Mental Health and Menopause

Many women notice changes in mood around the time of the perimenopause and menopause.

It can be difficult to know if the symptoms of low mood, anxiety, panic attacks, depression and mood swings are caused by the hormone changes associated with changing ovarian function, or are due to an underlying mental health problem. Indeed, it appears that when presenting with such symptoms, many women have been offered antidepressants when they have wondered themselves if the symptoms could be hormonal.

If these symptoms occur along with evidence of change in ovarian function, from a change in the period pattern with or without other menopausal symptoms such as hot flushes, sweats, joint aches and sleep disturbance, then a trial of hormone replacement rather than an antidepressant, would seem worthwhile. In fact, many women take HRT purely for control of such symptoms, rather than control of the classic flushes and sweats. Such mood, psychological and coping symptoms are often completely unexpected and, when untreated, cause more distress than the expected flushes and sweats.

We know that women who have previously suffered from clinical depression, particularly those who have experienced postnatal depression or premenstrual syndrome, are sensitive to hormonal fluctuations and are at risk of developing depression in the perimenopause, a time of significant hormonal fluctuation. Otherwise, while depressed mood is common around the time of the menopause, new onset clinical depression is not increased purely due to the menopause.

Mental health problems are very common, and can be associated with the menopause so should be treated early.

For more information, visit the symptoms section and psychological section of Menopause Matters.

A Sore Point

In many issues of Menopause Matters magazine we have included articles, results of surveys, research findings and advice about the very embarrassing topic of vaginal dryness and discomfort which is common during the menopausal changes of vaginal atrophy. With a lack of estrogen, many women experience thinning, drying changes, in the vagina which can lead to irritation, pain, discharge, bleeding, soreness and reduced response during sex. This can then also lead to relationship problems.

We know from our surveys that still, in the 21st century, women find it very difficult to discuss this with their partner, let alone a healthcare professional. This results in women often making excuses not to have sex, and putting up with the symptoms for many years. We know that their confidence can be affected, and this common symptom can have a great effect on self-esteem, quality of life and relationships.

Vaginal atrophy often occurs a few years after the menopause, or a few years after stopping HRT. Symptoms can be reduced using lubricants or moisturisers, and the underlying cause of lack of estrogen can easily be treated with vaginal estrogen in the form of small vaginal tablets, cream, pessaries or a vaginal ring. Vaginal estrogen can be used even when HRT is not desired or not recommended since the dose of estrogen is very small and is concentrated in the vagina. Vaginal estrogen can be used for many years and indeed may be required indefinitely.

If you are experiencing vaginal changes, be sure that help is available. See more info on the Menopause Matters website.

Menopausal Middle-aged Spread - Fact or Fiction?

For many generations, women have battled with the 'middle-aged spread', which so often starts to appear around the time of the menopause, with blame often being laid on the menopause, or on the use of HRT. Although it is often the source of jokes and teasing, weight gain can have significant health implications, not to mention the psychological effects - we all know how depressing it can feel when clothes just feel too tight, or don't fit at all.

It is known that as our hormone balance changes, with a shift in the balance of estrogen and testosterone production (estrogen declining and so steady levels of testosterone have more of a dominant effect), we tend to distribute fat more around the middle and tend to develop the male-like apple shape instead of the female-like pear shape. Along with the change in hormone balance, our rate of metabolism changes as does the way that our body handles glucose and insulin. So all in all, the hormone changes of the menopause itself contribute to weight gain and a change in shape. Taking HRT has not been shown to cause weight gain and, in some women, may help to restore the hormone balance and so have a beneficial effect.

What else can we do? There is no simple magic answer, but the time of the menopause should be the time that we review our diet and lifestyle and, when necessary, make simple changes to reduce weight or maintain a healthy weight and increase exercise to both reduce menopausal symptoms, and to improve later health. If we are overweight, losing weight can reduce risks of heart disease, stroke, breast cancer, diabetes and cancer of the womb. We all need to find an eating style that includes a good variety of vegetables, salads, fruits, lean meats, fish and with minimal sugars and processed foods that we enjoy and can stick to. Similarly, exercise should be something that we enjoy and is sustainable, whether it be walking, Zumba, a sport, gym classes, swimming...and don't forget lots of sex!

We can use the time of the menopause as a positive wake up call to invest more time than we may have done for many years, to look after ourselves.

For more advice, visit the Diet, Lifestyle & Exercise section of Menopause Matters.

Ten Wasted Years?

Having been involved for many years in advising, educating and always still learning myself about the menopause, the effects of estrogen deficiency, and treatments, I have seen many changes but none so dramatic as the views on Hormone Replacement Therapy (HRT). In the early days, HRT was seen as the answer to many problems and while it was known that it was not perfect and that all medicines carry some risk, it was strongly believed that for most women, the benefits outweighed the risks. Then, in July 2002, publication of the Women’s Health Initiative (WHI) trial led us to be more concerned about risks and less aware of benefits with a subsequent huge fall in the use of HRT.

