Far from just getting on with it – or more often, suffering in silence – women entering the menopause are now encouraged to speak out about their often debilitating symptoms and to seek help from their family doctor.
A long list of symptoms that the drop in hormones caused by menopause brings – hot flushes, night sweats, sleeping problems, weight gain, mood changes, vaginal dryness and urinary issues – can benefit from the appropriate medical intervention as well as some simple steps to self-care.
A “menopause revolution” is finally taking place, according to GP Helen Casey of the Grange Clinic in Donaghmede, Dublin. Along with her colleague Dr Brenda Maguire, she established a “one-stop shop” for women’s health as the medical profession and wider society wake up to the reality of menopause for women.
“That’s the really important thing, that women are now speaking about it, and they are looking for help,” she says. “It’s the time in their life when they have been through raising their kids and they think, ‘right, now this is my time’ and then everything goes pear-shaped for them.”
Part of this revolution is the change in attitude towards hormone replacement therapy (HRT). Now-debunked research provoked scares about a potential link between HRT and the risk of developing breast cancer, which meant for years women were not offered the therapy or were terrified to take it.
Dublin GP Deirdre Lundy is co-ordinator of sexual and reproductive health courses with the Irish College of General Practitioners and a women’s health specialist. She says it is now known that there is no causative relationship between HRT and breast cancer. “We know that relative to other risk factors – obesity, alcohol, smoking, etc – the impact of HRT on breast cancer diagnosis is relatively modest.
“The guidelines are very reassuring that if you need help with your menopause symptoms and if you do not have any absolute contraindications to using it – which are few thankfully – then why not? And if it makes a significant improvement to your quality of life, then you can use it for as long as you choose,” says Lundy, adding that the majority of symptoms will settle by the time most women reach the age of 60 to 65.
Dr Casey says she and Dr Maguire are “huge advocates” for the use of HRT and the benefits it can bring to women who are suffering the loss of oestrogen as they enter the menopause.
“We want people to think of menopause as a time of hormone deficiency. If they had diabetes or thyroid diseases, which are both deficiencies of hormones, they would never not think of treating themselves. We want the generations coming forth to think like that, that they simply realise their oestrogen is dropping and go get it sorted, and not get to the stage where they are years without it and on their knees,” adds Casey.
Bioidentical HRT is now used, meaning hormone levels are naturally replenished, she says , and it also has a preventative effect, in terms of heart and bone health.
But while hormone therapy can provide a drastic improvement in the worst of menopause-associated symptoms and its aftermath, Casey advocates for a holistic approach to what she says is a multifaceted problem, one that can severely affect quality of life for several years.
“HRT is a major part of the puzzle in treating perimenopausal symptoms but it’s never just that and we would often discuss a range of other simple steps that can really help,” she explains.
Diet is a big one. “Sometimes women’s mood can be ‘off’ and their energy levels are low so we would encourage a low-GI [glycaemic index] diet where they are getting stable energy output during the day,” says Casey. “This means not having foods like white bread that will just give you a sugar high, because the lows after a sugar high are never worth it.”
The reduction in hormones associated with menopause also leads to a loss of bone-mineral density, and can cause osteopenia or osteoporosis later in life. This means calcium becomes really important – Casey advises a glass of milk a day or some extra yogurt or cheese – but also a daily vitamin D supplement. Similarly, weight-bearing exercise is important in maintaining bone health and she suggests walking and running but also lifting weights – “it’s not just for men”.
Bloating can often be associated with menopause, and Casey says many of her patients describe it as being very uncomfortable. “I would suggest they can incorporate things like a daily probiotic which can be great for gut health and really help with bloating. Starting the day with a bowl of porridge which has lots of ‘friendly fibre’ is also a big help.”
Sleep can often be the symptom that affects perimenopausal women the most, however. “It’s impossible to function without sleep and that affects their home life, their relationships, and their work,” admits Casey. “HRT will really help that – progestogen, particularly at nighttime, is really good at getting your sleep cycle back.”
Other tips include encouraging women to keep good sleep hygiene, which means going to bed and getting up at roughly the same time, keeping the room very dark and also nice and cool – Casey says 18 degrees is most conducive to restful sleep. “Never use alcohol as something to help you sleep,” she adds.
Casey says she also encourages meditation during what can be a stressful time for many women. “Even if it’s just stepping out for five minutes twice a day, this can bring down cortisol which is the stress hormone and encourages dopamine and serotonin which are the happy hormones so there are huge benefits from it,” she says, adding that there are “super apps” that can help women incorporate it into their day.
Casey is keen to impress that this is not a prescriptive list of things every woman going through the menopause must approach like a to-do list – rather, it is a suite of medical and self-care measures that women can choose from to help alleviate their own individual symptoms.
Every woman’s menopause is different, she says. “Not everybody needs HRT as some women’s drop in oestrogen may be more gradual and have less of an impact on them. But for those whose deficiencies are affecting their quality of life, they need the right treatment and help – this shouldn’t be something that anyone suffers with.”