Menopause: How to cope

It may be a natural stage of life but the symptoms of menopause can be a challenge to handle.

Hot flushes, night sweats, sleep disturbances and mood swings? Welcome to menopause.

This ‘change of life’ is when your period stops because your ovaries no longer produce eggs or hormones. Clinically, you’ve reached menopause one year after your last period.

Common symptoms

The most common symptoms include:

• hot flushes
• night sweats
• sleep disturbance
• vaginal dryness
• mood disturbances, such as depression and anxiety
• memory loss
• weight gain

Usually, most of these symptoms will settle after two to five years. Vaginal dryness persists.

These symptoms don’t affect everyone — about 20 per cent of women won’t experience any —  but around 60 per cent of women suffer mild symptoms for approximately five to eight years. For about 20 per cent of women their quality of life will be severely affected and they will suffer symptoms into their 60s, or even the rest of their lives.

Some of these symptoms, such as anxiety, depression and memory loss, may be due to sleep deprivation caused by waking up during the night from hot flushes and night sweats.

When does it happen?

The average age that women reach menopause is 51, with most women naturally entering this phase between 45 and 55 years of age. Entering menopause between 40 to 45 years is defined as being early. Premature menopause, before the age of 40, can occur naturally or after some surgeries or cancer treatments.

There’s no way of telling when you’ll start to experience symptoms, although women whose mothers entered menopause early have a higher chance of doing the same. It’s also impossible to know how severe or prolonged your symptoms will be.

Manage your weight

Maintain a healthy weight

Being at a healthy weight can help ease symptoms, such as hot flushes and night sweats, and will also keep your heart healthy. As we get older our metabolic rate slows and the risk of weight gain increases.

Falling oestrogen levels mean any extra weight tends to be deposited around our middle, making women more apple-shaped. This centrally-deposited fat can predispose women to type 2 diabetes and cardiovascular disease. However, weight training can help preserve muscle mass, and therefore boost our metabolism.

Carrying excess weight during menopause can also exacerbate joint pain, increase the risk of developing cancer of the breast or bowel, make hot flushes and night sweats worse, and also contribute to poor self-esteem and low moods.

One study showed that for every 5kg lost, there was a 30 per cent improvement in hot flushes. Exercising regularly to the level of feeling hot and sweaty has ironically also recently been shown to reduce the number and intensity of hot flushes.

Easy does it

Women who embark on weight loss programmes need to ensure they have a diet that’s good for bone health and combine it with some weight-bearing exercise, such as walking, running or dancing, to minimise bone loss.

It’s especially important that women going through menopause avoid fad diets, as these can lead to rapid rebound weight gain, and you can find yourself heavier than you were before dieting. Also, radical weight loss diets are rarely balanced, so it’s possible they could even exacerbate menopausal symptoms, as well as increase bone loss.

It’s much healthier to follow a balanced diet with less energy than you require: 2000kJ less than what you need to maintain your personal weight is ideal to lose weight slowly and steadily.

Tweak your diet

Assess possible triggers

Alcohol, caffeine and spicy or hot foods and drinks are often cited as common triggers of hot flushes. There’s not actually a lot of science to support this, but symptoms are individual, so it’s a good idea to assess whether or not these seem to affect the severity of your hot flushes.

Menopause is a good time to take stock of your alcohol intake. Drinking to excess can thin your bones and we already know that post-menopausal women are at risk of osteoporosis.

What about soy?

Hot flushes are not as prevalent in countries where soy intake is high. This has led researchers to investigate whether or not having plenty of soy-based foods, which contain soy isoflavones such as genistein and diadzein, can help alleviate symptoms of menopause. Despite much research on the subject, results are still mixed. A 2015 review by the North American Menopause Society found that the most recent and rigorous clinical trials on soy isoflavones have found them to be no more effective than a placebo.

The most promising area of research on soy isoflavones that may offer help in the future is on S-equol. This is a substance produced by some — but not all — people in their intestine by bacteria from the soy isoflavone daidzein. In women who have the right balance of gut bacteria to produce S-equol, it seems to be able to alleviate hot flushes and other menopausal symptoms. We don’t have local numbers, but only around 30 per cent of North American women are able to metabolise diazdien to equol. To overcome this barrier for the other women, scientists have developed a supplement containing natural S-equol, which is being trialled for its effectiveness. We’ll be watching with interest!

