Managing the Menopause

Everybody knows what it feels like to sweat, but waking up drenched in sweat is something else. Cucumber clothing have designed some fantastic nightwear for women made of a fabric which draws the sweat away from the skin and avoids the need to change your pyjamas. If you’ve ever had a hot flush then you won’t be able to imagine it. It simply makes you think you are on fire and as if everybody in the room is looking at you. Actually they aren’t, but it completely saps your self-confidence and fills you with embarrassment. There are some excellent CBT techniques to help with this, and for sure the flush will pass and some mind over matter can be really helpful.

Low energy and exhaustion is, of course, a multifactorial thing. Low iron levels due to heavy periods, sleep deprivation due to night sweats, and anxiety about everything and nothing are all very draining. It’s important to have tests to check that your thyroid gland is working well and tests for anaemia. You may be lucky and have boundless energy if you start HRT but realistic expectation is that you will be better but that life in general may be taking its toll on your energy levels. It’s almost impossible to disentangle symptoms of hormone deficiency and symptoms of getting older.

As we get older there is a natural tendency to become ‘too busy’ to take proper, regular, vigorous exercise. Rushing about to meet deadlines and generally always having too much to do is not the same thing. That said there is a physiological change in weight distribution which occurs after menopause which women really hate. In fact in our recent survey of the things which women hate most about menopause this was their top hate. Fifty sit-ups every day will help, and obviously diet is key. 

Aging itself can lead to development of aches and pains. Joints that are used a lot can develop osteoarthritis, and backs start to get a bit stiffer. It is unlikely that the loss of oestrogen will have any sudden impact on this. Rather it is the long-term absence of oestrogen which leads to loss of bone density and osteoporosis. Different women have different risk factors for this. There is definitely a hereditary component so if your mother developed a stooping spine, do get advice about having a bone density done. This should definitely be a factor you take into account when deciding about HRT. 

There can be lots of reasons for not sleeping well. Being woken up by drenching sweats is certainly one of them. Lying awake worrying about things can be a feature of anxiety which may be helped by HRT or even some talking therapy. Waking at 3 or 4 in the morning and not being able to get back to sleep may a symptom of true depression. Many women reject the idea that they may have anxiety or depression as part of a mental health problem, saying 

The bladder and the urethra are almost as dependant on oestrogen nourishment as the vagina. Getting up at night and general bladder irritability may become a problem. Oestrogen cream put into the vagina will be absorbed through to the base of the bladder and the urethra and help these symptoms. It is a time for really working hard on the pelvic floor and for avoiding food and drink which irritate the bladder. Caffeine is the worst, but different foods affect different bladders and it is worth some experimentation like with an irritable bowel.

Worrying about everything and nothing is the most under-estimated symptom of declining ovarian function. It is often said that women become anxious at this time of life because their children are leaving home and their parents are needy. Both may be true, but this does not account for their steep rise in anxiety which occurs at this phase of life. Consider HRT if appropriate, but at the very least, do seek help and advice. The well-being of women of this age is central to the health of their family and often to businesses as well.

Of course skin quality will deteriorate with age, and with it go thread veins and droopy eye-lids. Good moisturiser is essential but whether the very expensive creams are any better than cheaper versions is doubtful. Hair fall bothers many women too and there really isn’t anything that can be done about it.

Women cope with the change in their appearance in different ways; helped or otherwise by the attitude of their partners.

Or ‘Knowing you ought to have sex with your partner and not wanting to’.

May women feel as if they have lost their sex drive. They say that their husbands ‘are very good’ and they mean tolerant of no sex, but secretly or otherwise they are worried that if they do not provide their partners with sexual satisfaction that their marriage will be at risk. In the main they are right, because sex is very important to most men and has to be done. There is no reason why a woman would want to do it if it hurts so it is important to ensure that the vagina is well nourished with oestrogen cream even if a woman does not want, or cannot have, HRT through the blood stream. Sometimes HRT tablets or patches do not supply a sufficient dose of oestrogen to the vagina and cream or pessaries are needed as well. Do seek advice about this as sometimes a small split at the entrance to the vagina can make sex dreadfully painful. Our gynaecologists will be able to advise.