Facts About Menopause & Hormone Replacement
What is menopause?
Menopause is a very individual experience, and the signs vary greatly. For many women, the first indication is that periods start to become irregular. Technically, it means your last menstrual period. However, in everyday speech it is used to describe the years when menopausal symptoms are experienced, both before and after the menopause itself. Approximately 75% of women experience some of the following symptoms/conditions, but some have virtually none.
Physical: hot flashes/flushes, night sweats, feeling dizzy, stress incontinence, urgency and frequency of passing water, palpitations, headaches, crawling sensation in the skin, loss lack of energy
Emotional: irritability, mood swings, sleeplessness, panic attacks, anxiety, loss of interest in sexual relations, memory lapses, loss of concentration, lack of confidence
Stress incontinence, thinning skin, bladder/vaginal infections, aches and pains, vaginal dryness, thinning hair, sex becomes painful, brittle nails
Increased risk of osteoporosis, brittle bone disease, increased risk of heart disease
In the normal menstrual cycle, the egg cells produced every month are ripened in the ovaries by the hormone estrogen. Another hormone, progesterone, prepares the womb for a fertilized egg. If no egg cells are fertilized, the womb lining is lost as the monthly period. In later life, the ovaries slow down and eventually the production of egg cells ceases. The accompanying decline in estrogen and progesterone cause the characteristic symptoms of menopause.
When does it occur?
The average age is 51, though this varies widely. Some women stop having periods in their early forties, while others go on until their late fifties. Premature menopause can occur before this age range (has been seen as early as the twenties), though this is very rare. Premature menopause may be related to family history. Some cancer treatments and surgery for endometriosis or nonmalignant ovarian cysts are also potential risk factors. Women, who have had a hysterectomy, or removal of the womb, continue to produce estrogen and have a normal menopause. Some younger women stop producing estrogen within two or three years of a hysterectomy. The surgical removal of both ovaries produces an instant menopause, as the sudden loss of estrogen can rapidly bring on severe menopausal symptoms.
How long does menopause last?
The length of menopause varies. Menstrual periods rarely stop without warning - most women find that they become irregular, and often heavier, for some time before stopping altogether. This stage is called the peri-menopause, and generally lasts for two to three years. On average, women who do experience symptoms continue to do so for up to two years after their final period, although some have hot flashes for up to ten years.
Can Hormone Replacement Therapy (HRT) help?
For over 50 years, hormone replacement therapy, or HRT, has been prescribed to relieve or prevent the immediate symptoms of menopause, and as long-term protection against osteoporosis. As its name suggests, HRT works by replacing the hormones which the body stops producing at menopause. HRT can be taken in several ways: orally (tablets or gelcaps), vaginally (pessaries, creams and vaginal rings), on the skin (patches and gels), or under the skin (implants). Your doctor or nurse will help you decide which is best for you.
Women who have had a hysterectomy are usually given HRT containing estrogen on its own. Otherwise, they will probably be prescribed a combination of estrogen and progesterone, which protects the lining of the womb. With these combination treatments, women experience a withdrawal bleed each month similar to a period. Period-free treatments are now also available for women who are at least a year past their final menstrual period.
Once women are settled on HRT, most doctors recommend continuing for between five and ten years to gain the long-term benefits. HRT is not the answer to everything and it is not necessarily suitable for everyone. Any decisions on treatment should be made with a doctor or nurse.