Women shouldn’t be hesitant to ask for solutions when coping with menopause writes Dr Azy Khalid
ARE you in your 40s and think you’re losing your mind because of mood swings, sweating and flushes?
Maybe you have lost interest in everything you used to enjoy, even sex?
At 38 and as a gynaecologist, I like to think that I have the knowledge to face the next phase in my life - menopause. But I can only prepare and brace myself.
There is such ignorance and stigma in our society surrounding ageing and menopause, which I hope to remove not only among women, but also among spouses, families and friends.
Ageing and the menopause is a natural progression in a woman’s reproductive life. Women nowadays are living longer and have active social lives. We are also more informed and open to speaking of our
troubles to seek solutions.
In the past, our grandmothers and great-grandmothers may never have
spoken of their experiences in going through menopause. Some sailed through without any symptoms while others struggled.
Nowadays though, to grin and bear these symptoms can be challenging and unnecessary. There are many approaches, both medical and non-medical, to help us through this phase.
The menopause is when our menstrual periods completely cease. The average age of menopause is 51, but symptoms can start years before and may continue for years afterwards. This period of time is called the perimenopausal period.
The symptoms of menopause are due to a decline in our hormones, mainly the female hormone oestrogen, as our ovaries shut down and stop responding to signals from our brain.
The most common symptoms women talk about are hot flushes, night sweats, mood swings, tiredness and feeling down.
Women don’t talk as much about vaginal dryness, painful sex, loss of libido, vaginal prolapse and incontinence - not because it doesn’t happen, but because they tend to be embarrassed about discussing it, even with a healthcare professional.
Sometimes, these symptoms can be severe enough to affect one’s quality of life, so please don’t ignore them and look for help.
I’ve seen women who needed to bring extra clothing to work or when going out because they felt too embarrassed and uncomfortable with their sweating.
I’ve also seen women who couldn’t get a good night’s sleep because of night sweats, and, in turn, felt tired and depressed.
There was one woman whose husband even suggested she seek help because her mood swings were becoming physically dangerous to
herself, him and their family.
Often, women seek help for their hot flushes and only when asked about sexual activity, do they admit that they have been avoiding it because of dryness and pain.
TREATMENTS
Hormone Replacement Therapy (HRT) is effective in relieving many of these symptoms. The main aim is to replace oestrogen with most preparations also containing the hormone progesterone to counteract the effects of oestrogen on the womb.
There was a scare on HRT years ago due to concerns about an increased risk of breast cancer. Doctors were afraid to prescribe it and women were afraid to try it. In fact, the absolute risk is extremely low.
Relief of symptoms can be seen in 80-90 per cent of women who are put on HRT and it comes in a variety of preparations and dosages - tablets, patches and vaginal pessaries. Plus, there is the bonus benefit of protecting your bones against osteoporosis and protecting your cardiovascular system too.
It’s all about weighing the risks and benefits. The timing of starting HRT is crucial to maximise the benefits and minimise the risks. Your doctor will need to do a full assessment before prescribing to ensure it is safe for you and to choose the most suitable HRT for you.
NON-HORMONAL
There are also non-hormonal medications to help specific symptoms you may have.
Talk to your doctor and discuss your options and understand how these medications work.
There are herbal remedies that have been shown to alleviate menopausal symptoms. These herbal remedies contain phyto-oestrogen, which somewhat helps the oestrogen drought.
The most well researched is soy. Just remember to cut out any added sugar. Funnily enough, hot flushes are less reported in Asian women compared to Caucasian and Afro-Carribean ethnicities.
Whether this is because of the abundance of soy in our diet, or merely under-reporting, remains unknown.
Other herbal remedies that may help are black cohosh and red clover. As these are all phyto-oestrogens, you should talk to your doctor about these alternative remedies to make sure they are safe for you.
PROACTIVE, SUPPORTIVE STEPS
PELVIC floor exercises or Kegel exercises tend to be forgotten in the grand scheme of things but it’s so important that we do them, even well
before menopause.
We even encourage women to do Kegel exercises during pregnancy and as soon as they can after childbirth. It can be done anytime and anywhere - at home, at work, on your way to work: you name it! We just need to constantly remind ourselves to do it.
How is it done? It’s basically just like trying to hold your urine when you need to pee, or trying to keep yourself from passing gas. As you squeeze, you should feel the muscles in your vagina and around your
anus tighten and move upwards. Your buttocks, thighs and abdomen should remain relaxed. Hold your squeeze for 3-5 seconds, then relax for 3-5 seconds and repeat 10 times each session, three times a day.
But it’s also a good idea to see a physiotherapist at least once to make sure you’re doing it right.
There are even vaginal “pillow” devices and apps that can guide you and help you keep track of your exercises.
If Kegel exercises don’t work for you, then talk to a gynaecologist who will examine you and discuss the surgical options best suited to your problem. Remember, these problems can really affect your quality of life. Getting it sorted out can be life-changing!
The need for support from loved ones during menopause should never be overlooked too. This is such a huge physiological change for a woman which can affect her confidence, her relationships and her quality of life.
Husbands must understand that this is not the time to ignore their wives and absolutely not the time to be fishing around for a younger partner!
Understand what she is going through and be there for her. Make her feel appreciated, wanted and supported and show that she matters to you.
Children, family and friends must also understand what the person is going through and be as supportive as they can.
Be a shoulder to lean on. Give her some space when she needs it, but also be there when she needs you.
Menopause is a natural progression but just because it’s natural, doesn’t
mean you can’t seek help. The days of ignorance and stigma should be gone. Spouses and families should all be aware and supportive through this milestone. The options are out there, just know how to reach out.
*The writer is a consultant obstetrician and gynaecologist working at University Hospital Waterford in Ireland, with a special interest in women's health.