Menopause

Understanding Menopause and Perimenopause

Menopause marks the point when your periods cease due to declining hormone levels, typically occurring between the ages of 45 and 55. This can sometimes happen earlier due to natural reasons, surgery (like oophorectomy or hysterectomy), cancer treatments such as chemotherapy, or genetic factors. In some cases, the cause remains unknown.

Perimenopause is the transitional phase leading up to menopause, characterised by the presence of symptoms before your periods have completely stopped. You are considered to have reached menopause after 12 consecutive months without a period.

Both perimenopause and menopause can cause a range of symptoms, including anxiety, mood swings, brain fog, hot flushes, and irregular periods. These symptoms can emerge years before periods stop and may continue afterwards. The impact of these symptoms can be significant, affecting aspects of daily life such as relationships and work.

Treatment Options for Menopause Symptoms

While there are many strategies to manage symptoms, medical treatments can effectively replace missing hormones or alleviate specific discomforts.

Hormone Replacement Therapy (HRT)

Hormone Replacement Therapy (HRT) is the primary medical treatment for menopausal and perimenopausal symptoms, working by replenishing low hormone levels. It is widely considered safe and effective for most individuals. Your GP can provide a detailed discussion about its suitability and any associated risks.

HRT primarily involves using oestrogen to restore the body’s hormone levels. Different types and doses are available, and finding the right combination often leads to symptom improvement.

Oestrogen can be administered via:

Skin patches
Gels or sprays applied to the skin
Implants
Tablets

If you have a womb (uterus), it is crucial to also take progesterone alongside oestrogen to safeguard the womb lining. This combination is known as combined HRT. Progesterone can be taken as:

Patches (often combined with oestrogen)
An IUS (intrauterine system, or coil)
Tablets

Benefits of HRT: The main advantage of HRT is its effectiveness in alleviating most menopausal and perimenopausal symptoms, including hot flushes, brain fog, joint pains, mood swings, and vaginal dryness. Hot flushes and night sweats often improve within weeks, while other symptoms like mood changes and vaginal dryness may take a few months. HRT can also help reduce the risk of hormone-related health issues such as osteoporosis and heart disease.

Risks of HRT: The risks associated with HRT are generally small and are often outweighed by the benefits. Your doctor or nurse can discuss these risks with you if you are considering HRT.

Follow-up and Duration: If you are undergoing HRT, you will typically have a follow-up review with your prescribing doctor or nurse after three months. Once your treatment is stable and effective, annual reviews are recommended. During these reviews, your healthcare provider will assess symptom control, check for side effects or vaginal bleeding, monitor your weight and blood pressure, and make any necessary adjustments to your HRT.

HRT can be continued for as long as needed to manage symptoms, with the benefits and risks discussed at your yearly reviews.

Targeted Hormone Treatments

Testosterone Gel for Reduced Sex Drive: If HRT does not adequately improve a low sex drive associated with menopause, a testosterone gel or cream may be offered. This can potentially enhance sex drive, mood, and energy levels. Although not currently licensed for women in this context, it can be prescribed by a specialist doctor after menopause if deemed beneficial. It can be safely used concurrently with HRT. Possible side effects are uncommon but can include acne and unwanted hair growth.
Oestrogen for Vaginal Dryness and Discomfort: Menopause and perimenopause can lead to vaginal dryness, pain, or itching. A GP can prescribe local oestrogen treatments, such as tablets, creams, or rings inserted into the vagina. These treatments deliver oestrogen directly to the vaginal tissues without entering the bloodstream, also improving urinary symptoms like discomfort during urination. They can be used long-term, though symptoms typically recur if treatment is stopped. Vaginal oestrogen is safe to use alongside systemic HRT.

Non-Hormonal Approaches

For individuals unable or choosing not to use HRT, several non-hormonal treatments are available.

Medications for Hot Flushes and Night Sweats:
- Clonidine, a blood pressure medication.
- Gabapentin, an epilepsy medication. Discuss these options, including potential side effects, with your GP.
Mood Symptoms: Antidepressants can be helpful for mood symptoms if depression or anxiety is diagnosed.
Cognitive Behavioural Therapy (CBT): This talking therapy can assist with low mood and anxiety related to menopause and perimenopause, and may also help with physical symptoms like hot flushes and joint pain. NHS psychological therapies services can be accessed directly.

Complementary and Alternative Therapies

Complementary and alternative treatments, including many herbal remedies (e.g., red clover, black cohosh) and compounded bioidentical hormones, are generally not recommended for menopausal symptoms. This is due to a lack of clear evidence regarding their safety and effectiveness. Furthermore, some alternative therapies may interact with other medications or cause side effects. Always consult your GP or pharmacist before using any complementary therapy.

It is important to distinguish between compounded bioidentical hormones, which are not recommended and not available on the NHS, and regulated bioidentical hormones (also known as body identical hormones), which have undergone testing for safety and efficacy and are available on the NHS as part of HRT.