There is a lot more to menopause than suddenly feeling hot.
Yet that is often how we describe it.
“She’s having hot flushes.”
As if that explains everything.
In the pharmacy, I’ve spoken to women who come in for something completely different and, during the conversation, mention that they haven’t slept properly for months, their mood has changed, they are exhausted, their periods are all over the place and they no longer feel like themselves.
Then comes the familiar sentence:
“I think it might just be my age.”
It might be.
But menopause deserves a little more attention than that.
So what actually is menopause?
Menopause is the point when a woman has gone 12 consecutive months without a menstrual period, assuming there is no other medical explanation.
It happens because the ovaries gradually produce less oestrogen and progesterone.
The transition leading up to menopause is called perimenopause, and this can begin several years before periods finally stop.
For some women it is relatively straightforward.
For others, it can be a miserable period of their lives.
And there is no reliable way of predicting which woman will have which experience.
It’s not just hot flushes
Hot flushes and night sweats are probably the symptoms most people associate with menopause.
But there can be many others.
Periods may become irregular or heavier before eventually stopping.
Sleep can deteriorate.
Some women experience anxiety, low mood, irritability or a feeling that they simply aren’t coping as well as they used to.
Concentration and memory can become troublesome.
There can be headaches, palpitations, joint and muscle aches, fatigue and changes in body composition.
And then there are symptoms that women may be embarrassed to mention.
Vaginal dryness.
Pain during sex.
Reduced sexual desire.
Urinary symptoms and recurrent urinary infections.
These are genuine physical consequences of falling oestrogen levels.
They aren’t something women should simply be told to put up with.
And what about the emotional side?
This is the part that sometimes gets overlooked.
Imagine not sleeping properly for months, waking up drenched in sweat, feeling exhausted during the day, struggling to concentrate and suddenly finding yourself anxious or irritable.
Then add work, children, ageing parents, relationships and everything else life throws at you.
It isn’t difficult to understand why some women feel overwhelmed.
Not every episode of depression or anxiety around this age is caused by menopause, of course.
But hormonal changes can contribute to symptoms, and menopause can coincide with a period of enormous change in a woman’s life.
So dismissing everything as “just stress” isn’t particularly helpful either.
There are longer-term consequences too
Oestrogen has effects throughout the body.
After menopause, the decline in oestrogen contributes to accelerated bone loss, particularly around the menopause transition.
That matters because osteoporosis can eventually lead to fractures of the hip, spine and other bones.
Cardiovascular risk also increases as women get older and after menopause, although this is part of a much bigger picture involving age, blood pressure, cholesterol, smoking, diabetes, weight and lifestyle.
So menopause isn’t simply about surviving a few hot flushes.
It is a stage of life that deserves proper attention to bone health, cardiovascular health, mental wellbeing and general health.
What can actually be done?
Thankfully, quite a lot.
Hormone replacement therapy — HRT
For many women with troublesome menopausal symptoms, HRT is one of the most effective treatments.
It replaces some of the hormones the body is no longer producing, usually with oestrogen and, for women who still have a womb, a progestogen to protect the lining of the womb.
It can significantly improve hot flushes and night sweats and can also help other menopausal symptoms, including vaginal symptoms and sleep problems.
HRT can also help prevent bone loss while it is being taken.
But HRT isn’t suitable for every woman.
The benefits and risks need to be considered individually, taking into account factors such as age, medical history, previous cancers, unexplained vaginal bleeding, blood clots and cardiovascular disease.
This is where proper medical assessment matters.
What about vaginal symptoms?
Women shouldn’t feel they have to suffer in silence.
Local vaginal oestrogen can be extremely useful for vaginal dryness, discomfort and some urinary symptoms.
Only a small amount is absorbed into the bloodstream compared with systemic HRT, and it is often used long term when needed.
There are also non-hormonal vaginal moisturisers and lubricants that can help.
What if HRT isn’t suitable?
There are non-hormonal options.
Depending on the symptoms, doctors may consider medicines such as certain antidepressants, gabapentin or clonidine.
These aren’t simply “antidepressants for menopause”. Some medicines can reduce hot flushes even when depression isn’t the reason they are prescribed.
There are also newer treatments targeting the brain pathways involved in hot flushes, although availability varies considerably between countries.
What about Malaysia?
This is where I think we need to be particularly practical.
Menopause doesn’t stop being menopause because a woman lives in Malaysia.
But access to healthcare, attitudes towards menopause, cost of treatment and willingness to discuss intimate symptoms can be very different.
There can also be a tendency for women to simply accept symptoms as something they have to endure.
They don’t.
A Malaysian woman experiencing troublesome menopausal symptoms should be able to discuss them with a doctor or appropriately trained healthcare professional without embarrassment.
And healthcare professionals need to ask the questions too.
Sometimes the woman sitting in front of you isn’t going to volunteer that she is experiencing vaginal dryness, painful sex, anxiety or severe sleep disturbance.
She may need someone to open the door to that conversation.
Lifestyle still matters
No tablet can replace healthy living.
Regular weight-bearing and resistance exercise is particularly important for maintaining bone and muscle strength.
Walking is excellent.
Strength training is even better when combined with aerobic exercise.
A balanced diet with adequate protein, calcium and vitamin D is important for bone and general health.
Stopping smoking is one of the best things a woman can do for her long-term health.
Alcohol should be kept within sensible limits.
And sleep deserves attention.
Easier said than done when night sweats are waking you up, but good sleep habits can make a difference.
Keeping cool at night, wearing lighter clothing and identifying personal triggers for hot flushes can also help.
And a word about supplements
The menopause supplement market is enormous.
You will find products promising to balance hormones, stop hot flushes, improve sleep and restore your youth.
Some may help individual women.
But “natural” doesn’t automatically mean effective or safe.
Supplements can interact with medicines, and the evidence behind many menopause products is nowhere near as strong as the evidence behind properly studied treatments.
Be particularly cautious about products making dramatic promises.
If it sounds too good to be true, it probably is.
My view as a pharmacist
I think menopause has been under-discussed for far too long.
Women can spend years thinking they are going mad because they can’t sleep, can’t concentrate, feel anxious, have gained weight and don’t recognise themselves anymore.
And sometimes the response they get is simply:
“That’s menopause. Get on with it.”
I don’t think that’s good enough.
Menopause is a normal biological stage of a woman’s life.
But normal does not mean that troublesome symptoms have to be tolerated.
There are effective treatments.
There are lifestyle measures that genuinely matter.
There are ways of protecting bones and cardiovascular health.
And there are conversations that need to happen without embarrassment.
For women in Malaysia, Britain, or anywhere else in the world, the message should be the same:
You don’t have to suffer in silence.
Menopause is not an illness.
But the symptoms and consequences deserve proper medical attention.
Until next time take care of yourself.
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