Menopause, truly a time for change!

Talking of change...

alt‘Menopause’ -what does it mean? The word comes from the Greek men = month + pausis = cessation, so it literally means the stopping of regular menstruation. This normally occurs at any time from the early 40’s to the late 50s, but may be earlier or later. An early menopause can be related to cigarette smoking, high body mass index, racial and ethnic factors, illnesses, and of course it can be brought on artificially by surgical removal of the ovaries. Unless surgery has removed the ovaries, menopause is a gradual change, occurring over months to years, during which the woman is perimenopausal. A woman can be said to have completed menopause once she has not menstruated for 12 months.

What it is not

Menopause is a normal part of the cycle of life, and is not a disease. It may be accompanied by various unpleasant symptoms, and may also be the trigger for psychological issues in a woman realising that her reproductive years are over. The timing may coincide with children leaving home, leaving mother feeling redundant while husband has been forging ahead with his career, sometimes resulting in a somewhat estranged relationship.

What are the causes?

Menopause occurs when the ovaries cease to function, and no longer produce the cyclical hormones responsible for the menstruation. After menopause, estrogen continues to be produced in other tissues, notably the ovaries, but also in bone, blood vessels and even in the brain. However the dramatic fall in circulating levels at menopause impacts many tissues, from brain to skin, leading to the common symptoms as set out below.

The symptoms?

The most obvious symptom is a change in the menstrual cycle. At times the periods may become heavier, they become irregular, and eventually stop altogether. Any bleeding happening more than 12 months after the last period is regarded as post menopausal bleeding and needs investigation to exclude malignancies of the cervix or womb.

Other symptoms include hot flushes, loss of libido with vaginal dryness, irritability, depression and sleep disturbances. Weight gain is commonly thought to accompany menopause, but there is no evidence that it is hormone related. It is due to the fact that the woman is less active and possibly eating more than in her youth. Incontinence is also at times a problem, especially in women who have had several children. This is often relatively easily treated by a gynaecologist. Post menopausal women also revert to sharing the same cardiovascular risks as men, as it is estrogen that protects against this. Bone loss after menopause can lead to osteoporosis and spontaneous fractures later in life.


Hormone replacement therapy comes in many forms, from creams and patches applied to the skin, to pills or skin implants. Traditional therapy combines estrogen and progesterone for those with an intact uterus, or oestrogen only if a hysterectomy has been performed. This is because continuous estrogen has been shown to eventually induce cancerous changes in a postmenopausal uterus. These changes are prevented by using cyclical progesterone once every 3 months or so. An estrogen cream may also be used in the vagina to treat the dryness and thinning of the tissues commonly called ‘senile vaginitis’.This can often relieve both mild incontinence and painful intercourse.

There are some groups of women who should not use hormone replacement, including those who have had hormone dependent breast or uterine cancer, blood clots or a stroke, and some forms of serious liver disease.

To prevent osteoporosis women should try to do weight bearing as well as anaerobic exercise at least 3-4 times a week, the former for keeping bone density and the latter for prevention of muscle loss after the menopause.

What Other treatments are available?

There are several natural remedies for menopause, the best known being black cohosh, red clover and agnes castis.

Red clover contains isoflavins, a form of phytoestrogen. These are plant-derived compounds with estrogen like action which bind to the estrogen receptors and help modulate estrogen activity. If estrogen levels are dominant then they will decrease the effect by competing for receptor space, and if estrogen is deficient then they can help improve its activity. These plant estrogens have shown positive effects on cardiovascular function, bone health, cancer protection and the management of menopausal symptoms. Other examples include soy, and oil seeds such as linseed and sesame.

Black cohosh is used to treat menopausal symptoms such as hot flushes, mood disturbances, sweating, palpitations and vaginal dryness.

Don Quai is sometimes called the female Ginseng. It may alleviate menopausal symptoms without causing proliferative changes in the uterus.

Liquorice root has estrogen-like effects, may reduce body fat and positively impacts on testosterone metabolism. It has been shown to decrease serotonin reuptake by up to 60%, which may alleviate menopausal depression.

Agnes castis is particularly useful for premenstrual symptoms.

Maca or Peruvian Ginseng regulates several key pathways of sexual dysfunction in women and men, by regulating adrenal gland function and optimizing levels of brain neurotransmitters, so reducing the risk of depression, decreased libido and sexual dysfunction.

When to worry

If you are experiencing disabling hot flushes, sleep disturbance or depression, please see your Dr and get help!

For married couples who find themselves estranged by years of career following, there are many counselling services available; please don’t be ashamed, preserve your relationship!

Bleeding after 12 months of no periods MUST be investigated by your Doctor. Uterine and cervical cancers are readily treated if found early.

Breast checks for lumps are an essential self care for every woman, and this does not cease with menopause. Take any dubious lump straight to the Dr!

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