Menopause is when a woman stops menstruating and they are no longer fertile. The time around this, called perimenopause, can occur for about five years when menstruation becomes irregular and menopausal symptoms occur. Menopause typically occurs between the ages of 42 and 56, and is marked by 12 months in a row of no periods. If you are using birth control, talk to your doctor about the best contraception to use during menopause as you can still be fertile up to a year after your last period.
Menopause symptoms are caused by unbalanced hormone levels in the body as it finds its new normal. These symptoms vary greatly for different women, but some common symptoms include:
- Irregular periods, including more or less frequent and lighter or heavier flow
- Hot flushes and night sweats
- Lower libido
- Vaginal dryness
- Headaches and migraines
- Sleep problems
- Mood changes
- Skin and hair changes (thinning hair)
- Bone thinning (osteoporosis)
Some self-care techniques can ease common menopause symptoms. Health Navigator recommends the following:
- Relaxation and stress relief techniques, such as meditation, acupuncture, and massage
- Managing your weight and diet – keep your diet low in fat, sugar, and salt, and try eating foods high in calcium and fibre to support your bones, joints, and heart
- Get regular exercise, including weight-bearing exercises to support your bone health, and pelvic floor exercises to improve incontinence
- Use lubrication for vaginal dryness. This can be prescribed by your doctor
- Try counselling for mood changes and managing emotions
- Get more sleep
- Stop smoking
While these techniques can help alleviate menopause symptoms, if you feel you still cannot manage your symptoms you should talk to your doctor about further options. Your doctor will be able to prescribe you topical oestrogen cream for vaginal dryness, non-hormonal prescription medications, or recommend menopausal hormone therapy if it is right for you. This can also be a good time for a general health examination to check your blood pressure, take a cervical smear, and have a mammogram.
Hormone replacement therapy
Hormone replacement therapy (HRT), also called menopausal hormone therapy (MHT), can help reduce the symptoms of menopause such as hot flushes, night sweats, vaginal dryness, low libido, mood changes, and sleep problems. HRT is usually a combination of oestrogen and progesterone, and can be prescribed during perimenopause or after surgically induced menopause. This is designed to boost hormone levels while your body is finding its new natural balance.
If you are considering HRT, it is important to seriously consider the pros and cons because this therapy does have some associated risks. Recent studies have shown that the benefits of HRT outweigh the risks for most women under 60, but these should still be considered before starting treatment. Medsafe recommends using the lowest dose for the shortest amount of time necessary to keep the risks low. HRT can include increased risk of blood clots, and long-term use (over 10 years) can increase the risk of heart disease and stroke.
If you have moderate to severe menopausal symptoms, you may want to discuss with your doctor whether HRT is right for you.
Endometriosis and menopause
Endometriosis is a condition where tissue similar to the lining of your uterus grows in other areas of the body, such as on other organs and structures in the pelvis. This tissue sheds like endometrial tissue in your uterus, but there is no way for the blood outside the uterus to exit the body. This causes pain, scar tissue, and inflammation. More information on endometriosis can be found at Endometriosis NZ.
Endometriosis is stimulated by oestrogen, however after menopause your body still produces small amounts of oestrogen and you may still experience symptoms of endometriosis. Your symptoms may alleviate somewhat post-menopause, but endometriosis cannot be cured.
In rare cases, endometriosis can develop after menopause. You may be able to discuss treatments such as hormone therapy or surgery to relieve some symptoms of endometriosis post-menopause.
Women aged between 25 and 70 should have regular cervical smear tests to check their cervical health. Cervical screening is testing for abnormal cells that develop from the human papillomavirus (HPV), which can cause cervical cancer. If abnormalities are found early, cervical cancer can be cured.
It is important to continue getting smear tests as you get older because you are still at risk, even if you are immunised against HPV, have been through menopause, or are no longer having sex. It is recommended that you have a cervical screen every three years up to the age of 70, and two consecutive normal smears should be collected before you stop screening. To organise a screening, you can contact your doctor, Family Planning, or the National Screening Unit.
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