Dr Megan A. Arroll and Liz Efiong - The Menopause Maze: The Complete Guide to Conventional, Complementary and Self-Help Options

Preface

If you are reading this book, we would guess that you are either experiencing the menopause or wanting to prepare yourself for it. Around one third of a womans life is lived after the menopause and after the menopause women become vulnerable to associated health conditions, such as heart disease, osteoporosis, and cognitive decline. In this book we cover preventative steps you can take to minimise your risks of these and other conditions.

Although the menopause is a natural milestone in womens lives and not a disease, it can have some unpleasant symptoms. The good news is that there are things you can do to improve your symptoms and your quality of life during and after the menopause. Fortunately, gone are the times when women had to suffer in silence through the menopause. Women today are much more informed than our mothers and grandmothers were and we have a wealth of information available to us almost an information overload but most of us lack the time to read it all. The internet is a wonderful resource but unfortunately it can be full of contradictory, and often incorrect, information.

There are many different options to help you deal with menopausal symptoms and we believe that every woman should be well-informed of the different options available in order to make a balanced choice. This is an ideal time of life to really assess your health so you can be in the best possible health in the future.

This book is timely as many of the major menopause societies around the world have updated their guidelines in the last few years, which we have included in the take home messages, which summarise the latest information and expert opinions throughout the book. 18th October 2015 was International Menopause Day. The International Menopause Society marked the day by publishing a report encouraging women to have a health audit at menopause, and to make any necessary changes which will benefit their future wellbeing.

How to get the most out of this book

Chapter 1 gives you an overview of the physiology of menopause, including symptoms and impact on life, and risk factors for associated health issues, many of which are modifiable. Reducing risk factors is covered throughout the book.

Chapter 2 covers basic principles for health, including dietary and environmental factors, and the top ten health recommendations from the World Cancer Research Fund/American Institute for Cancer Research.

Chapter 3 discusses diet, supplements and herbs that can be used to alleviate the symptoms of the menopause.

Chapter 4 covers the importance of reducing stress levels, and psychological therapies and stress reduction techniques that have been studied in relation to menopause, such as cognitive behavioural therapy (CBT) and mindfulness/ meditation.

Chapter 5 covers the research evidence on non-dietary complementary therapies such as yoga, acupuncture and reflexology and a guide to finding a reputable Complementary and Alternative Medicine (CAM) practitioner.

Chapter 6 covers self-help techniques, such as meditation/stress management, exercise, and social support.

Chapter 7 covers what HRT is, how it works, the difference between bioidentical and non-bioidentical HRT, benefits and risks, and what the experts say.

Chapter 8 should help you decide if HRT is right for you and, if so: what type, how to take it, and when to start/stop.

Chapter 9 covers non-hormonal medications that may be an option if HRT is not suitable for you.

Chapter 10 pulls everything together and can act as a guide to support you through the often overwhelming amount of information and options.

Our greatest wish is that the information contained in this book will help your menopause transition to be as smooth as possible and that you have the energy and vigour to really enjoy this period of your life.

Chapter 1

Overview and the experience of the menopause

In this introductory chapter well outline factual information regarding the physiological changes that occur within the menopause and the common symptoms women experience during this time. Next, we will cover known risk factors for diseases associated with increasing age and menopause, such as osteoporosis and heart disease. The good news is that many risk factors for these conditions are modifiable and there is action you can take to reduce your risk, which we explain below. Finally well explore both positive and negative consequences of the menopausal transition and more general aspects of ageing. We believe that whilst its helpful to be aware of the more unwelcome features of the menopause, its also useful to consider research and womens personal experiences that demonstrate the advantages of the cessation of menstruation. Of course when you are symptomatic these benefits may feel distant, but there are strategies that can facilitate wellbeing and physical health at this time, which we will discuss later in this book.

Physiology of the menopause

The average age of natural menopause is 51. Although life expectancy has improved considerably, the average age of menopause has not changed since records began, which means that women now spend about one third of their lives past menopause.

Before official menopause, which is when you have not had a period for 12 months, there is a transition period, called perimenopause, which can last anything from five to 10 years. This is when you may start to notice changes in your menstrual cycle with periods becoming very unpredictable, often more frequent and heavier, followed by the possibility of no periods at all for 60 days or more. It can take anything from five to eight years after your final period before hormone levels settle.

Why does menopause happen?

At birth, women have over a million egg cells (oocytes). By the time a woman reaches her forties, there may be a few thousand left, and few or none postmenopause. It is the depletion of oocytes which eventually leads to the cessation of menstruation. This is where the word menopause comes from, derived from the Greek men, meaning month, and pausis, which simply means a pause or cessation. Because we are running out of eggs, the oestrogen signal from our ovaries to our brain becomes weak (as do other hormone-stimulating signals) and ultimately no progesterone is produced because progesterone during the reproductive years is produced as oestrogen peaks at ovulation, which is no longer happening.

The menstrual cycle

The menstrual cycle typically lasts 28 days, although it can range from 2335 days. Bleeding lasts on average for five days, although this too can vary from one to eight days. You can skip this section if you are already familiar with the endocrine system and the functions of oestrogen and progesterone during the menstrual cycle.

Figure 1.1 shows the different stages of the menstrual cycle and the rise and fall of oestrogen and progesterone.

Figure 1.1 The different stages of the menstrual cycle

From puberty, the ovaries release egg cells (ova). They also manufacture the sex hormones that influence the menstrual cycle and the development of female characteristics. Each ovary contains numerous cell clusters called follicles, in which egg cells develop. The growth of the follicle is initiated by a hormone called follicle-stimulating hormone (FSH), which also causes oestrogen to be secreted inside the developing follicle. Then another hormone called luteinising hormone (LH), kicks in, which stimulates further development of the follicle and secretion of oestrogen, and triggers ovulation mid-cycle. At ovulation, the follicle ruptures, releasing the mature egg into the fallopian tubes. The empty follicle develops into a small tissue mass, known as the corpus luteum, which secretes progesterone and oestrogen.