Menopause is a normal event in the life of an older woman, but as with other transitions in life like puberty and the onset of menstruation, menopause throws up challenges. Most women experience some difficulties adjusting to the physical and emotional changes of menopause.
What is Menopause?
Taken literally, ‘menopause’ means the last menstrual period, but in everyday language it means the time around the last period, which typically happens between the late 40s and early 50s. The average age is 51 years. Around this time, menstruation stops and starts – it’s usually considered to be menopause if there’s been no vaginal bleeding for 12 months. In a very small number of cases (less than one per cent) it happens before the age of 40.
What happens in menopause?
The experience of menopause varies widely from woman to woman and from culture to culture. All women, however, undergo the same basic hormonal changes during menopause. The ovaries run out of functional eggs so ovulation stops and the sex hormones oestrogen and progesterone are no longer produced.
The degree to which each woman’s body responds to these normal hormonal changes varies.
- 25% of women do not have any problems with menopause
- 50% of women experience some menopausal symptoms, varying from mild to moderate.
- 25% of women have more severe problems.
It is important to recognise that not all symptoms that women experience at this stage in life are related to menopause. Some are just part of the normal ageing process.
Signs and Symptoms:
- Hot flushes and night sweats. These are sensations of heat that last between 30 seconds and five minutes, felt in the face, chest, neck, or over whole body, sometimes with sweating, nausea, and flushing of the skin. When they happen at night they’re called night sweats.
- Genital changes. The vaginal tissue becomes thin, less elastic and drier; natural lubrication diminishes and sex may become uncomfortable and orgasm less intense. The pH of the vagina alters and it becomes more prone to bacterial and fungal infections. The labia and clitoris may decrease in size because they lose some of their fatty tissue.
- Irregular periods. Over a period of years leading up to menopause, hormone levels can fluctuate wildly, causing erratic, irregular periods, some lighter, and some much heavier than normal.
- Urinary problems. Similar changes in the bladder and urethra make urinary tract infections more likely. There may be painful and frequent urination, and a sensation of needing to urinate even when the bladder is empty. The muscles of the pelvic floor become weaker, so stress incontinence (leaking of urine with exertion) is more likely.
- Skin and hair thinning. Skin becomes thinner and less elastic and lines may appear. Skin may feel drier than it was before.
- Sleep disturbances. Insomnia is more common – so is waking at night with night sweats.
- Weight changes. As a woman ages, her metabolism tends to slow, and she becomes more sedentary (as do men) and so tends to put on weight. She may lose weight from the hip and thigh area and put it on around the abdomen.
- Mood changes. Some women become depressed, anxious, irritable, and forgetful. The mood changes are partly hormonal. But they may also be related to a sense of loss of fertility and diminished womanhood. Those women who have been deeply involved with family may feel a sense of emptiness and a loss of purpose, especially if, around the same time, children leave home.
These symptoms can be controlled by the use of Hormone Replacement Therapy, if you are experiencing these symptoms, contact your GP to discuss a treatment that will work for you.
Post-menopausal women have an increased risk of a number of health conditions, in particular osteoporosis and cardiovascular disease.
What is Osteoporosis?
This is a condition characterised by the loss of bone density as well as a deterioration in the bone structure. These changes result in a weakening of the skeleton, leading to an increased chance of breaking a bone; a fracture. The most common sites of fracture are the bones of the spine, the hip and the wrist.
What causes osteoporosis?
Many factors contribute to a loss of bone as people age. In women, the decrease in the level of sex hormones (oestrogens) after the menopause is an important cause of bone loss.
It is estimated that in Australia approximately 60% of women, and 30% of men, over the age of 60 years will suffer an osteoporotic fracture in their remaining lifetime.
Prevention of Osteoporosis?
- Diet and exercise
- Quit smoking
- Reduce the use alcohol
- Calcium and Vitamin D supplements
Treatment of Osteoporosis?
Recently a number of new medications have been developed and in the last few years these have been shown to be effective in restoring lost bone and can decrease the risk of an osteoporotic fracture by approximately 50%. Other new drugs are also currently being investigated which potentially may be even more effective in the treatment of osteoporosis.
It is important to minimise the risk of falls, which may result in a fracture. Some medications, like sedatives and some blood pressure tablets, may also increase the risk of falling and this should be considered in the use of these medicines in the elderly.
Varicose veins are twisted, widened, darkish-blue veins that form just under the skin of the legs. They’re harmless, but for some people they can be a bit of an embarrassment.
Signs and Symptoms:
Varicose veins don’t cause any symptoms or do any harm in most people. But they do look unsightly and this may make people anxious and worried about them.
In some cases, however, they cause discomfort – aching, a feeling of heaviness, and/or itching, which is often worse at the end of the day, or after long periods of being upright. These symptoms tend to reduce when the legs are elevated or by wearing support stockings. Sometimes there are more serious complications.
Swelling. Sometimes legs will swell, although this isn’t common, swells, and swelling is generally confined to one leg. But swelling in a leg is usually caused by something other than varicose veins.
Inflammation. Another complication is thrombophlebitis which means inflammation of the veins. The veins become red, painful and tender to the touch.
Skin changes In more severe cases of varicose veins there can be changes to the surrounding skin, as blood oozes out of their veins into the surrounding tissues of the leg or foot. The skin can take on a brown discolouration and as this becomes advanced it can turn into eczema and in more severe cases, a skin ulcer.
Treatment of Varicose veins
- Vein removal The traditional approach is to surgically remove the varicose veins. If the person has obese legs and/or the varicose veins are large there may be some bruising after the operation but most people recover well.
- Sclerotherapy Another, more commonly used technique especially for smaller veins and spider veins. An irritant chemical is injected into the veins, causing them to collapse. After a period, the walls of the veins naturally seal together so the vein can no longer carry blood.
Breast cancer is the most common cancer among females in Australia. This cancer mostly affects women after the age of 40.
Early detection methods:
- Breast awareness: awareness by a woman of the normal look and feel of her breasts
- Breast self-examination: examination of the breasts by the individual
- clinical breast examination: examination of the breasts by a doctor
- screening mammography: use of mammography in asymptomatic women to detect breast cancer at an early stage (BreastScreen Australia is the national mammographic screening program).
Any of the following breast changes should be reported to your GP:
- A lump
- Any change in the shape or appearance of the breast such as dimpling or redness.
- An area that feels different to the rest.
- Any change in the shape or appearance of the nipple (nipple inversion or retraction)
Many women are concerned that a breast change might be breast cancer. Even though it might not be cancer in most cases, it is very important that all breast changes are carefully investigated. As early detection of breast cancer provides a much better chance of effective treatment.