Problems at the menopause

Some women sail through the menopause almost without noticing, but for others this is a time when a variety of unpleasant symptoms can interfere with ordinary daily life and cause difficulties at home and work.

The term ‘menopause’ refers to the time that regular periods stop or become irregular. The exact age at which this happens varies considerably from the early 40s to late 50s. At the time periods stop, production of oestrogen and other hormones from the ovaries starts to decline. The body has been used to a fairly high level of oestrogen since puberty; the decline in this level may produce symptoms in the few years following the menopause.

Symptoms can come on gradually and a woman may not realise that the way she feels is a result of the menopause, but occasionally they are obvious and dramatic. Dizziness, headaches, tiredness, palpitations and depression are not uncommon. Loss of concentration can affect those with exacting work. ‘Hot flushes’ are a sudden, often severe, flush of the face which may spread to involve the whole body or be associated with dizziness. These flushes tend to come on some time after periods stop, and although many people think they are characteristic of menopausal symptoms, do not always occur. Vaginal dryness and soreness can make intercourse painful.

To some extent, features which we all regard as the normal processes of ageing are due to a lack of oestrogen. After the menopause the bones become more brittle and there is greater proneness to heart attacks. Some doctors are trying to reverse these processes using very long- term oestrogen treatment. We feel that it is still too early to know whether this is going to be successful and free from undue risk.

Home Treatment

Individual symptoms may be helped by appropriate home treatment. For an occasional headache take paracetamol or aspirin. If depression occurs, take a look at other aggravating factors. Loneliness, with a family growing up and moving away, may be a problem. Difficulties with intercourse may be caused by vaginal dryness. Try using KY Jelly for lubrication. If symptoms are seriously interfering with ordinary daily life or sexual relationships, make an appointment to see your doctor.

A word of warning about contraception: if sexual activity is taking place and pregnancy is to be avoided, an efficient method of contraception should still be used for a year after the last period if under 50, and for six months after the last period if over 50. Ovulation can sometimes occur some months after the last period; an unwanted pregnancy at this age can add to the problems.

What the Doctor Will Do

Take a history of your complaints and symptoms and ask about your last periods. He may decide to prescribe low- dose oestrogen treatment to correct the deficiency in the body’s own oestrogen. This is called Hormone Replacement Therapy or ‘HRT’. Expect a routine blood- pressure check and sometimes a cervical smear before this starts. Occasionally a vaginal smear is also taken which may be of some value in assessing possible oestrogen deficiency. Symptoms will usually be relieved by HRT quite quickly although it may need to be continued for some months or years. It is a matter of considerable debate amongst doctors as to how long the treatment should last, but expect regular checks from your doctor whilst taking it.

If your doctor has reservations about using HRT, and you are very bothered by menopausal symptoms, you may ask to be referred by him to a gynaecologist. In some hospitals there are clinics specialising in HRT to which you can be referred.