Officially you are not menopausal until you haven’t had a period for a year.
As women get older their ovaries don’t work quite as well and stop producing as much of the sex hormones oestrogen, progesterone and testosterone. An egg is no longer released every month and periods start to change in nature and frequency. Usually they start to become less frequent and can take months or years to stop completely.
Sometimes periods stop very suddenly, where ovaries are removed in surgery or after other gynae surgery. Also chemotherapy or radiotherapy to the pelvic area can affect how ovaries work.
This normal decline in oestrogen occurs between the ages of 45 and 55 years of age. In the UK, the average age for menopause is 51.
1 in 100 women under the age of 40 have an early menopause and 1 in 1000 under the age of 30.
Perimenopause
is the time leading up to menopause where you experience menopause symptoms but are still having periods. Periods change, becoming further apart or closer together and can be more irregular and the flow can change becoming heavier or lighter.
Symptoms of Menopause
Symptoms can occur months or years before your periods stop and last around 4 years after your last period. Most women will experience symptoms with the common ones including:
- Hot flushes
- Night sweats
- Vaginal dryness and discomfort during sex
- Difficulty sleeping
- Low mood or anxiety
- Reduced sex drive (libido)
- Problems with memory or concentration
Genitourinary Syndrome of Menopause
This was previously known as vaginal atrophy or atrophic vaginitis.
The name has changed to recognise that it is not just the vagina that is affected by the reduction in oestrogen. Changes also occur to the clitoris, labia, bladder and the urethra, the tube running from the bladder to the outside.
The vagina is the muscular canal travelling from the outside of the body to the womb
The vulva refers to all the external sex organs, including the labia, clitoris and vaginal opening.
Lacking oestrogen affects the walls of the vagina and the vulva. They become thinner and have less stretch meaning they are more susceptible to injury. Also a lack of oestrogen changes the vaginal fluid. It becomes thinner and less is produced causing the symptoms below.
- dryness (up to 75% of women experience this)
- irritation and itching
- burning and discomfort
- discharge
- more at risk from infections and inflammation
Treatment Options:
- Vaginal moisturisers and lubricants
- local oestrogen replacement gel or pessaries
The changes in hormones affect the bladder and urethra, the tube from the bladder to the outside.
Symptoms may include:
- Recurrent urinary tract infections (UTIs) - occur in 20% of females
- Over active bladder symptoms - urinary frequency and urgency and urge incontinence. (Stress incontinence also possible)
- Pain with emptying your bladder
- Leaking a dribble after going to the toilet
- Wakening at night to need to go to the toilet
- Blood in the urine
Self Help Tips
- Ensure you drink a good amount of fluid: approximately 1.5 - 2 litres of fluid per day
- Stop drinking or take only small sips 2-3 hours before going to bed but make sure you still drink 6-8 glasses of fluid each day (try sucking ice cubes or ice lollies)
- Reduce or remove caffeine and fizzy drinks from you diet, especially in the evening
- Avoid constipation
- Avoid going to the toilet “just in case”
- When you need to go to the toilet, try not to panic and rush to get there
- Make sure you empty your bladder properly, sit down rather than crouching over the toilet
- Rock back and forward after going to the toilet to fully empty (i.e. double void)
- Sitting in a good posture allows you to stand up with less effort, which can reduce leaking
- Train your pelvic floor muscles and get them working before you cough or sneeze or as you walk to the toilet
- Stop smoking: smokers are 1.5 times more likely to have an overactive bladder due to the effect of nicotine
- Elasticated waist bands are easier to manage in a hurry.
Patient Leaflets
For 66% of women their symptoms of menopause impact on their enjoyment of sex.
- Post coital bleeding
- Decreased libido, arousal and orgasm
- Pain and discomfort during sex (38-40%)
Self Help
- Vaginal moisturisers and lubricants
- Local oestrogen replacement cream/gel or pessary
The pelvic organs (bladder, womb, vagina and bowel) are supported and kept in place by the pelvic floor muscles and surrounding tissues. Sometimes these muscles and tissues develop problems and one or more of the organs may no longer sit in the ideal position and droop. They may bulge into the vaginal canal or even externally. This affects about one third of women over their life time.
It is thought that the stability of the support to the pelvic organs may be affected by a reduction in oestrogen.
There is a link with increased BMI and waist circumference and pelvic organ prolapse. Post menopausal women have a tendency to carry more weight around their abdomen.
Self Help Tips
- Limit heavy lifting where you need to strain. Avoid holding your breath. Lifting from ground level is harder than from waist height.
- When it can’t be avoided, before lifting, engage your pelvic floor muscles. Lift with a good posture.
- Avoid constipation
- Sitting position on the toilet is really helpful:
- Ideally knees should be higher that hips
- Lean forward with a straight back
- Avoid straining
- Do not hold your breath, try to breath out as you let go
- Support underneath using your hand or a finger or thumb internally, to help you empty your bowels
- Rock back and forward after going to the toilet to fully empty. i.e. double void.
- Maintain a healthy weight
- Strengthen your pelvic floor muscles, this may be easier in lying initially.
- If feeling particularly heavy, lie down, knees bent, with a pillow under your bottom to allow gravity to reduce the heaviness. Do some pelvic floor exercises in this position.
- Exhale with every effort. Never hold your breath or pull your tummy in strongly during an exercise