Ten years on, and a full review of the WHI trial and of other available evidence has been published. The key message is that in fact, when used appropriately especially for women under the age of 60, or within ten years of the menopause, HRT provides far more benefits than risks. It is reassuring that the media did give this news some attention, since women and their healthcare providers need to be aware of this information, so that they can make informed choices about the management of their menopause. It seems that for the last ten years, decisions have been made based on incorrect information.

Many have stated that as a result of the WHI trial and the ensuing publicity, we have had ten wasted years and that women have suffered unnecessarily. This may be the case but we cannot turn back the years and decisions were made in good faith. Lessons have been learned and perhaps we should realise that major shifts in practice should not be based on one study, no matter how large. Women can once again be reassured that HRT is safe when used correctly and while not all women will need HRT, those that do need not worry unduly about risks but can enjoy the benefits. It is time to move on.

For more information about Menopause and HRT, visit Menopausematters.co.uk

Menopause is Everywhere

It cannot be said often enough, menopause, and the consequences of ensuing estrogen deficiency affect EVERY woman.

Yet why, in the 21st century, do we still find it difficult to discuss, surround it with embarrassed laughter, and speak in hushed tones? What is so bad about openly discussing a physiological process which is simply a hormone deficiency, the consequences of which have now a much greater effect on our health than ever before, because we are living longer, so we are experiencing the consequences for more years than any previous generation?

I do get the feeling that more people now are wanting to talk about it, wanting to find out more information, but it doesn’t come easily. A recent taxi journey during a trip to Dublin highlights the issues: when asked why I was in Dublin, I replied that I was speaking at the Irish Menopause Society annual conference. The response was hilarious—“Holy Mother of Jesus, my wife has been through the menopause 3 times!!” There then followed an enlightening discussion about her symptoms, which were severe, but there was frustration that she did not feel that she could visit her doctor, or indeed talk to anyone about this highly embarrassing subject. A Menopause Matters magazine was duly produced from my bag and given to pass on, in the hope that the information would be helpful!

Perhaps it’s the word “Menopause” which is so highly charged with associations with negativity, periods, female hormones? Whatever the reason, this needs to change. In the absence so far of an internationally accepted alternative word to describe the transition that all women experience, let’s just all do what we can to help others be open, informative and supportive.

Menopausematters.co.uk

National Shortage of Testosterone

Hormone replacement therapy aims to replace estrogen to control the effects, both short and long term, of estrogen deficiency. In addition, for women who still have their womb, some form of progestogen is given to protect the womb lining from being stimulated by the estrogen. Some women also benefit from the replacement of testosterone, particularly those who experience premature ovarian failure, or have surgical removal of their ovaries, since our ovaries produce about 50% of our testosterone, the rest being produced from the adrenal glands. The lack of testosterone in women can cause fatigue, low mood and low libido.

Previously, women could be given testosterone in the form of a twice weekly patch or a six monthly implant and many found these preparations very helpful. Unfortunately, the patch has now been withdrawn from the market, and implants of both estrogen and testosterone are not readily available in the UK, although some clinics have been able to purchase them from America.

This has caused much concern, reducing treatment options for some women and the British Menopause Society are trying very hard to provide pressure on relevant organisations to improve the situation. Meanwhile, for postmenopausal women, the HRT tablet tibolone provides a combination of estrogen, progestogen and testosterone and is a very useful option for postmenopausal women who wish to take HRT and for whom low libido is a symptom. For women who require to use a separate form of testosterone along with HRT, several brands of testosterone gel are available. While they are only licensed for use in men, they can be used for women “off-license” under specialist supervision.

For more information see www.menopausematters.co.uk/testosterone.php

New Year, New Me

A New Year is here again and many will be thinking about the year just gone, and forward to the year ahead. Inevitably, many, including myself, start the year determined to make changes, common areas being in diet and exercise. Yet again, I resolve to take more exercise by dragging my friend with me to Zumba at least once per week, walking whenever possible, and to increase my salad, vegetable and fish intake while cutting down on tempting biscuits and cakes. The difference this year is that now that I am officially postmenopausal myself, I realise that I need to actually follow this through since my hormonal changes will already be having an effect on my blood pressure control, cholesterol level and vessel function. I do take HRT which should be providing protection against these heart risk effects of estrogen deficiency, but it is vital that in the menopausal years in particular, we all do as much as we can to reduce our heart risk.

Let’s find healthy food that we can enjoy and stick to, and find an exercise that is fun and sustainable. Zumba works for me, especially since it has become my weekly catch-up time on the way there and back with my friend. The music is fab, the steps are fun and before you know it, you have stepped out, jiggled and shaken your bum for an hour without feeling like it was serious exercise. Going with a friend is not only fun but the commitment of picking up on the way makes it much harder to stay at home because of being “too tired”, or have “too much to do”.

So ladies, while the emphasis is frequently on breast cancer as a major health risk for women, take note that three times more women die from heart disease than breast cancer. 

We can all make changes this year to look after our hearts so let’s do it!

More information on heart disease and CVD.