The menopause, also known as the ‘change of life’ is the end of menstruation. When a woman’s ovaries stop producing  eggs,  she will no longer have a monthly period or be able to have children. In the UK, the average age for a woman to reach the menopause is 52, although women can experience the menopause in their 30s or 40s. If a woman experiences the menopause when she is under 45 years of age, it is known as a premature menopause.

Heart disease

Heart disease is a leading cause of death in women in the U.K. Risk increases after menopause, regardless of age.  Before menopause, a woman’s natural oestrogen protects her from heart disease; however this protective effect is lost after the menopause.

Women should consider if they have additional risk factors for heart disease including obesity, family history, high cholesterol or smoking.

Research in women who had surgical menopause before age 45 suggested that oestrogen replacement therapy may protect against heart disease that is associated with early menopause.

 

Bone health

Bone density is categorized a person’s bone density as “normal,” “osteopenia,” or “osteoporosis” when compared to other individuals of the same age and gender. Osteopenia refers to low bone mass or density. Osteoporosis is a more serious loss of bone density, which weakens the bones. Loss of oestrogen through natural or surgical menopause can lead to increased weakening of the bones. Some degree of bone thinning occurs as a natural part of the aging process. Significant weakening of the bones, however, increases risk for fractures (broken bones).

A bone density test may be useful to determine baseline bone density in a woman with a premature menopause.  If there is any thinning of the bones, repeat scans may be recommended after 2 or 3 years.

Hormonal and nonhormonal medications can lower the risk for fractures due to loss of bone density.

Weight-bearing or resistance exercise may lower the risk for fractures in postmenopausal women. However, in women with osteoporosis it is important to discuss exercise with your physician as some exercise especially involving flexion or rotation of the spine may have an increased risk of fracture.

Women should ensure they are getting adequate calcium from their diet or with supplements.  It is recommended that all adults take vitamin D supplements especially during the winter months.

 

It is currently recommended that all women who have not had cancer and who have their ovaries removed take HRT until they are 50 years old to maintain bone density, and heart health and avoid symptoms of menopause.

How long a woman takes HRT for depends on her individual needs. For women who have had risk reducing breast surgery they may continue to benefit from taking HRT until they are in their late fifties or sixties. As women get older they may find that they require a smaller dose of oestrogen to relieve their symptoms.

If a woman carrying a BRCA mutation has not had risk reducing breast surgery there is probably an overall benefit in reducing overall mortality by taking HRT up until age 50.  After this women with BRCA2 mutations who are more likely to develop oestrogen receptor positive breast cancers need to consider taking as low a dose for as short as time as possible to relieve their symptoms. The different forms of HRT are discussed in more detail below.

 

Hot flushes

Hot flushes are the most common symptom experienced by menopausal women. During a hot flush a woman typically experiences mild to extreme heat throughout the body, which may also be accompanied by sweating, flushing, and a rapid heartbeat. Studies show that hormone replacement is the most effective treatment for hot flushes. HRT will reduce the frequency and severity of the hot flushes and night sweats but 20% (one in 5) women will still have some symptoms.

Certain non-hormonal medications—antidepressants called selective serotonin reuptake inhibitors (SSRIs), for instance—may relieve hot flushes and certain other menopausal side effects. There is no evidence that herbal supplements are effective in relieving hot flushes.

Keeping cool, with layering of clothing, avoiding spicy foods and using fans or chillows may relieve flushes and exercise, yoga and Pilates can help reduce the impact of the symptoms.


Sexual function

Menopause can lead to symptoms that can impact sexual satisfaction, including vaginal dryness and decreased libido.

Menopause can cause the walls of the vagina to become thin and dry, leading to painful sexual intercourse, which can reduce women’s interest in sex. Vaginal dryness can be improved in several ways, including the use of vaginal lubricants and moisturizers.

Systemic hormone replacement therapy (e.g. oral tablets or skin patches) can also improve vaginal dryness but additional low-dose local vaginal oestrogen medications can boost the levels of oestrogen in the tissues. Research suggests that only a small amount of oestrogen applied vaginally is absorbed by the rest of the body and it may be suitable for breast cancer survivors who cannot take systemic hormones.

“Libido” refers to an individual’s level of sexual desire. Many women experience decreased libido as a side effect of menopause. Hormones can improve libido in women who are surgically menopausal. Some physicians recommend the addition of testosterone replacement for women who have loss of libido with menopause that isn't alleviated by oestrogen and progesterone alone. Testosterone gel is usually prescribed at a specialist HRT clinic and may also relieve fatigue.

 

Brain function

Loss of oestrogen from both natural and surgical menopause is known to affect memory—women in menopause often report memory loss or difficulty focusing on tasks. A number of studies have shown that women who undergo a premature menopause are at increased risk of cognitive decline and dementia.  Many of these studies also showed that cognitive issues improved when women started oestrogen replacement therapy after surgery and continued it until they were at least 50.

Additionally, experts recommend eating a healthy diet, avoiding alcohol, stimulating your brain with puzzles and reading, and getting adequate sleep.

The majority of women will experience some menopausal    symptoms after BSO. The natural menopause is usually   very gradual, giving a woman time to adjust to the changes that are happening to her body. However, when the menopause occurs because the ovaries are surgically removed the symptoms can be more intense.

Oestrogen is a hormone that has effects on many organs of the body including the heart, brain and bones.

 

The type and severity of symptoms  from woman to woman, but some of the symptoms that may be experienced are:

Hot flushes

Night sweats

Vaginal dryness

Decreased libido (sex drive)

Tiredness

Mood changes

Poor sleep pattern

Memory changesd the symptoms can be more intense.

Oestrogen is a hormone that has effects on many organs of the body including the heart, brain and bones.

Weight gain

Urinary incontinence

These symptoms may diminish over months or years but some women still report menopausal symptoms for many years with or without treatment.