The menopause is a natural process. It is when a woman no longer has periods. It is normal and a natural part of ageing. Every woman will go through it, and even though symptoms can vary in nature, degree and duration, there should be help available to support women through the process. Whilst the average age is 51 years, symptoms can begin many years before this.
Common symptoms of the menopause include:
- Hot flushes,
- Reduced sex drive,
- Night sweats,
- Lower mood
- Irregular bleeding.
While menopause is natural, it can be quite debilitating and it is important to ensure that every woman has the resources they need to manage and promote physical and mental wellbeing throughout the process, which can often take many years. I am passionate about helping people access those resources and do a huge amount of work with women who are going through the menopause.
Every woman’s experience of menopause will be different. This means that there is not a ‘one-size-fits-all’ approach to care and treatment. Instead, care must be individualized, because what is acceptable for one woman may not be acceptable for another. Working through this properly requires a real partnership between myself, the patient and their GP, as we will all be involved in working closely together to ensure the process is as comfortable as possible for them.
When I first meet with somebody going through the menopause, I will talk with them about what they are hoping to get help for, what they would ideally like ‘fixed’. Again, the menopause comprises a whole array of symptoms, both physical and emotional, and the exact symptoms somebody has will shape the care and treatment provided. This initial conversation is a really good way to see the type of help you may need.
Some women will tell me that they feel warmer than usual (the classical hot flushes or night sweats). Actually, women don't necessarily have to suffer from night sweats; they may just have symptoms of feeling warm and hot and flustered, and this can be enough to interfere with their sleep pattern.
Other women will complain of physical symptoms such as joint pains or palpitations. Mental health symptoms can also be fairly common, with low mood, anxiety and paranoia. It is important not to dismiss any of these symptoms as being “just caused by the menopause”, as this may not necessarily be true. If careful investigation shows or suggests an element of depression, that will need to be properly managed by the correct specialist.
A number of women tell me of symptoms that are related to genital urinary health. This may be recurrent urinary tract infections, the vagina feeling dry or feeling uncomfortable during intercourse.
The approach taken to treatment for symptoms will depend on personal preference of the patient and the type and severity of symptoms.
I am very much an advocate of patient-centered care and believe that patients should be involved from the start of the process through to the finish of treatment; after all, they are the ones experiencing the menopause! Treatment needs to be focused around what best suits somebody within their lifestyle, as long as it's within the realms of clinical safety.
Sometimes, holistic (‘whole person’) therapy can be helpful, such as self-help therapies or talking therapies. Physiotherapy can also be of benefit.
Sadly, there is a lot of negative press around HRT, much of it unjust in my opinion. I believe the value of HRT depends on having the right healthcare professional to guide people through the risks and benefits of HRT, and to individually risk assess each woman individually before any treatment is started.
Sometimes, you do need to consider the benefits of hormone replacement therapy. There are different options and treatments out there for women and depending on what those treatments and options are, we can guide women and support them through that process. There can be a number of benefits of HRT with regard to preventing osteoporosis and promoting overall physical and emotional well-being, and these need to be discussed with people. Educating people so that they have the facts and information they need to make an informed decision is a big part of my job, and it is the right approach to care.
As with any medication, there are risks associated with HRT, but these need to be assessed against the benefits. Cardiovascular and stroke risks may be beneficial or disadvantageous, depending on when HRT is started and the type of HRT used: there are many.
The most well-known risk associated with HRT is breast cancer, and this has been given a lot of negative press and publicity. It needs to be said that the risk depends on a number of factors, including the type of HRT used and how long it is taken for.
What we mustn't do is let all the negative press that currently exists undo all the good work that has been done over the last number of years in promoting the menopausal treatments and the menopause. It is important that treatment pathways are tailored for each individual, and that they have access to up-to-date, reliable and evidence-based information about any treatment.