Kia Ora New Zealand
Kia ora,
Menopause is a significant and natural phase in a person’s life that may present many challenges. Understanding the underlying mechanisms and the wide array of available treatments can empower individuals to navigate this transition with confidence. Whether you or a loved one is experiencing these changes, our goal is to provide evidence-based information you can trust.
What is Menopause?
The medical definition is when someone’s menstrual periods have ceased for 12 consecutive months. However, it can be difficult to pinpoint the exact date because periods can become irregular at this time. This typically occurs between the ages of 45 and 55 when the ovaries stop producing eggs.
The associated hormonal shifts can lead to symptoms such as hot flushes, mood fluctuations, and sleep disturbances. It is important to recognise that menopause is not a medical condition but a natural progression in the lives of those who menstruate.
What is Perimenopause?
Perimenopause is the transitional period leading up to menopause. Starting around the age of 35 to 40, the number of eggs remaining in the ovaries begins to decrease, and the release of an egg from the ovary, known as ovulation, occurs less frequently. It often begins several years before menopause and is characterised by the natural decline in oestrogen production. During perimenopause, the same symptoms as menopause may start, such as hot flushes and irregular periods, due to these hormonal changes.
What are the symptoms of Menopause?
During menopause about 20% of people experience no symptoms, 60% have mild to moderate symptoms, and the remaining 20% suffer from severe symptoms that disrupt daily life. These symptoms can be influenced by factors such as life stage and overall health.
Physical symptoms may include hot flushes, night sweats, sleep problems, sore breasts, dry skin, fatigue, loss of libido, headaches, bloating, urinary problems, and weight gain. Emotional symptoms might encompass irritability, anxiety, difficulty concentrating, forgetfulness, mood swings, and feelings of being overwhelmed.
Hot flushes and night sweats are particularly common, affecting more than 57% of people. These sensations start in the chest area and spread to the upper chest, neck, face, and sometimes the whole body.
Sleep disturbances are common during perimenopause and menopause, affecting around 25% of people aged 50–64. Poor sleep has been linked to various health issues, including cardiovascular disease, obesity, and mood disorders.
Mood and emotional health may also be affected during menopause, leading to irritability, increased anger, low mood, depression, and anxiety. Those with a history of depression or PMS may be more susceptible.
Bladder, vaginal, and vulval problems may affect up to half of postmenopausal people due to declining oestrogen levels. These changes, known as vaginal atrophy, can lead to vaginal dryness, reduced elasticity, pain during sex, loss of libido, and urinary symptoms. While some symptoms like hot flushes may disappear over time, bladder, vaginal, and vulval problems can persist or worsen.
Aches and pains are also common during menopause, particularly in the knees, hips, shoulders, neck, elbows, and hands. Changing hormones, especially a drop in oestrogen levels, can cause painful joints and other musculoskeletal symptoms.
How Menopause Causes Hot flushes
The mechanism behind hot flushes in menopause is complex and not entirely understood, but it’s closely linked to the decline in oestrogen and other gonadal (sex) hormones. This hormonal shift appears to narrow the thermoneutral zone, the temperature range within which the body feels comfortable. Consequently, even minor changes in core body temperature can cause the hypothalamus in the brain to perceive the body as overheated, even when it’s not.
This mis-perception triggers a hot flush, leading to the dilation of blood vessels in the hands, feet, and face, and a sensation of intense heat. Hot flushes can vary in duration, lasting from minutes to hours, and often contribute to sleep difficulties. However, they are not the sole cause of sleep disturbances during menopause.
Therapies Available
There are several therapies available to manage menopausal symptoms, each with its own set of benefits and considerations.
Hormone Therapy
Studies have found that hormone therapy can significantly reduce menopausal symptoms, thereby improving the quality of life. Transdermal oestrogen, combined with micronised progesterone, can be more effective and have fewer side effects than previous oral therapies.
However, it’s vital to remember that hormone therapy, while effective, also carries potential risks, such as a slight increase in the risk of certain conditions like blood clots and stroke. A thorough discussion with your healthcare provider about these risks is key before deciding on any treatment option.
