World Menopause Awareness Day: A Guide to Menopause and Symptom Management

What is menopause? 

Menopause refers to a natural stop in the menstrual cycle and fertility. Menopause happens because the ovaries stop producing the hormones oestrogen and progesterone. The usual age at which women experience this is between 45 to 55 years old. Currently, the average age is 51 years old. It is usually accepted that menopause has been reached when there has not been a menstrual period for 12 months. 

Symptoms include changes in the pattern of the cycle e.g. periods heavier, lighter, a change in the length of the cycle; hot flushes/night sweats also called vasomotor symptoms (VMS); mood swings; vaginal dryness/urinary urgency/UTI also called genitourinary symptoms of menopause (GSM); weight gain/thinning hair. 

How to manage the menopause 

There are several lifestyle changes which are very effective 

• Dietary changes

  Avoidance of certain foods and drinks – caffeine, tea, alcohol and spicy foods – which are known to trigger hot flushes/insomnia - may lessen the severity and frequency of these symptoms. Increased dietary protein is recommended to combat the sarcopenia or muscle loss associated with menopause.

• Exercise 

  Exercise for menopausal women is vital. It helps improve sleep, assists in weight management, combats stress and tension, and generally improves women's quality of life.

  Resistance training to recruit muscle and combat insulin resistance is the preferred form of exercise and some cardiovascular exercises to improve cardiovascular well-being.  More gentle forms of exercise such as yoga which teaches controlled breathing techniques can be very useful in coping with such symptoms as VMS and anxiety. 

• Complementary therapies 

  There is very little scientific evidence that complementary therapies are effective in relieving menopausal symptoms. However, some women do report an improvement in their vasomotor symptoms i.e. flushes and sweats with these compounds and they may be worth trying on a short-term basis. 

• Non-hormonal options 

  These can be used with some significant effect in women who cannot or choose not to use hormonal therapies. These include SSRI for mood disorders and vasomotor symptoms, fezolinetant for vasomotor symptoms and Cognitive Behavioural Therapy (CBT) for insomnia.

• HRT 

  HRT is an excellent treatment option for the management of menopausal symptoms. It is safe to use in the vast majority of women with very few contraindications to use. It is preferable to use it between the ages of 45-60 but of course, is safely used in the case of premature or early menopause. It is also indicated for use in the management of osteopenia and osteoporosis up to the age of 60.

  The HRT that is prescribed today is very different to the HRT studied several decades ago. We now use “body similar” oestrogen and progesterone products When used under the age of 50 there is no increased risk of breast cancer. Over the age of 50 the progesterone used today - primarily dydrogesterone and micronised progesterone seem to have a more favourable breast-friendly profile. When used for 5 or more years over 50 there are a few extra cases of breast cancer but less than what is seen in association with daily alcohol intake and obesity. When used transdermally oestrogen does not increase the risk of thromboembolism.  

Types of HRT 

Depending on the stage of menopause, different types or regimens of HRT are recommended. 

• Women who are still having periods or who have had a period in the last 12 months require a combination of oestrogen for 28 days and progestogen for 14 days (or Mirena coil) which allows them to have a monthly bleed. 

• Women who have not had a period for one year or more require a combination of both oestrogen and progesterone daily for 28 days (or Mirena coil)  which allows them to be bleed-free.

• Women who have had a hysterectomy require only oestrogen as their HRT. 

If you are a nurse, midwife, general practitioner or family physician considering training in Obstetrics & Gynaecology please visit our RCPI Professional Diploma in Obstetrics and Gynaecology online course page for more information.