Myths and facts about menopause: The big change

Around 1 in 10 women experience symptoms of the menopause for up to 12 years approximately. Symptoms usually start appearing a few months or years before their last period. These changes can be daunting.

We spoke with an expert in women's health and leading London consultant gynaecologist, Ms Ferha Saeed, to discuss the symptoms of the menopause in detail, what the best approach to manage it is, and what are the misconceptions about the menopause and its treatment.

What is the menopause and how can it affect a woman's life?

The menopause refers to the time when a woman is no longer able to naturally bear children, and this is usually marked by one year after her final menstrual period. However, clinical diagnosis can be made in women above 45 years of age based on their symptoms. It usually happens between the ages of 45 and 55 years, with an average age of 51. In the years leading to the menopause, women may start to notice significant changes, which may signal the menopausal transition. This is known as the peri-menopause.

Periods usually start to decrease in frequency over a few months or years before they stop altogether. Sometimes, they can even stop rather abruptly. This happens because the woman's oestrogen hormone levels decline.

Most women will experience menopausal symptoms. There is a wide spectrum of how women experience these symptoms. On one hand, some women have no noticeable symptoms other than their menstrual period stopping. On the other hand, there are women who experience severe symptoms which have a significant impact on their everyday activities.

• night sweats
• dry skin
• discomfort during sex
• pressing need to urinate more frequently
• difficulty sleeping
• emotional changes (irritability, mood swings, depression)
• impaired memory and concentration

More importantly, the oestrogen hormone is a natural bone protector. When it declines at the menopause, women lose this protection and their bones become weak and porous, what we call osteoporosis. This increases the risk of bone fractures.

Many menopausal symptoms that are accepted as a part of ageing or the maturing process are actually symptoms of change that need awareness and medical attention.

What is the best approach to manage the menopause?

All women are different and respond differently both to oestrogen deficiency and in their response to treatments. Decisions to treat the menopause have to be made on an individual basis, taking into account the severity of symptoms, medical history, family history, diet, lifestyle, and individual preferences and concerns.

Emphasis has to be made on the importance of explaining to women about the effect and consequences of the menopause. This extends beyond flushes and sweats and includes psychological symptoms, musculoskeletal symptoms, vaginal, bladder and sexual effects, as well as long-term effects on bone and cardiovascular health.

Lifestyle and diet advice should be considered, particularly smoking cessation, weight loss, alcohol reduction, and physical exercise to help general health and wellbeing.

Moreover, there are a number of treatments that GPs and gynaecologists can suggest. These include hormone replacement therapy (HRT) in the form of tablets, skin patches, implants and skin gels that relieve menopausal symptoms by replacing oestrogen. There are various alternatives to HRT for menopausal symptoms that can be offered.

Women with psychological symptoms may benefit from cognitive behavioural therapy (CBT). This therapy can help if you have anxiety and a low mood.

What are the misconceptions about the menopause and its treatment?

Although it impacts all women at some point, talking about it is still seen as a taboo subject and it still is something people avoid addressing. This actually has provided an opportunity for various misconceptions to spread in our community. The first misconception is that it's an old age thing and nothing can possibly be done.

We need to increase awareness that women have to live with the menopause for decades and therefore, they will need a well-managed quality of life with or without hormones, rather than bearing it as an accepted ageing process.

The other common belief is that HRT gives you breast cancer. The absolute excess risk is small, probably increased slightly after a minimum of five years' use of combined HRT. We see additional three to four cases for every 1,000 women who are using combined HRT.

The safety of HRT largely depends on age. However, healthy women who are younger than 60 years shouldn't be worried too much about the safety profile of HRT. The benefit of treating the symptoms and a better quality of life has to be balanced with the small risk.

Finally, modern forms of HRT and other alternatives can also be incredibly helpful. Clear national guidelines already exist to guide GPs and gynaecologists to prescribe the right treatment and care. Unfortunately, we see so often that these aren't being implemented. Outdated myths about HRT are still widespread; therefore, awareness programmes will help to change the perception about this big change of the menopause and its management options.

In order to prepare for the menopause, you may like to speak with a consultant obstetrician and gynaecologist such as Ms Ferha Saeed. Visit her Top Doctors profile today for more information on her expertise.