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by Kathie Cooke

Consultant Nurse BMS recognised Menopause Specialist

Your Menopause Specialist at Liverpool Women’s

At Liverpool Women’s we have a dedicated Menopause clinic supporting all women through menopause.

Menopause can be devastating for some women. It often occurs at a time in life when they are juggling lots of challenging roles – elderly parents with failing health, teen/adult children worries, possibly caring for grandchildren as well as doing their own job.

I’ve met many women who simply stop coping. Through fatigue from sleeplessness and anxiety about severe flushes they lose a sense of self and become withdrawn…isolated….depressed. Libido disappears.

Relationships suffer, and breakdown. Many women walk away from their career.

Some women are plunged into menopause overnight – possibly after cancer treatments. As well as the significant menopause symptoms and treatment side effects, they have the emotional rollercoaster of their cancer diagnosis to contend with.

And younger women, who may not have started, or completed, their family, can enter early menopause. Their situation is complicated by the emotional burden of adjusting to a different future. Long-term heart and bone health can be another worry.

As the Menopause Specialist I offer a holistic approach to menopause management, providing individual advice and support about treatment options – including HRT, nonhormonal treatments and lifestyle changes.

Why do menopausal symptoms occur?

Menopausal symptoms affect at least 70% of women, this is due to the changing hormone levels, particularly estrogen, but many factors such as diet, lifestyle and stress, as well as certain medication can influence the symptoms.

What can help to reduce menopausal symptoms?

For some people, life-style factors such as reducing/stopping smoking, reducing alcohol intake, reducing caffeine intake, reducing stress, eating healthily and taking regular exercise can considerably help the symptoms of menopause.

For others, HRT can be very beneficial. Alternative therapies may also be considered for menopause symptom control.

It is important for those who go through the menopause at an early age (before 45) to understand how taking HRT can help to reduce osteoarthritis and heart health in later life.

Currently, Bioidentical HRT is gaining a lot of media coverage. These are unlicensed, compounded duplicates of human hormones produced by specialist pharmacies and are not authorised by the UK medicines regulating body, the MHRA. These products do not have research based evidence about their safety or effectiveness. Therefore, the BMS do not recommend these products

Bodyidentical HRT, however, is evidence based, regulated and licensed. These products are also precise duplicates of human hormones – and are actually what menopause specialists have been widely prescribing for many years!

More can be read on the British Menopause Society website about BIOINDENTICAL v BODYIDENTICAL HRT  here: https://thebms.org.uk/publications/consensus-statements/bioidentical-hrt/

When do menopausal symptoms begin?

Many women notice early symptoms while still having periods, when the hormone production is declining very gradually. This stage of gradually falling and fluctuating hormone levels is often called the "climacteric" or the "change" and often begins in the 4th decade and can last for several years. Because ovarian function fluctuates, women may experience menopause symptoms intermittently. Some women experience an early, or premature menopause, symptoms may occur immediately, depending on the cause. Immediate onset of menopause symptoms can often come following a surgical menopause. The duration of "early" symptoms is very variable from a few months to many years and the severity varies between individuals.

  • Hot flushes

    A well-known menopausal symptom that affects 60–85% of women. Hot flushes and sweats are called vasomotor symptoms and vary immensely in both their severity and duration; for many women, they occur occasionally and do not cause much distress, but for about 20% they can be severe and can cause significant interference with work, sleep and quality of life.

    Hot flushes usually last 3–5 minutes and are thought to be caused by a change in the temperature-controlling part of the brain. Normally, there is a daily pattern of rises and falls in your body temperature, being lowest at about 3am and highest in the early evening. These small changes are not normally noticed, but a menopausal woman may flush with every temperature rise, whether these are normal changes or not – for example, moving between areas of different temperature or having a hot drink – because of a change in the setting of the temperature control centre in your brain; your body thinks it is overheating even when it isn’t.

    Other factors that can also cause flushes include being overweight, alcohol, excess caffeine, spicy foods, monosodium glutamate and some medications. Eating a healthy diet and losing weight if necessary can be helpful.

    Other simple measures that can help include:

    • wearing cotton clothing
    • wearing loose thin layers of clothing rather than thick tight-fitting clothes
    • keeping your bedroom temperature fairly cool at night – either leave a door or window open or consider a fan.

    Headaches, palpitations (sensation of heart racing) and dizziness can be associated with vasomotor symptoms (hot flushes). Excess caffeine can worsen palpitations, so take coffee, tea and caffeinated soft drinks in moderation.

  • Insomnia

    Insomnia (sleeplessness) or disturbed sleep (leading to tiredness and fatigue), may be partly due to the night sweats, control of which can lead to an improved sleep pattern.

  • Joint aches

    Joint aches commonly occur, often affecting neck, wrists, and shoulders but recognition of their possible association to menopause is often lacking.

  • Mood swings, irritability, anxiety, difficulty concentrating, difficulty coping and forgetfulness

    All may be related to hormonal changes, either directly or indirectly e.g. due to sleep disturbance. However, other life events such as worry over elderly relatives, teenage children, and pressures from work commonly occur around the time of menopause and may contribute to such "symptoms".

  • Sexual Problems

    May be caused by vaginal dryness due to low estrogen levels, resulting in discomfort during intercourse. Effective treatments are available. As both men and women get older, interest in sex may decrease but this particularly affects women. Treatment of other menopausal symptoms may indirectly improve libido by improving feelings of well-being and energy levels, e.g. by improving sleep through control of night sweats, but restoring hormone levels can also improve sensation. Relationship problems have an obvious effect on libido, so hormonal treatment may not always be the "magic" solution.

  • Vaginal and bladder symptoms

    Are very common and can cause significant distress yet are often under-reported and under-treated. Women are frequently too embarrassed to discuss these problems. Very effective treatments are available and should be discussed. Bladder symptoms include passing urine more frequently, discomfort when passing urine, bladder leakage and infection. For vaginal dryness, non-hormonal vaginal moisturisers may be used. For bladder and vaginal symptoms, and to treat the underlying cause, ie lack of oestrogen, local vaginal estrogen (tablet, cream, pessary or ring) can be very helpful. Low dose, vaginal estrogen can be used when systemic estrogen is inappropriate and can be continued in the long-term without any known adverse effects. Vaginal estrogen may be required in addition to systemic HRT since in some women, the systemic HRT, although helping symptoms such as flushes, may not be sufficiently helpful for vaginal symptoms.

How to be seen at Liverpool Women’s Menopause Clinic

If you would like to be seen in our clinic please visit your GP and request a referral to the Liverpool Women’s Hospital Menopause clinic.

The clinic is run at the Liverpool Women’s Crown Street site and also at the Liverpool Women’s Aintree Centre at Aintree Hospital.

Credits to:

22 May 2019

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