What is the menopause?
Menopause is a normal part of life. It is one step in a long, slow process of reproductive aging. For most women this process begins silently somewhere around age 40 when periods may start to be less regular. Declining levels of the hormones estrogen and progesterone cause changes in your periods. These hormones are important for keeping the vagina and uterus healthy as well as for normal menstrual cycles and for successful pregnancy. Estrogen also helps to keep bones healthy and maintains good cholesterol levels in their blood.
Hormones and ‘the change’
Menopausal transition, commonly called the perimenopause, is the time when a woman’s body is closer to menopause. At this time, a woman’s periods may become less regular, and she may start to feel menopause symptoms, such as hot flushes and night sweats. Perimenopause usually begins about 2 to 4 years before the last menstrual period and lasts for about 1 year after the last period.
The menopause is marked by a woman’s last menstrual period. You cannot know for sure what is your last period until you have been period free for 1 full year.
Postmenopause follows menopause and lasts the rest of your life. Pregnancy is no longer possible. There may be some symptoms, such as vaginal dryness, which may continue long after you have passed through menopause.
How Can I Stay Healthy Throughout Menopause?
- To stay healthy you can make some changes in the way you live. For example:
- Don’t smoke.
- Eat a healthy diet that is low in fat and cholesterol and moderate in total fat. Your diet should aim to be high in fibre and include fruits, vegetables, and whole-grain foods. It should also be well balanced in vitamins and minerals, including calcium.
- Lose weight if you are overweight.
- Take part in weight-bearing exercise, such as walking, jogging, running or dancing at least 3 days each week.
- Take medicine to lower your blood pressure if required.
- For vaginal discomfort, use a water-based vaginal lubricant (not petroleum jelly) or an estrogen cream.
- If you frequently feel an urgent need to urinate, you can consider techniques such as pelvic muscle exercises, biofeedback, and bladder training that can help you improve muscle control.
- Be sure to get regular pelvic and breast exams, Pap tests, and mammograms.
- If you are having hot flushes, keep a diary to track when they happen. You may be able to use this information to help find out what triggers them.
Try these tips to help manage hot flushes:
- When a hot flush starts, go somewhere cool.
- If hot flushes wake you at night, try sleeping in a cool room.
- Dress in layers that you can take off if you get too warm.
- Use sheets and clothing that let your skin “breathe.”
- Have a cold drink (water or juice) at the beginning of a flush.
What About Hormone Replacement?
In the perimenopause, it might be a good idea to take birth control pills especially if you are having problems with very heavy, frequent or unpredictable menstrual periods. This medication will make your periods more regular. It may also help with symptoms like hot flushes. However, birth control pills can hide the arrival of menopause. If you think you might have reached menopause, you can stop taking the pill for a while and see if you start having regular periods again. But if you were using birth control pills to prevent pregnancy, you should remember to use another type of contraceptive until you have gone 12 months without a period.
The use of Hormone Replacement Therapy (HRT) has changed dramatically in recent years. Current evidence suggests that HRT may relieve menopause-related symptoms, such as hot flushes, and reduce loss of bone but that HRT has risks. It should not be used for long-term prevention of heart disease. Taking HRT increases, rather than reduces, the risk for heart disease and stroke. It also increases the risk of breast cancer and blood clots but it appears to decrease the risk of colon cancer. HRT can be taken in a variety of forms such as pills, skin patches, creams, or vaginal inserts, depending on a woman’s needs.
Please make an appointment if you have specific problems or would like to discuss the menopause.