Understanding the menopause

Consultant Gynaecologist Anne Henderson looks at the symptoms of menopause and the treatments available. 

The menopause is the time when a woman stops producing eggs and which heralds many hormonal and physical changes to her body. As the recent NICE guidance on the menopause has confirmed, no one should suffer in silence and there are a number of effective treatment options available to reduce the effects of the menopause.

Each woman and her body is unique and therefore a ‘one size fits all approach’ to the menopause does not work. The age at which it starts, the symptoms experienced, and the length of time it takes all vary from woman to woman. I believe that women should be treated as individuals at this stage of their lives and have access to the best possible specialist advice.

Many women experience the perimenopause from mid-forties onward, signalling the gradual changes leading to the menopause, finally ending when a woman has gone for 12 months or so without a period, and she is deemed to be post-menopausal.

The average age a British woman begins the menopause is around 50; typically, this causes hot flushes, excessive sweating, tiredness, headaches, mood swings, loss of libido and difficulty sleeping. The chronic lack of sleep alone can, over time, be very debilitating. For many women this happens at an age when they also additional responsibilities with children and elderly parents who may be dependent on them, and or demanding jobs, which adds to the hormonal stresses and exhaustion.

There may also be increased hidden health risks which the menopause brings, such as osteoporosis, heart disease and a greater risk of breast cancer with increasing age. One in 8 women will develop breast cancer during their lifetime and whilst it is important for all women to consider their family history, a small minority, around 5%, will have a genetic predisposition and carry the BRCA 1/2 or TP53 genes which increase the risk of both breast and ovarian cancer. The actress Angelina Jolie has recently raised awareness of the hereditary risks by revealing she is a BRCA 1 carrier, and has undergone a preventative mastectomy and removal of both ovaries. In November we held a BRCA Update Day at KIMS which was very well received, and regular meetings for the local Kent BRCA support group will continue to be held there in the New Year.

In the late 1990s and early 2000s, concerns regarding the link between HRT and the increased risk of breast cancer were raised, but recent data confirms that this risk was overstated. What is often overlooked are the immense benefits taking HRT can bring. For example, in women taking HRT up to the age of 60, the risk of heart disease, a major killer in women, falls by over 50%, and the overall mortality rate in HRT users in this age group also falls by around 40%, which is rarely reported in the media.

It is not just my personal view, but also that of the British Menopause Society, that all women should be encouraged to try HRT and continue therapy until the age of 60. With the correct treatment, many menopausal symptoms will improve rapidly, sometimes within 24 hours of therapy starting. Flushes and sweats tend to improve first, followed by sleep which improves within a week or so, and many women feel can rejuvenated by this change alone. Within 3-6 months, collagen in the skin, hair and nails is rebuilt which improves the texture and appearance. Headaches, joint pains and low mood can also respond positively. Finally, after 6-12 months, bone density also improves, which reduces the long term risk of osteoporosis and fractures.

So why don’t all women over the age of 50 take HRT? In my view, that is largely down to the adverse publicity spread over the last decade in the media. There is also a reluctance from health professionals including GPs, to recommend HRT, even in light of recent research which has confirmed the positive benefits of treatment and substantial reduction in mortality rates, as well as the exciting developments in bio-identical HRT, including patches and gels.

Hopefully this trend will change following the publication of the NICE Guidance on the Menopause and HRT in mid-November this year, which strongly advocates the use of HRT, and encourages the use of specialist local clinics to provide key advice and ongoing support to patients and GPs.

So what are the options locally? KIMS Hospital already provides a full gynaecology service to women and appointments can be booked for consultation at your convenience via the appointments team. KIMS Hospital also offers a Menopause and HRT Clinic which I will be running in conjunction with support from my colleagues in related specialties. The care provided in the clinic is second to none, with access to all the necessary investigations under the one roof including blood tests, pelvic imaging, mammography and bone densitometry. Each woman will then be offered an individual treatment plan, and ongoing support, if necessary.

So don’t feel you have to put your life on hold, make time to take advice now before the menopause stops you leading the life you choose. For more advice or to make a booking call the advice team at KIMS Hospital on 01622 237 726, or email enquiries@kims.org.uk