HOWA GYNAECOLOGIST HANDLES HER MENOPAUSE

Most of us hit the menopause with just a vague idea of what to expect. But knowing exactly what’s happening to our bodies can help us make life-changing decisions, says Dr Jennifer Gunter

he menopause is like being sent on a canoe trip with no guidebook and only a vague idea of where you are headed. There is no advice on how to manage any of the obstacles, such as rapids – that’s if any exist, who knows? From fear and uncertainty to unpleasant symptoms and medical ramifications, have fun figuring it out! Most women have no idea what to do when they are no longer having regular periods or any periods at all and are instead suffering with uncomfortable symptoms. When they try to seek help, instead of receiving important health screenings or therapies, they are often told, ‘This is just part of being a woman,’ or, ‘It’s not that bad.’

Having started medical school when I was 20 years old and my obstetrics and gynaecology training when I was 24, I can’t remember a time when I didn’t have a detailed understanding of the hormonal changes of both the menstrual cycle and the menopause. And not just the biology, but how to apply it practically to my own body: I never once thought, ‘Wow, that is unexpected!’ My medical knowledge didn’t prevent me from having acne, hot flushes, or those ‘special’ heavy periods that are all typical of the lead up

T

two or more days a week, and balance training.

The good news is that it’s never too late to reap the rewards. I tell my own patients to start with a ridiculously little amount of exercise, just keep at it every other day. Exercise is like free money: even a little is good.

WEIGHT GAIN

Many women are bothered by weight gain during their menopause transition and/or find that losing weight after menopause is harder than it was previously. The average age-related weight gain is approximately 0.3kg (0.8lb) per year and is primarily due to the loss of muscle mass that in turn reduces calories burned and raises insulin levels. It’s not uncommon for women to experience an age-related gain of 1.5kg to 3kg (3.3lb-6.6lb). Most of the gained weight is fat, so the percentage of body fat also increases with age. Handle it like a gynaecologist It’s important to acknowledge how hard it is to lose weight, but even more so to maintain that loss. Pay attention to your food consumption, cook at home (studies have linked meals out as a risk factor for obesity) and avoid ultra-processed foods.

The best eating plan is the one that works for you and is sustainable over the long-term. By this I mean, can you follow this plan? When you adhere to it, do you lose weight? Do you think you can eat this way for the rest of your life?

HOT FLUSHES

When many people think of menopause, they think heat. This is because hot flushes and night sweats – collectively known as vasomotor symptoms or VMS – affect 80 per cent of women at some point during their menopause. The hot flush experience lasts on average just over seven years.

Medically speaking, a hot flush is a wave of heat that envelops the head, neck, upper chest and arms. And it isn’t just a feeling of heat – the body is warm to the touch, accompanied by sweating, redness in the face, nausea, agitation and anxiety. A hot flush happens when a wonky inner thermostat informs your brain that you’re hot when you are not. It lasts an average of two to four minutes and

GENITOURINARY SYNDROME OF MENOPAUSE (GUSM)

This term refers to the significant changes that the vulva and vagina undergo during the menopause and with age – either directly from the lack of oestrogen or indirectly because of the reduction in blood flow to the tissues.

As many as 15 per cent of women report manifestations of GUSM during their menopause transition, and eventually up to 80 per cent of women will experience some symptoms, which include vaginal dryness, burning or a sandpaper-like feeling, pain with penetration, itching, irritation, decreased lubrication during sex, a change in odour and discharge. The vagina also shrinks a little in length and width, likely due to changes in blood flow and collagen, which, in addition to the loss of tissue elasticity and increased fragility, can also lead to pain with sex. (Although, interestingly, the penis also shrinks with age due to declining testosterone levels, decreased blood flow and collagen production. We just don’t hear about that as much...)

Handle it like a gynaecologist The foundation of managing GUSM is vulva and perianal skincare. Avoid wipes at all costs and don’t use soap: it can damage the acid mantle (the protective layer of fat and other microscopic substances that coat the skin). Soap can also react with the vulva skin, raising the ph from a typical 4-5.2 to 10. After washing, moisturise: dryness is the enemy of irritation. Use incontinence pads if you experience any urine leakage: menstrual pads aren’t up to the job, and consequently stay wet leading to skin irritation. As for pubic hair, which increases humidity and hence traps moisture against the vulva, trim rather than wax or shave it, as removing hair by those methods damages the top layer of the skin.

LOSS OF LIBIDO

It’s normal for desire to decrease with age, but for some women, due to the menopause transition, that decrease can accelerate: in one study, 12 per cent of women aged 43 to 64 had desire disorders, and for women over the age of 65 that number was around seven per cent greater. Interestingly, this is unrelated to hormone levels, meaning there are many women with lower levels of oestrogen and testosterone with high levels of desire, and the reverse is true.

Handle it like a gynaecologist When desire feels dead, the first step is to look at medications that may have loss of libido as a side effect, medical conditions, life in general, and communication with your partner.

As women age it isn’t uncommon to need more physical stimulation to achieve orgasm. A great way to boost arousal is with a vibrator. If you’re already using one, switch to one that can deliver more stimulation or one that can stimulate other areas. CBT, mindfulness and learning to cultivate desire – with communication, apps, books, erotica, foreplay and afterplay – are important strategies, as well as the right lubricant. Another consideration is, again, to work on strengthening your pelvic floor muscles with Kegel exercises as these physically contract during orgasm.

This is an edited extract from The Menopause Manifesto: Own Your Health with Facts and Feminism by Dr Jennifer Gunter, which will be published by Piatkus on 25 May, priced £14.99. To order a copy for £13.19 go to mailshop.co.uk/books or call 020 3308 9193*