Menopause | The Facts 

Menopause is a time when sleep can be disturbed. This can mean difficulties getting to sleep and often problems waking in the night or waking too early and not being able to get back to sleep. There is also often a reduction in the quality of sleep and waking up not feeling rested. This leads to chronic exhaustion.

It is important to:

Not going to bed too early

Avoid excess coffee and excess alcohol

Make sure hot flushes are treated

Get into a routine

Look at sleep apps

Consider antihistamines

Consider HRT

Make sleep a priority

If you start HRT the progesterone part gets converted into a chemical that helps you sleep. Starting progesterone can dramatically improve the quality of sleep if you’re able to take it.

Cardiovascular disease in women is really common, more common than breast cancer.

At age 45 around 30% of women have undetected hypertension. It is really important to check blood pressure and not to ignore high readings.

Between 50 and 60 years of age, cholesterol levels in women rise by 15%. This is due to changes in hormone levels and a reduction in exercise.

Atrial fibrillation increases with age.

Exercise is increasingly important and should become part of your daily routine. This can be small actions such as toning your stomach muscle while sitting in the car to walking further to places (at a pace, not chatting).

Diet is important. Reducing carbohydrates so as not to put on weight and increasing green leaf vegetables will have a positive impact on wellbeing. We know cholesterol starts to increase after the age of 50 so it is important to watch saturated fats in your diet.

When you see your doctor for your well-women check it is important to make sure the doctor checks your pulse and blood pressure and listens to your heart.

Periods can become increasingly heavy. This can go on for many years and women struggle in silence. A woman may become anaemic because the body is not able to cope with the level of blood loss. This can be exhausting.

There are some excellent medications which you can request. You only take these during your period and they reduce the blood loss by around 30%. This can make a period go from being overwhelming with flooding and pain to being totally manageable again. As this may go on for a few years it is worth asking for tranexamic acid. You take this 2-3 times a day during your period and the bleeding will reduce. You can also take mefenamic acid which reduces pain and also reduces blood loss.

This is often a magic cure for women who are struggling and make everything manageable again.

If this doesn’t work consider a coil or if you are under 50 consider the contraceptive pill.

Accurate information on menopause and menopause treatment is paramount to enable women to make informed choices.

When women are first experiencing menopausal symptoms they are often feeling vulnerable. They do not understand why they are feeling the way they are. Women can often feel very unwell, feel they are getting dementia, struggle with mood swings, difficulty coping and forgetfulness.

As a GP, just explaining that all of these symptoms are due to menopause can often go a long way.

Reassurance, in some cases, maybe enough.

Making sure women know hot flushes can last 13 years and they are unlikely to ease in 6-months can prevent women from struggling on thinking the end is just around the corner.

Assessing which symptoms are having the biggest impact is also important. For example, is it the hot flushes? Heavy bleeding? Urinary symptoms? Sexual issues?

Treatments should be individualised and adaptive.

Diet and lifestyle have a major part to play in the severity of menopausal symptoms.

A diet high in natural phytoestrogens can help reduce symptoms.

Glucose intolerance begins when women are menopausal meaning it is no longer possible to eat whatever you want and maintaining a healthy weight can become more difficult.

Exercise becomes more important, not just for weight control but for maintaining bone density levels.

Women may experience increased sensitivity to caffeine contributing to the severity of hot flushes.

Often women find their tolerance for alcohol lessens when they become menopausal.

Smoking increases health risks during menopause.

There are very few women who should not have HRT. The main contraindications to HRT are:

1. Oestrogen dependent tumour.

2. Undiagnosed vaginal bleeding (not periods) .

3. Pregnancy.

4. Active liver disease.

5. Acute thromboembolic disorder(stroke) or acute MI.

If you do not have any of the above and have symptoms then speak to your doctor about HRT as a treatment option.

On average women take HRT for around 7 years. Some take it for less time and some take it for longer.

Studies have shown 42% of women still have menopausal symptoms are 60-65.

HRT can be stopped at any time during the treatment and reassessed to see if you continue to need it.

It is the patient choice to decide if HRT is the right treatment for them and evaluate the risks vs the benefits of treatment.

For example, if the indication for starting HRT was osteoporosis then you may wish to continue HRT for longer.

The digestive system is incredibly complex.

Gut microbes (present in the digestive system) are gaining increased attention and focus as being more important to our overall health than has been previously recognised.

Here are some simple tips to start improving gut health. Gut microbes respond well to:

1. Diverse diet of good quality plant-based foods.

2. Fermented foods.

3. Time-restricted eating.

Gut microbes do not respond well to:

1. Processed food.

2. Refined carbohydrates.

3. Artificial sweeteners.