Menopause: answering your questions
Menopause can often be very easily dismissed as just one or two hot flashes. It is so much more, but a serious lack of understanding and awareness can diminish the experience of any person going through menopause. As a result, questions may not be asked, limiting the ability to make informed choices. When it comes to menopause, there are no embarrassing or ridiculous questions. Learning about menopause is essential. Always ask.
Dr Caoimhe Hartley founded Menopause health in 2021 to help women access the best advice and care throughout menopause. Dedicated to women’s health, Dr. Hartley is aware of the difficulties women experience in understanding and managing their journey through menopause. Dr Deirdre Lundy of the Bray Women’s Health Center is a women’s health specialist and oversees menopause training for Irish general practitioners at the Irish College of General Practitioners.
Here they answer some of our concerns about menopause.
I am 49 years old but I do not feel postmenopausal. Does every woman have symptoms of menopause?
“The majority of women will experience symptoms of perimenopause or menopause,” says Dr. Hartley. “It can affect their mood, sleep, or physical symptoms like hot flashes or night sweats. For some women, it may be vaginal dryness or bladder symptoms. The loss of bone density that occurs when our estrogen production declines during menopause is, for the most part, silent.
“Fortunately, however, there is a percentage of women who have no symptoms. Likewise, not all women experience significant bone density loss after menopause. The reasons why some women have symptoms and others do not may depend on genetic factors. If your period has stopped for more than a year [and you are over the age of 50], you can be sure that you have gone through menopause.
My body is in pain. Is this a sign of menopause?
“Generalized pain is common during menopause,” advises Dr. Hartley. “This may be due to the loss of estrogen, which has weak anti-inflammatory properties. Similar symptoms have been seen with aromatase inhibitors which are antiestrogen drugs sometimes used in patients who have had breast cancer.
“There may be a ripple effect from these pains, including poor sleep and a reduced ability to exercise or be active. Living with aches and pains can also negatively impact our mood. You may find that an old injury is reappearing or it is a completely new symptom. Know that you are not alone and that there are options to help you. Joint pain can also be due to other causes such as osteoarthritis, inflammatory arthritis, and other conditions. It’s always a good idea to discuss this with your GP as you might need further investigation.
My symptoms are relentless. What can I do?
“A lot,” reassures Dr. Hartley. “The first step is to seek advice and help. Do not suffer in silence! The course of management will depend on the symptoms you are experiencing, the health risks, and any values you may have. I usually start by discussing lifestyle interventions, exercise, CBT with patients. [cognitive behavioural therapy], caffeine and alcohol reduction, and a discussion of sleep hygiene, etc.
“There are also non-hormonal and hormonal options for managing the symptoms of menopause. Estrogen [as part of hormone replacement therapy] is most effective at treating symptoms such as hot flashes and night sweats and vaginal symptoms in addition to protecting against the development of bone density loss and osteoporosis.
“If the symptoms of menopause are not relieved by lifestyle changes, and they often are, we recommend that you see a doctor who has had menopause training,” says Dr. Lundy.
I am postmenopausal and so anxious. Is this normal?
“It is extremely common to experience mood swings and anxiety with menopause,” says Dr. Hartley. “Many women report loss of confidence, low self-esteem, irritability or loss of motivation. Sometimes these symptoms come and go and may be mild. For others, they can be debilitating.
“Women who have suffered from depression, anxiety, significant PMS, or postpartum depression / anxiety in the past may be at greater risk of developing mood or anxiety issues around menopause. It is important to talk to your GP about the many options for managing all of these symptoms.
Menopause is ruining my sex life. What can I do?
“It depends on so many factors,” says Dr. Hartley. “What are the underlying issues affecting your sex life? Do you have vaginal dryness that makes sex uncomfortable or painful? Do you suffer from sleep disorders or a bad mood? There are a lot of things that can impact sexual desire and function. I would advise you to speak to your GP.
I am full of rage! Why is this happening to me?
“There could be many reasons for this,” says Dr. Hartley. “The fluctuations in estrogen levels that occur during perimenopause [the years of hormonal changes that lead up to menopause, the final period] can have a big impact on mood, irritability, anxiety levels and self-confidence. Estrogen has an important role in our nervous system and has an impact on how we make neurotransmitters, the expression of hormone receptors in our brains, and the protection of our nerve cells from damage.
“Rabies is not uncommon during menopause. It needs to be treated with health care, ”says Dr. Lundy. “HRT can help, but sometimes the hormonal changes during menopause only trigger the onset of underlying psychological disorders such as bipolar, severe anxiety and depression.
“Vulnerability to mood swings or irritability is worsened by insufficient sleep, fatigue and other possible symptoms,” advises Dr. Hartley. “Know that you are not alone and that there are many options available to help you manage. “
Is hormone replacement therapy right for me?
“This is a very difficult question to answer because it depends on so many different factors,” says Dr. Hartley. “Hormone therapy for menopause [HRT] is one of several management options we have to help women relieve symptoms of menopause. Along with HRT, there is also protection against loss of bone density, and for some women there may be a reduced risk of developing cardiovascular disease. It depends on your own underlying risk and the symptoms you are hoping to treat. It depends on your own values and health goals.
“For the majority of women, the benefits of hormone therapy, both symptom relief and health improvement, outweigh the slightly increased potential risks. The type of HRT, the hormones prescribed, and how long you take them are also important when you consider the risk. Again, for most women, the benefits outweigh the risks. The length of time you take HRT is also very individual, and there is no age or arbitrary length of use to stop your medicine.
“It is important to look at lifestyle factors such as smoking, physical activity, alcohol consumption and diet, which can impact the long-term risk of developing osteoporosis. or loss of bone density and cardiovascular disease.
“Having your blood pressure and cholesterol checked every year, keeping up to date with breast and cervical cancer screening is also essential. There are many alternatives to using HRT, but it will depend on the symptoms that are affecting your quality of life and, therefore, the goal of treatment. Whichever treatment route you choose, you should be well informed and have a thorough discussion with your healthcare professional about the best option for you.
How long before I feel like myself again?
“This is a difficult question to answer,” replies Dr Hartley. “The duration and severity of symptoms depend on many factors and are very individual. The average duration of hot flashes and night sweats is five to seven years. Most symptoms will improve over time, but some problems, such as vaginal dryness and discomfort, may continue to get worse over time.
Dr Lunday says, “Most women start to feel better around the age of 55 to 60. Others can be charged for much longer, and remember, some women may not have any symptoms. “