How to survive your menopause

David Griffiths Consultant GynaecologistChristine Pearce Consultant Nurse

3rd Sept 2014

What is the menopause?

Normal, natural event. Defined as the last period confirmed after 12

months of no bleeding

When is the menopause?

Average age 51Medical/surgical intervention can

cause early menopauseImpaired ovarian function eg

anorexia, family history

A new phase of life Beginning of the end

The PerimenopauseThe time leading up to the menopause10-15% no signs or symptoms10-15% disabling symptoms Approx 90% varying physical and or emotional levels of distress

Signs and symptoms•Changes in menstrual cycle•Vasomotor symptoms, night sweats, hot flushes•Vulvovaginal symptoms, discomfort with sex•Sleep disturbance•Poor memory/concentration•Mood changes, anxiety, depression

The PostmenopauseThe years after the last menstrual periodWith current life expectancy 1/3 to 1/2 of your life in the menopause

HeartHead

Hormones

• Stress• Anxiety• Exhaustion• Depression• Aging – physical

symptoms of menopause

• General health• Energy• Loss of libido

• Relationships• Self confidence• Appearance

Diet & Lifestyle

HRT

Alternative therapiesPrescribed non

HRT

Testosterone

Diet & Lifestyle

Healthy diet and exercise

Who’s for the gym?

Smoking and alcohol.

Vitamins and minerals

Eat less, move more, smaller plate, slow but sure.

HRT(hormone

replacement therapy)

Continuous combined

Sequential

Mirena intra uterine system

Local oestrogens.

Patches.Tablets.Creams.Vaginal ringVaginal cream

Alternative therapies

• Acupuncture.• Aromatherapy• Homeopathy• Hypnosis.• Yoga• Reflexology.

• Red clover• Agnus castus• Sage leaf

Prescribed non HRT

• Clonidine• Dixarit• Venlafaxine• Paroxetine• Gabapentin• Progestogens• Natural progesterone cream.• Testosterone

• Improve mood and sense of well being• Improve sexual function.• Only available as a gel• Must be titrated accordingly as licenced for men.

Testosterone.

Is it hot in here?

• Regular exercise• Light clothing.• Cool Bedroom.• Reduce stress levels.• Avoid triggers – spicy food,

caffeine, smoking, alcohol

• Does it work and is it safe?• Does it work for the symptoms I

have?• What are the side effects?• What are the long term risks?• Is the treatment licenced?

• Talk to your GP.• Do your research.

My advice?

Sexual healthSexual problems 45-64 yearsDecreased oestrogen, reduced lubrication and elasticity – vaginal atrophyDecreased testosterone, waning of sexual desire/sensationRisk of sexually transmitted diseases

Urinary symptoms

• 50% of women over 50 have bladder problems

• Frequency, urgency, leakage

• Weight loss, pelvic floor exercises

• Medication

OsteoporosisCompromised bone strengthIncreases fracture risk13-18% over 50 have osteoporosis of hipLow oestrogen accounts for 2/3 of bone loss around menopause

Risk factors for osteoporosis• Advanced age• Family history• Smoking• Prolonged steroid use• Excess alcohol

Cardiovascular DiseaseHeart disease/stroke

Leading cause of death for women over 65Rates increasing in 35-54 age group Obesity, diabetes, and blood pressure

Cancer Menopause not associated with increased riskBut cancer rates increase with age and Ca is the second leading cause of death in women

Screening for Cancer• Breast Ca - three years from 50-70• Colorectal Ca - biannual from 60-69• Cervical Ca – 5 yearly until 65• Endometrial Ca – urgent assessment of any bleeding• Ovarian Ca – no programme

Maximise your health!• Eat well – healthy

balanced diet• BMI 19-25• Drink less alcohol• Stop smoking• Exercise

Be happy

Thank you

Questions?