Menopause. What Causes The Menopause? Symptoms. Health Risks
The experience of the menopause can vary greatly from one woman to another. For some, it is completely trouble-free. Others may need help to cope with the physical and psychological effects of the menopause. For these women, a range of options and support is available.
What causes the menopause?
The menopause happens when the ovaries stop responding to certain hormones from the brain, and so eggs stop maturing regularly. There is a drop in the levels of oestrogen and progesterone (the two female sex hormones produced by the ovaries). It is this fall in hormone levels that causes symptoms of menopause.
Timing
The menopause usually happens gradually. Most women find that their monthly cycle and blood flow become irregular during the few years before their last period. Bleeding may even stop for a few months and then start again. A woman is considered to be through the menopause when a year has passed since her last period.
It's not known why the menopause starts earlier in some women than others, although inherited factors are thought to play a part. Women who smoke go through the menopause an average of two years early. Surgery that removes the ovaries causes an immediate menopause. When the menopause happens before the age of 40 it is considered to be a premature menopause, and usually requires medical treatment.
Menopause symptoms
Although some women have no symptoms of the menopause other than the ending of their periods, most women have some other symptoms. Many of these improve with time:
-- hot flushes and night sweats,
-- fatigue,
-- emotional changes such as mood swings or a change in sexual interest,
-- sleep disturbances (insomnia),
-- drier skin and hair,
-- increased growth of facial and body hair,
-- aches and pains in the joints,
-- headaches,
-- palpitations (rapid, irregular heart beats),
-- generalised itching.
Other symptoms can be long-term or get worse with time:
-- vaginal changes - dryness, pain during intercourse, increased risk of infections,
-- urinary symptoms - inability to control urination (incontinence), increased frequency of urinary infections.
Research has shown that women who have close friends and family, or who are in full-time work, appear to have fewer symptoms. In addition, how a woman feels about reaching the menopause can have an impact on her experience. Many women see the menopause as a positive event that frees them from having periods and the risk of unwanted pregnancy.
Health risks and the menopause
The reduced oestrogen levels that happen during the menopause can lead to long-term health effects.
-- Loss of bone density: the bones may become brittle and break more easily (a condition called osteoporosis).
-- Heart disease, such as atherosclerosis. Fats may be deposited in the blood vessels, which increases the risk of heart attacks and strokes.
-- Increased blood pressure.
-- Weight gain, which increases the risk of cardiovascular problems.
-- Increased cholesterol levels.
-- Pelvic floor weakness: the pelvic muscles and joints become weaker, which can lead to prolapse of the womb (when the womb drops down into the vagina).
Treatment options
Lifestyle changes and medical treatment can help to reduce the symptoms and health risks of menopause. Treatment will vary from one woman to another, depending on her experience.
Diet
-- It's important to get 1500 mg of calcium per day (from milk, dairy products, canned fish with bones such as sardines and mackeral, and leafy green vegetables; 200 ml of milk contains around 300 mg of calcium.
-- Vitamin D is important to help prevent osteoporosis. It's found in oily fish such as salmon.
-- Avoid the saturated fats found in meat and butter - choose olive oil, fish and low-fat dairy products instead to help keep weight down.
-- Include plenty of fruit and vegetables, wholegrain cereals and fibre, lentils, beans and peas to keep fibre intake high.
-- Foods that are high in oestrogen-like chemicals called phyto-oestrogens may be helpful. These include soya products, beetroot, parsley, root fennel and yams. However, there is little definite scientific evidence for the effectiveness of phyto-oestrogens.
Exercise
Weight bearing exercise such as walking helps keep the bones strong. Aerobic exercise, which increases the heart rate, is good for cardiovascular health.
Hormone replacement therapy (HRT)
HRT is designed to replace some of the hormones reduced during and after the menopause. Women who have had a hysterectomy can take oestrogen alone. Other women, who still have their womb, need to take a combination of oestrogen and progesterone, because taking oestrogen alone increases the risk of cancer in the lining of the womb. Combined HRT causes bleeding every month.
The benefits of HRT
-- relief from hot flushes, night sweats and vaginal dryness,
-- maintenance of vaginal muscle tone, helping reduce incontinence,
-- reduction in the risk of osteoporosis,
-- reduction in mood swings,
-- relief of aches and pains in the joints.
The risks associated with HRT
Taking HRT slightly increases the risk of breast cancer in the long term. About 45 in every 1000 women aged over 50 who are not using HRT will develop breast cancer over 20 years. This rises to 47 women per thousand after five years of HRT, 51 after 10 years and 57 after 15 years HRT. The increased risk seems to disappear within about five years of stopping HRT. It is particularly important for women on HRT to have regular mammograms and to check their breasts regularly for any changes. HRT is not suitable for women who have recently had breast cancer.
HRT increases the risk of developing a blood clot in a leg vein (deep vein thrombosis), which can be life-threatening. There is also an increased risk of gallstones and liver damage in women who have been on HRT for more than five years.
Combined HRT comes as tablets and patches. For oestrogen-only treatment, tablets, patches, implants and skin gels are available.
The course of treatment can contain a fixed amount of oestrogen and a progestogen in the same tablet, to be taken every day (continuous treatment). Other courses of treatment consist of two or three different pills - usually of different colours - that are taken at different times in a monthly cycle.
Alternative methods for taking HRT include skin gels and implants, which are thin, match-shaped rods inserted under the skin. Preparations of oestrogen such as vaginal creams, pessaries and a vaginal ring may be helpful for vaginal problems such as dryness.
HRT may have side-effects, including tender breasts, heavier periods, enlarged fibroids, water retention, weight gain, depression and irritability. Changing the type and dose of progestogen may reduce the side-effects, and this should be discussed with a doctor.
Complementary approaches
Some women find that phyto-oestrogen helps with hot flushes. Sources of phyto-oestrogen include roasted soy beans, soy milk, tofu and miso.
Some women find that herbal remedies, such as black cohosh, angelica, evening primrose and valerian help with some symptoms. However, there is limited scientific evidence that these are effective treatments, and they may have side-effects. Anyone using a herbal remedy should let their doctor know what they are taking.
Other complementary therapies promote relaxation, exercise, and wellbeing (aromatherapy, acupuncture, yoga and reflexology, for example) and may help reduce symptoms in some women.
Further information
The Amarant Trust
An independent charity set up to promote understanding of the menopause and HRT.
01293 413000
Women's Health
0845 125 5254 (weekday mornings)
http://www.womenshealthlondon.org.uk
Published by BUPA's Health Information Team
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