September was Menopause Awareness Month and October is World Menopause Month so we thought it would be a good opportunity to fight the taboo and talk menopause. This is a good time to raise awareness of the menopause and associated disorders and diseases.
The menopause is a significant life event. It is a unique time in women’s lives and can vary from person to person. With increased life expectancy, women will live an average of a third of their lives in menopause.
We believe that with increased awareness and informed choices, menopause should not be a taboo subject but a part of life that should be embraced. Menopause is normal. All women go through it.
It is okay to have conversations with partners, friends and work colleagues. Encourage people to feel more confident speaking about menopause. If you need help, don’t be afraid to ask. There are many wonderful medical clinics and hospitals in the VI. The professionals are here to help.
The usual age range of the menopause is 45 – 55 years, as the oestrogen levels decline. The average age in the UK and US is 51, although it is important to remember that there are other contributing factors.
* Genetics – if your birth mother had early menopause, you are likely to as well.
* Poor nutrition can be associated with an early menopause
* Smokers tend to have earlier menopause by 1-2 years compared to non-smokers.
There are 2 different types of menopause. Natural menopause and induced menopause. Induced menopause is the permanent stop in menstruation due to the surgical removal of both ovaries or the suppression of ovarian function due to chemotherapy or radiotherapy. This may or may not be permanent. Surgery is permanent.
Early menopause occurs before the age of 45. If experienced at a younger age, symptoms may be more severe and so may result in the lady requiring a higher dose of Hormone Replacement Therapy (HRT) to achieve adequate symptom control, especially following induced menopause when there is a sudden drop in oestrogen.
Oestrogen is one of the two female sex hormones. It has many important factors.
* Controls the menstrual cycle
* Maintains pregnancy
* Keeps cholesterol levels in control
* Protects bone health
* Affects the brain (including mood), bone, heart, skin and other tissue.
During menopause there is a gradual decline in oestrogen levels, resulting in periods becoming less frequent. There are thought to be around 35 symptoms of menopause. Some women may experience all of these symptoms at different levels of severity. Others are lucky enough to breeze through it with only minor symptoms. Not all symptoms will necessarily be linked to menopause, so if you are in any doubt, check with your doctor. Writing a diary and documenting your symptoms is a really helpful way of keeping track.
Most common symptoms are a result of the gradual decline in oestrogen. Symptoms will improve in 2 – 7 years. It doesn’t go on forever.
* Hot flushes
* Night sweats
* Mood changes – low mood, anxiety and forgetfulness.
* Increased weight distribution
* Vaginal dryness
Falling levels of oestrogen decrease bone density. It is really important to remain active (just 20 mins per day). Eat a healthy balanced diet, rich in calcium and Vitamin D. This is good for building strong bones. Women are advised to decrease alcohol consumption and stop smoking as it increases the risk of osteoporosis.
Why do women put on weight?
This is due to the change in hormone levels. Oestrogen helps to regulate metabolism and body weight, so when the oestrogen levels decrease, body weight can increase.
Energy levels tend to decrease around menopause, so making it more difficult to get motivated to exercise. This decrease in activity can cause loss of muscle mass, which also slows down metabolism. Finding an exercise that fits your lifestyle and body will help. If you hate running there is no point taking it up. Think of other forms of exercise that you enjoy, like walking, swimming, aerobics. Increasing muscle mass helps boost metabolism, which is certainly a positive.
It is important to decrease your stress levels, as it can be a hidden cause of weight gain. Such as by comfort eating. Reducing stress can help your overall health and well being. Try yoga or mindfulness.
With many women leading busy lives at both work and home, it is important that time is made for adequate rest and relaxation. It is important in relieving stress and anxiety, improving mood and overall well-being.
Keep hydrated. This helps your body metabolise fat quicker. Drinking plenty of water rather than caffeinated sugary drinks is advised.
Managing menopause in a hot climate such as the Virgin Islands can be a challenge. A few simple tips can help you feel more comfortable.
* Wearing cotton and linen clothing is more comfortable and cooling compared to synthetic clothing.