It seems that including more soy in the diet could work for some women who naturally produce S-equol, so it may be worth trying.

Include bone-friendly nutrients

Calcium

During menopause there’s an accelerated loss of calcium from our bones due to falling oestrogen levels, which can continue for up to 10 years after menopause. If women reach this stage with bones that are weak to start with, it’s even more essential to have a bone-friendly diet. For menopausal women, the amount of calcium recommended is 1300mg daily (the equivalent of about three glasses of milk). Weight-bearing exercise, such as walking, dancing and weight training, is good for bone health and can help to offset osteoporosis.

Vitamin D

This is also essential for bone health as it helps the body to absorb calcium. However, many people have low levels of vitamin D, especially those who get little sun exposure. Ask your GP whether testing your vitamin D levels is appropriate. A supplement may be recommended.

Watch vitamin A

Excessive amounts of vitamin A, well beyond the recommended daily intake, is associated with an increased risk of osteoporosis. If you eat liver, which is naturally very high in vitamin A, limit this to once a week to keep intake within the recommendations. Also, avoid vitamin A supplements if you do eat liver each week, and check that any supplements you take (including fish liver oils, such as cod liver oil), contain less than 1.5mg of vitamin A.

Q&A with Dr Beverly Lawton

Co-founder of Wellington Menopause Clinic, past president of the Australasian Menopause Society and author of the book Menopause: a guide for every woman.

How do you treat menopause?

We don’t treat menopause itself but instead provide appropriate relief for symptoms if they are significant and affecting the woman’s quality of life.

Non-hormonal treatments

• SSRIs – antidepressants
• Other medications, that are primarily used to treat other conditions, are sometimes used
• Nerve blockers (stellate ganglion blocks) – where anaesthetic is injected into the sympathetic nerve tissue of the neck
• Vitamin E

Hormone replacement therapy (HRT)

Hormone replacement therapy is an effective way to treat hot flushes, night sweats and vaginal dryness caused by menopause. HRT consists of oestrogen or progesterone, or a combination of both, depending on the woman’s medical history. It comes in tablets, skin patches and gels.

Each woman needs to weigh up the risks and benefits of taking HRT with their doctor. The woman’s decision should be based on her symptoms, medical history and risk factors. It’s the woman’s choice – she should be in control.

The benefits of HRT include:

• It’s effective and improves quality of life for women who suffer significant symptoms
• It reduces the risk of fragile bones from osteoporosis after menopause
• HRT is usually not associated with weight gain
• Women who take combined HRT are less likely to have type 2 diabetes

The risks of HRT include:

• Long-term use (longer than five years) may increase the risk of breast cancer
• HRT increases the risk of blood clots and strokes but in women aged under 60, the risk is low; the risk may be lower when only oestrogen is used
• Taking HRT orally has been associated with an increased risk of gallbladder inflammation

What about complementary therapies?

Complementary therapies include treatments such as bioidentical hormones, Chinese medicine and herbal treatments.

Randomised controlled studies and trials have shown there is no evidence that these therapies work beyond the placebo effect, which can wear off after three to four months.

I’ve put on weight and can’t seem to lose it. Is this due to menopause?

It is common to put on weight as we age because our metabolic rate declines. The solution is to exercise more and eat less.

Studies have shown the average weight gain around menopause is 5kg. The places that extra weight goes is under the arms, the belly, hips and back.

Large trials have shown that women who have had HRT put on less weight during menopause.

I feel depressed and  anxious, and have mood  swings. Is this normal  and what should I do  about it?

Mood swings are a symptom of menopause, and could be caused by sleep disturbances from waking at night with hot flushes and from night sweats. Your doctor may prescribe an antidepressant to help manage your mood.

Does menopause cause  loss of libido?

Libido decreasing doesn’t happen to everyone during menopause but it is a commonly reported. Libido is complex, and is related to many other issues.

Lack of oestrogen can cause vaginal dryness, which makes sex painful, but a topical oestrogen cream can help a lot.