Your doctor can advise you on treatment for n-migraines.

Poor memory: Some women going through the menopause do suffer from poor memory, which can be very worrying. It's probably just a result of general tiredness and stress.

The menopause - a new start

Although it can cause problems, the menopause need not be as bad as many women think it will be. There are, undoubtedly, problems for some, but, in the same way that the majority of women are able to cope with puberty and childbirth, most women pass through the menopause without any really major problems. It's reassuring to know that many changes associated with the menopause can be dealt with successfully.

The menopause marks a change in one part of your life and the beginning of another. It is useful to think of the menopause as a new start. If you look around, there are thousands of women who are past the age of menopause enjoying an active and long life.

Contraception

Just because you have reached the menopausal time of life, you shouldn't forget about contraception. If there is any chance that you may still be ovulating you must continue using contraceptives. Doctors recommend a woman continues using contraception for up to 2 years for women under 50, or up to 1 year for women over 50, after monthly bleeding has ceased.