* Wear loose-fitting clothing
* Layer your clothes. Enabling you to peel off a layer or add a layer according to the environment
* Sleeping in cotton sheets and switching on the AC/fan at night will allow you to have a comfortable and more restful sleep
* Keep a little hand fan in your bag
Before commencing any new treatments it is strongly advised to discuss with a doctor first. There are a variety of treatments that can help with menopause such as HRT, herbal remedies, lifestyle changes, and complementary therapies. Women need the opportunity to have an informed choice to be able to make the right decision for them as an individual.
HRT is not dangerous. It is like finding the right pair of shoes – if one doesn’t suit try another, please don’t give up too soon. Most side-effects ease off within the first few weeks. This is the only treatment that can completely relieve menopausal symptoms. All women should be given the opportunity to discuss and consider the role of HRT in managing their symptoms with a doctor.
Ongoing research shows that for healthy women under 60, particularly regarding the quality of their life, the benefits of HRT outweigh the risks. Professor Gillian Reeves from the University of Oxford, UK, states “There appears to be little risk from use of menopause hormone therapy for less than one year, or from topical use of vaginal oestrogen that are applied locally as creams or pessaries and are not intended to reach the bloodstream.”
The Primary Care Women’s Health Forum states “Women need to assess the impact that their symptoms are having on the quality of their life. They should consider the effect on their family, their ability to work and the value that relief would represent. They need to understand that while a longer duration of hormone exposure might increase breast cancer growth, attendance for screening allows early diagnosis and better treatment outcomes. They also need to factor in the avoidance of fractures, heart attacks, bladder infections and other proven benefits of HRT and make a decision that is appropriate for them and review it annually.”
“Women must be informed of the small increase in the risk of breast cancer so they can weigh these up against the benefits that they may have from taking HRT. Every woman experiences menopause differently and symptoms vary. These can be extremely debilitating and have a significant impact on a woman’s physical and psychological health, career, social life, and relationships. Unfortunately, many women are still suffering in silence and are reluctant to seek advice and support due to concerns around the risks of breast cancer associated with HRT.”
There may be circumstances where you cannot take HRT, for example, if you are undergoing treatment for certain types of cancers. You may have tried HRT and not tolerated it because of the side effects or prefer not to take it and have chosen to take a more “natural” approach to manage the menopause. As mentioned above good nutrition is essential at all stages of life but especially in menopause where eating a balanced diet can help reduce weight and minimise symptoms. It is also important in reducing the risk factors associated with heart disease and osteoporosis. It is important to discuss new treatments with a doctor or pharmacist before commencing any new medication or remedies.
Vaginal atrophy is very common during the menopause. Unfortunately, it is a subject that is rarely talked about. It is caused by a lack of oestrogen and can cause the tissue of the vagina to become dry and more fragile, which can cause discomfort, itching, discharge, and pain during intimate relationships. There are a number of treatments available to help ease these symptoms. You can purchase soap substitutes such as Aqueous cream and vaginal lubricants from the local pharmacies. Vaginal oestrogen preparations (cream, vaginal ring or pessary) can be used in combination. They will improve the lining of your vagina and increase moisture, making exercise and sexual intercourse more comfortable again.
Herbal remedies are used by many women and report an improvement in symptoms like flushes, sweats and mood swings. A few examples are Agnus Castus, Black Cohosh, Ginkgo Biloba and Sage. Although there is very little scientific evidence available on the use of these remedies. Herbal remedies which may be useful for some women, however, are not recommended for women who have had breast cancer as can have oestrogenic properties. Please do check with a doctor/ pharmacist before taking anything new.
Complementary therapies such as acupuncture, reflexology and homeopathy aim to treat the whole person rather than the specific symptoms of the menopause. Some women feel that a combination of these with other lifestyle changes can help their symptoms improve.
Women can find that talking to friends, family and other support networks, sharing information and experiences is beneficial and helps them to feel that they are not alone. To help support our local community we have decided to set up a Menopause workshop on Wednesday 30th October, 6pm at Village Cay Road Town, Tortola. We want to raise awareness about the menopause and decrease the taboo surrounding it.
Helen Kiernander. Bachelor of Nursing (Hons)