Oestrogen Patch
Oestrogen patches are a type of hormone therapy that work by sending hormones straight from the patch, through your skin, and into your blood. This way of delivering hormones avoids the liver, which usually breaks down drugs and can sometimes cause side effects.
A big study in 2019 looked at hundreds of thousands of people and found that using oestrogen through the skin didn’t increase the risk of blood clots (1). This is really good news, because blood clots were a major risk with oestrogen pills.
With oestrogen patches, hormone levels stay steady, meaning you won’t experience the ups and downs sometimes seen with pills. Plus, these patches are handy because they usually only need changing twice a week.
Progesterone
For those with a uterus, it’s important to balance oestrogen with progesterone. In the past, synthetic progesterone could cause a few side effects. However, now we have something called micronised progesterone, which is identical to the progesterone our bodies naturally make. This new form of progesterone is taken by mouth and is often used with oestrogen therapy. One of its great benefits is that it can help with sleep—a common issue during menopause. So, it’s fantastic in more ways than one! Just remember to take it at night.
The cost of micronised progesterone, once a barrier at $50 per month, is now free and readily accessible.
Non-Hormonal Therapies
Non-hormonal options, like Gabapentin, an anti-epileptic drug, and SSRIs, a type of antidepressant, can be effective alternatives for people who can’t or choose not to use hormone therapy(2)(3). These medications work by balancing the body’s temperature control, which can fluctuate during menopause.
Non-Pharmacological Interventions
Additionally, interventions like mindfulness-based stress reduction, cognitive-behavioural therapy(4) can be useful. Regular exercise, a balanced diet, adequate sleep, and stress management (5) can also significantly aid in managing menopausal symptoms.
Health Check-ups and Preventive Screenings
Menopause and lack of oestrogen can impact bone health and increase the risk of osteoporosis and heart disease. Studies have shown reduced risk of heart problems(5) and osteoporosis(6) with oestrogen treatment. Regular health check-ups and preventive screenings during and after menopause are crucial.
Conclusion
Menopause is a natural transition in life for a large proportion of the population. Its symptoms, while discomforting, are readily treatable with safe options.
Should you or a loved one experience menopausal symptoms, reach out to a healthcare provider. They can provide guidance and help you find the best treatment options for your unique situation.
Stay healthy, New Zealand!
- Yana Vinogradova, Carol Coupland, Julia Hippisley-Cox. Use of hormone replacement therapy and risk of venous thromboembolism: nested case-control studies using the QResearch and CPRD databases. BMJ, 2019; k4810 DOI: 1136/bmj.k4810
- Yoon SH, Lee JY, Lee C, Lee H, Kim SN. Gabapentin for the treatment of hot flushes in menopause: a meta-analysis. Menopause. 2020 Apr;27(4):485-493. doi: 10.1097/GME.0000000000001491. PMID: 32049930. https://pubmed.ncbi.nlm.nih.gov/32049930/
- Stubbs C, Mattingly L, Crawford SA, Wickersham EA, Brockhaus JL, McCarthy LH. Do SSRIs and SNRIs reduce the frequency and/or severity of hot flushes in menopausal people. J Okla State Med Assoc. 2017 May;110(5):272-274. PMID: 28649145; PMCID: PMC5482277.
- Samami E, Shahhosseini Z, Elyasi F. The effects of psychological interventions on menopausal hot flushes: A systematic review. Int J Reprod Biomed. 2022 May 23;20(4):255-272. doi: 10.18502/ijrm.v20i4.10898. PMID: 35822187; PMCID: PMC9260068.
- Effect of hormone replacement therapy on cardiovascular events in recently postmenopausal people: randomised trial https://www.bmj.com/content/345/bmj.e6409
- Eastell, R., et al. (2019). Pharmacological management of osteoporosis in postmenopausal people: An endocrine society clinical practice guideline. https://academic.oup.com/jcem/article/104/5/1595/5418884
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