Taking Back Control

Dr Mary Ryan explores the difference between perimenopause and menopause, the various symptoms involved, treatments available and what we can do to better support women

For some women, the first clue that they have been experiencing symptoms of the menopause is after they arrive at the doctor, fearful that something is gravely amiss.

“Women often think, God am I losing it?” Dr Mary Ryan reveals. “I have patients coming to me believing they are showing the first signs of dementia, but it is actually hormonal imbalance as they enter the menopause.

“They are not depressed and are not getting dementia. It is all hormone imbalance. But it can be extremely distressing”.

The consultant endocrinologist at Bon Secour Limerick and Aut Even Hospital Kilkenny is determined to bring the spotlight onto menopause so that women and their families are informed and supported in what is a hugely transitional time in a woman’s life.

She says: “The biggest thing women need is knowledge. I started campaigning for more awareness around the menopause six years ago. Women have been crying out for information for years, and all this time they suffered unnecessarily because they simply didn’t know what they were experiencing was menopause.

“They didn’t know the symptoms and warning signs. Things are improving and the taboo subject is becoming increasingly open but we need to continue that. It is known as the

‘second spring’ in Asia, and it really is. It’s the second chapter in women’s lives and it should be seen in a very positive light – not something to be feared. The way to do that is to educate women.”

Is there anything I can do to stop or delay this process?

Once the menopause process begins it is inevitable. When you notice perimenopause symptoms, typically menopause will come four to five years’ later. You can certainly improve and reduce symptoms, but once the eggs become depleted, you are not going to retrieve them. There is some evidence to suggest that certain risk factors like smoking and a lot of alcohol could speed the process, but typically with patients we find once they have started perimenopause, the key thing is to readjust and manage symptoms. Rest will help enormously in this and the more you look after yourself the better you will feel physically.

Symptoms

The symptoms for perimenopause and menopause are extremely similar. The key difference is the severity of symptoms. Perimenopause will come first, and often with that the first thing women may notice is a change in periods, they could get heavier, more sparse or irregular.

Women might experience occasional hot flashes or sweats as a result of the declining oestrogen or aches and pains in their muscles.

Some women may pick up changes in their sleeping patterns on their Fit Bit and notice they aren’t actually getting much deep sleep and therefore are noticing a growing fatigue, due to the hormonal changes.

Once the menopause occurs your periods will cease totally. After this, women may notice sleep worsens, aches and pains, headaches, IBS symptoms, vaginal dryness, hot sweats and flushes, reduced energy, bloating and reduced sex drive. Some women have severe symptoms, while others may only experience mild symptoms.

After the menopause you are also at increased risk of bone issues and heart disease, so it is essential to pay close attention to cholesterol levels, blood pressure and abdominal fat because after menopause your metabolism slows right down and many women

It should be seen in a very positive light, not something to be feared

gain weight who may have never struggled with weight in their life.

For the majority of women, menopause symptoms will settle after three to five years, while some don’t notice any symptoms at all. But I’ve had patients in their 70s who are still experiencing symptoms, so it is very dependent on the individual.

Treatment

Rest is crucial at this time. The key thing is to keep yourself healthy and get early treatment if you need it. There are things we can offer to help with every symptom from sleep to vaginal dryness – women do not need to suffer needlessly. Some people won’t require any help, but some women suffer dreadfully with symptoms, and they do need HRT.

Supplements

Both Omega 3 and B vitamins are of benefit at this time. Vitamin B6 contributes to the regulation of hormonal activity and along with vitamins B1 and B12 it also contributes to normal psychological function. Calcium is essential to protect your bone health against the falling oestrogen levels, while Biotin is great for the hair loss and thinning that can occur around this time. A great supplement to take is Cleanmarine which covers most of the basics you need at this time.

HRT

Many women may be nervous of hormone replacement therapy (HRT), but as doctors we are always protecting patients. We will always check any family history that could be of concern and if there is, we will help the patient find an alternative. But provided it is safe we will prescribe HRT if it is required. Some women don’t need it at all, but for those who do, it can be transformative. We tend to prefer the transdermal patch. But we can offer an oestrogen gel or a patch, and there is also a patch where you can combine oestrogen and progesterone.

Many women move on to HRT after they have tried all the natural options and it can be fantastic for those struggling with hot flushes, sweating, and vaginal dryness.

You don’t stay on HRT indefinitely. For most women it is a short-term solution for a year to five years and we tend to stop it after the age of 60, unless an individual requires it for longer.

In addition to HRT, there are quite a lot of bioidentical hormones we can now prescribe. These are natural and come from plant sources, and provided they are FDA-approved, there is no issue with us using them.

Knowledge is power

The biggest thing women need and are lacking, is knowledge. For too long women were left on the back foot and due to being uneducated on the topic, they were suffering needlessly.

Menopause doesn’t need to be something to be feared. Once women know the symptoms they can be aware when it happens to them and be in a position to make choices around their treatment options.

They can try all the lifestyle measures to manage their symptoms – eating well, managing their sleep, getting enough rest, taking the right supplements – and then if they are still feeling unwell they can go to their doctor and they can be prescribed HRT or another appropriate medication to help them. But the key point here is that they will not be left to suffer.

It is also so crucial for women to know that symptoms that have them in a panic, like brain fog or low libido, can be completely normal at this time and they can be addressed and rectified.

Women should be able to enjoy healthy and enjoyable sex lives for 40 years after the menopause, just like a man. There is no reason at all they can’t. In society we are always talking about men’s sexual lives but we don’t look at women’s sexual needs enough. We can ensure all women enjoy a healthy and enjoyable sex life by addressing any areas of concern such as vaginal dryness or issues with libido.

By opening up the conversation around menopause, we are on the way to making sure women are treated equally and we’re empowering women to better understand their bodies. Menopause is a natural evolution in the body, not to be feared, and it should always be treated and listened to, too.