Vasumathy Sivarajasingam is a GP in West London and an Honorary Clinical Research Fellow at Imperial College London. She is on Twitter: @vasu27765631
Menopause is not a health condition, but a normal biological stage in a women’s life when menstruation ceases permanently due to the loss of ovarian follicular activity. It is a clinical diagnosis based on symptoms and signs, single point in time, diagnosed in retrospect 12 months after the last menstrual period.
A study carried out by Nuffield Health Group highlighted that women experiencing menopause are hardly getting the support they need with diagnosis and/or treatment.1 As a result, 1 in 4 women have been struggling to cope with life due to menopausal symptoms. Another study established about two-thirds of women’s working lives being affected negatively by their symptoms, with a third losing self-confidence.2
…1 in 4 women have been struggling to cope with life due to menopausal symptoms…
With the increased life expectancy, women spend more of their life in a post-menopausal state, making it a necessity to understand this natural process. Perimenopause is the transition phase of life, equivalent to puberty, but in reverse. Fluctuations in hormone levels result in a host of physical and psychological symptoms and can be incredibly challenging time for women, leaving women feeling confused and unable to cope at times.
It is imperative that any woman has a good understanding of the physiological changes in her body – from perimenopause to postmenopause. In particular, all women should be aware of the potential long-term health issues caused by changes in hormone levels, and the options available to help manage menopause symptoms to maintain a good quality of life. This would unquestionably help the woman to feel in control and less overwhelmed by the changes she is experiencing, and be in a better position to meet any challenges of this life stage.
The mean age of natural menopause is 51 years in the UK, although this can vary between different ethnic groups. Every woman is different, and has her own journey as she transitions through to menopause. The symptoms experienced will be unique to her, to the extent that some experience severe symptoms whilst others experience no disruptions to their life.
Vasomotor symptoms (hot flushes and night sweats) are the most commonly reported menopausal symptoms – affecting 75% of postmenopausal women with 25% being severely affected, decreasing the quality of life and level of self-respect.3,4 Other symptoms occurring during the transition include mood changes, musculoskeletal symptoms, cognitive problems, urogenital symptoms, and sexual disorders. Along with chaotic bleeding, these symptoms can be distressing, embarrassing, and cause sleep deprivation, lethargy, and low mood, during perimenopause. The menopausal transition occurs during the most crucial part of a woman’s working life.
How can the primary care team break the silence on menopause?
How can the primary care team break the silence on menopause? Firstly, raise awareness and create a culture where staff feel comfortable talking openly about menopause at work. This would encourage clinical and non-clinical members of the team to receive necessary support without feeling embarrassed or fear of judgement. Each staff member’s privacy should be respected, especially following disclosure of their symptoms. Consider implementing a menopause policy for the staff, to emphasise that you care about their wellbeing. Be considerate and make any adjustments that could be made to help alleviate menopausal symptoms (e.g. good ventilation, access to cold water, providing desk fans), flexible working patterns including breaks when required.
Education of staff further increases the opportunity to raise patient awareness, inviting women to open up and discuss the potential menopausal symptoms, management and the long term effects of reduced oestrogen. This should be supported by resources/leaflets on information about menopause and its management. Furthermore, we should highlight the importance of lifestyle changes that could modify long term health and promote wellbeing (e.g. blood pressure screening, attendance for mammograms, and cervical screening). Be aware, this is the time in a woman’s life when she takes charge of her overall health and is keen to take opportunistic lifestyle advice for health promotion.
The British Menopause Society recommends every woman to have a health check on reaching the age of 50. Health-promoting lifestyle advice, such as regular aerobic exercise, safe alcohol intake, quitting smoking and caffeine intake can reduce the severity and frequency of vasomotor symptoms.5
Recognition and acknowledgement of menopausal symptoms is a positive step, but this is not enough. Primary care team has a central role in supporting menopausal women in managing their symptoms. Despite the evidence that hormone replacement therapy (HRT) significantly improves the quality of life and protects younger women from long term diseases including osteoporosis, a third of women visiting a GP were not made aware of HRT, with another third being told HRT was not suitable for them.1 It is not uncommon that menopausal symptoms are treated as separate issues in primary care when they should be addressed holistically. Symptoms such as urogenital symptoms due to atrophy are hugely under-recognised and undertreated, though they respond well to local vaginal oestrogen. Additionally, raising awareness of the continued need for contraception in perimenopause women who are potentially fertile is crucial to avoid unplanned pregnancies and terminations.
Menopause is an inevitable part of a woman’s natural life process. Typically, it is not a topic that is openly talked about in society. It is welcoming news that menopause is added to the school curriculum from September 2020, which will help a new generation of women to gain a better understanding of their bodies well in advance.6