Physical and psychological wellbeing

Professor Isaac Manyonda (MRCOG, Consultant Gynaecologist) and Dr Vikram Talaulikar (MRCOG, Specialist in Reproductive Health), take a look at physical and psychological wellbeing around the menopause.

Many women 'sail through' the menopause. They welcome, at long last, the cessation of monthly periods. Some will experience the occasional hot flush, but nothing they can't manage. Others will experience forgetfulness, some may not feel as energetic as they felt a year ago. The slight vaginal dryness they experience during intercourse is readily dealt with using a lubricant gel. Other women, liberated from a fear of pregnancy, experience a surge in their libido (sex drive), while some accept a decline in libido as just 'one of those things'.

But a sizeable proportion of women experience significant symptoms that negatively impact on their quality of life. These can become a frequent occurrence and there may also be a feeling of global anxiety for no obvious reason and a loss of self-confidence.

Some of the major physical and psychological changes that happen at menopause are:

• Many women will feel snappy or irritable with those around them during the menopause. Lack of sleep, depression and adapting to changes in life can be the cause of this, just as much as the menopause though.


• Hair loss and brittle nails may be experienced.


• Intimate relationships can be impacted due to the dip in libido.


• Energy levels may have declined dramatically.


• Skin becomes itchier and drier after the menopause, particularly on the vulva. The vaginal and vulval tissues become thinner and more fragile without oestrogen and this can make them become irritated or more prone to infections and skin conditions.


• Hot flushes are one of the commonest problems. They are overwhelming tidal waves of heat, flushing and sweating that come out of the blue. This is because of changes in the part of the brain that regulates temperature and can make women very self-conscious.


• Hormone changes can cause some women to retain water or produce more gas than before the menopause. Becoming less active can also make bloating worse. Women often blame the menopause for weight gain at this time of their life, but most cases of weight gain around your 40s and 50s are actually due to decreasing activity levels and changes in diet.


• Many women report that they struggle to get to sleep during or after the menopause. Hot flushes are often the cause of this. Insomnia or lack of sleep may mean that one feels tired and sleepy throughout the day.


• Many women report that they started to become forgetful after their periods stop, or their memory is clouded and they have a decline in concentration. There is a link between getting older and not being able to remember things as well.


• Psychological impact - the familiar stereotype is of the knife-wielding, menopausal woman. Contrary to popular opinion, women do not turn into axe-wielding maniacs once they stop needing to buy Tampax and there is much than can be done to help cope with the irritability and mood swings that some women experience.

There are other symptoms associated with the menopause which people do not generally recognise are part of the effects of the decline in oestrogen levels. These include flatulence, aching in muscles and joints, aches in the back of neck or head, decrease in physical strength and stamina, weight gain, increased facial hair, involuntary urination on laughing or coughing, being dissatisfied with one's personal life, feelings of wanting to be alone, and being impatient with other people, and feeling depressed.

What happens to these symptoms over time, if left untreated? In some women the symptoms do burn out, while in others they may persist for decades. Unfortunately, it is not possible to predict what will happen in any given woman.

What is evident is that no woman has to put up with debilitating symptoms just because the menopause is a natural phenomenon. Most, if not all of the symptoms can be controlled or eradicated. Conventional HRT (oestrogen replacement with progesterone) is the most effective weapon, but, where it may be contra-indicated (such as in women with a history of breast cancer) there are other options, such as alternative therapies.

Testosterone is frequently forgotten by many healthcare professionals. It plays a crucial role for women in terms of their libido, mental clarity and levels of energy, stamina and physical abilities. So, supplementing testosterone alongside oestrogen should be seriously considered.

For more information, contact the Menopause Clinic, London