What is the menopause?
Menopause is a time when a person’s periods stop and the ovaries stop producing hormones. The average age of menopause in the United Kingdom is 51. In a natural menopause people may experience symptoms for several years prior to periods stopping, this is known as perimenopause. Some people may experience an early menopause due to having treatment which involves removing the ovaries, radiotherapy to the pelvis or chemotherapy. Some people experience premature ovarian insufficiency where often the reason is not known.
This leaflet will explain what the symptoms of menopause are and will give advice on some things that can help to control the symptoms and life style advice on reducing some of the longer term effects of the menopause.
There is limited data regarding the use of hormone replacement therapy (HRT) after cancer. The situation is often complex but you may wish to discuss the risks, benefits and uncertainties regarding HRT with your doctor.
What are the symptoms of the menopause?
Symptoms vary from person to person but common symptoms include:
- Hot flushes
- Night sweats
- Headaches
- Tiredness
- Joint pains
- Palpitations (feeling your heart beating)
- Poor memory
- Poor concentration
- Low mood/mood swings
- Irritability
- Anxiety
- Reduced sex drive
- Vaginal dryness
Longer term effects can include:
- Thinner and dryer skin
- Bladder problems (needing to pass urine more, pain when passing urine, incontinence, being prone to urine infections)
- Heart disease
- Thinning of the bones (osteoporosis)
Coping with hot flushes and night sweats
Hot flushes and night sweats can be very uncomfortable and distressing, some people feel embarrassed. The following can help you to cope with hot flushes:
- Wear loose fitting cotton clothing. Dress in layers so you can remove something if you feel a flush coming on
- Keep cold water close at hand
- Use a fan or hand held fan
- Yoga and yoga breathing can help
- Avoid foods that can trigger a hot flush. This is usually hot and spicy foods, tea and coffee that contain caffeine, alcohol and cigarette smoking
- Use lighter bedding and if you can sleep with a window open or keep a fan by the bed. Some people find cool pillows or a pet cooling mat help
- Relaxation techniques such as deep breathing and visualisation can help
- Acupuncture can help
- Cognitive behaviour therapy can also help with coping with the symptoms of menopause.
There are a range of over the counter medications that can help with hot flushes. We would advise that you speak to your doctor before trying any of these. There are also a range of prescribed medications that do not contain hormones that you could discuss with your doctor.
Bone health
When people go through the menopause their bones can begin to thin and you can develop osteoporosis. Thinning of the bones can increase the risk of a fracture. Other factors which can increase your risk of developing osteoporosis are having a previous fracture, a history of anorexia or not having periods due to extensive exercise, a family history of osteoporosis, steroid use, excessive alcohol or caffeine consumption, smoking and an overactive thyroid.
It is important you have enough calcium in your diet. Calcium can be found in dairy products such as milk, cheese and yogurt, eggs, green leafy vegetables and fish such as sardines and pilchards. You can complete the Edinburgh Calcium Calculator (https://webapps.igc.ed.ac.uk/world/research/rheumatological/calcium-calculator/) to check if you are eating enough calcium in your diet. If you are not eating sufficient calcium you can discuss this with your doctor and they may recommend taking a supplement. Vitamin D is also essential for healthy bones. We produce vitamin D from exposure to the sun. You may benefit from taking a supplement. You can discuss this with your doctor. Avoid fizzy drinks, reduce your caffeine and alcohol intake and avoid cigarette smoking as they can all increase your risk of thinning bones.
Exercise can also help to maintain bone health. The best exercises are called weight bearing exercises such as walking, aerobics, pilates and yoga. Pilates and yoga can be very good for improving balance which can reduce the risk of a fall. The current government recommendations are to have two and a half hours of exercise each week which can be spread over the week.
Depending upon your age your doctor may arrange for you to have a bone scan, called a DEXA scan which can diagnose osteopenia (thinning of the bones which has not progressed to osteoporosis) or osteoporosis. If you are diagnosed osteoporosis your doctor may start treatment for this.
Heart health
When someone goes through the menopause the risk of heart disease begins to increase. The hormones estrogen and estradiol have a positive effect on the heart. They help to control cholesterol levels and reduce the risk of fat building up in the arteries. They can also help to keep the blood vessels healthy.
Cardiovascular disease is a general term for conditions affecting the heart and blood vessels. It is usually associated with a build-up of fatty deposits inside the arteries and an increased risk of blood clots. There are many different types of cardiovascular disease. The four main types are:
- coronary heart disease which can lead to angina, heart attacks and heart failure
- strokes
- peripheral arterial disease
- aortic disease
Causes of cardiovascular disease include high blood pressure, smoking, raised cholesterol levels, diabetes, being inactive, being overweight, a family history of cardiovascular disease and excessive alcohol intake. To reduce your risk of developing cardiovascular disease:
- Eat a balanced diet. Reduce saturated fat in your diet such as butter, fatty cuts of meat, lard, cream, cakes and biscuits and replace this with healthier fats like olive oil and vegetable oil, oily fish and nuts.
- Reduce salt and sugar in your diet
- Increase fibre intake such as wholemeal bread, wholemeal pasta, lentils and beans
- Include fruit and vegetables in your diet. Government recommendations are five portions per day.
- Exercise regularly
- Maintain a healthy weight
- Stop smoking
- Drink alcohol sensibly and try not to exceed the recommended limit of 14 units of alcohol per week.
Between the ages of 40-74 adults should be invited for a health check by their GP surgery every 5 years. As part of this check blood pressure, cholesterol and weight are checked. This can help to identify any signs you are at risk of developing heart disease, take measures to reduce your risk and for your GP to prescribe treatment if required.
Genitourinary syndrome of the menopause
Genitourinary syndrome of menopause (GSM) is a condition which can affect people following the menopause. It is a group of symptoms and changes in the genital and urinary tract area that is caused by the decline in estrogen and estradiol. Symptoms can include:
- Vaginal dryness which can cause a burning sensation
- Vaginal discharge
- Genital itching
- Needing to pass urine more often, urgency and a burning sensation when passing urine
- Recurrent urinary infections
- Discomfort during sex
- Shortening and tightening of the vagina
Vaginal moisturisers can help to improve symptoms. There are a range of moisturisers available on prescription. Your Clinical Nurse Specialist will be able to provide you with samples. Vaginal estrogen cream or tablets can also be considered, you should discuss this with your G.P. Avoid using scented soaps and shower gels in the genital area. Pelvic floor exercises can help to improve bladder symptoms.
Sexual difficulties
It is common for people to experience sexual difficulties around the time of menopause. Having a cancer diagnosis and treatment can impact this further and affect body image and confidence. Relationships can also be affected by a cancer diagnosis and treatment. Common difficulties include:
- Pain during intercourse
- Reduced sensation
- Loss of desire
- Difficulty with arousal
- Not being able to achieve orgasm
- Fear of sexual contact
- Reduced intimacy
- Communication difficulties with your partner
If you have concerns or questions regarding sexual health please discuss this with your nurse specialist. They may need to arrange an appointment to see you to assess and discuss this in more detail.
Below you will find a list of organisations that can provide additional information and support about menopause and consequences of menopause.
