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How to deal with menopause

by Simone McClenaughan | 15 Jul 2013

Hot flushes, joint aches, muscular pain, mood changes and poor concentration can all be symptoms of menopause, with 60 per cent of women being affected for four to five years. Here's how to deal with them.

Menopause 101

“Menopause is just one day in your life,” explains Dr Barry Wren, gynaecologist, author of Menopause: Change, Choice and Hormone Replacement Therapy and former president of Australasian Menopause Society (AMS). “It is simply the last day of your last period.” Peri-menopause is the five-odd years leading up to then. If you haven’t had a period for 12 consecutive months, you’re post-menopausal. “About 40-45 per cent of a woman’s life is spent in postmenopause,” says Dr Wren.

Menopause occurs when a woman runs out of eggs in her ovaries, the only part of the female body that is programmed to stop working.

“Women have about two million eggs when they’re born,” says Dr Wren. “Some have more, some have less. Throughout a woman’s reproductive life those eggs are gradually lost. For some women, the rate of decline is faster than others.” This means that menopause occurs at a different age for each woman.

It generally happens between the ages of 45 and 55. The average age that a woman experiences menopause in Australia is 51.

Signs of menopause include joint aches and muscular aches and pain, hot flushes, dry vagina, mood disturbance, poor concentration and memory, as well as sex drive issues.

“Twenty per cent of women have a minor degree of symptoms, 60 per cent have four to five years of moderate symptoms and 20 per cent have severe symptoms. We don’t know why this is the case,” explains Dr Jane Elliott, GP at the Menopause Clinic, Adelaide Women’s Health Centre, University of Adelaide, and current president of AMS. “We do know that the experience can impact on a woman’s quality of life.”

How women change

In your teens you may not have worried about your health. In your 20s and 30s it’s possible you were thinking about and having a family, so you focused on conceiving healthily and the health of your family.

In your 40s, as your children were growing up and looking after themselves, you may have started to notice some changes to your health – you were gaining weight more easily, losing it was harder, you had to have a few more check-ups to keep an eye on things like heart disease and diabetes risks.

It’s also likely that you started to go through peri-menopause. Now that you’re over 50, there are a few more things to be aware of. You could put on more weight, your nutritional and physical activity needs are changing, you need to be mindful of your mind – all things that come with ageing – and you are also impacted by menopause.

Red faces?

The pink cheeks may not just be from hot flushes – some women are embarrassed about menopause.

“Many women feel that their body is deteriorating or that they’re losing their sexuality, and they mourn,” says Dr Wren.

As a result, women are hesitant to talk to their doctors about their menopausal symptoms. “It’s good to talk about all of your symptoms with your doctor. They’ve heard it all before,” Wren says. Menopause is normal and inevitable. It happens to every woman.

More than this, it is so much easier with the help and support a doctor can provide.

“The first thing I do is go through the regular health checks such as blood pressure and pap smears,” Dr Elliot says. “I’ll also investigate whether you need to take a contraceptive, as women can still get pregnant during peri-menopause.

“You should also stop smoking, reduce alcohol intake, lose weight if necessary and exercise. The theory behind this is that we know if you’re feeling better and healthier, you can handle menopause better. Then we can discuss hormone replacement therapy (HRT) with you if your symptoms are significantly impacting quality of life.

Healing with hormones

"HRT is the best evidence-based treatment for menopause at the moment,” says Dr Elliott. “HRT won’t alleviate menopausal symptoms 100 per cent, but it will certainly reduce them."

The aim of HRT is to replace the oestrogen that you’re losing and to keep you as healthy as possible,” explains Dr Wren. Those hormones also impact on your bones, cardiovascular system, your brain and your sexual health.

Dr Elliott recommends that HRT should not be started for the first time in women over 60 or who are 10 years postmenopausal, nor is it for unhealthy women or women who have had cardiovascular disease.

“The window of opportunity for oestrogen HRT is within the first five years of menopause,” says Dr Wren. “If HRT is begun for healthy women at that time, they may continue therapy for many years in order to maintain the reduction in osteoporosis and to reduce the risk of increased heart attacks and dementia.”

HRT can be delivered via tablets, patches, implants under skin or creams. Dosage and delivery is determined on a case-by-case basis – no two women are the same. Side effects of HRT may include breakthrough bleeding, breast enlargement, tenderness and nausea. These side effects can be managed by tailoring the dose and type of HRT.

Cancer is not a side effect. The NSW Cancer Council says that there is currently no evidence to suggest an increase in breast cancer rates in women who are taking oestrogen-only HRT.

However, taking combined HRT (oestrogen and progestin) may create a slight increased risk of developing breast cancer. The NSW Cancer Council recommends talking to your doctor about your individual needs.

“HRT does not cause cancer, but it may cause a microinvasive cancer to grow more rapidly than would otherwise occur,” says Dr Wren.