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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
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
• Stress• Anxiety• Exhaustion• Depression• Aging – physical
symptoms of menopause
• General health• Energy• Loss of libido
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