What is the Menopause?
All women go through the menopause. This is the time when Menstruation comes to an end, when fertility ends, the ovaries cease functioning and there are no more eggs or Oestrogen produced.

Some women pass through this natural process without any undue difficulties.

Others can experience a long and painful struggle which leaves them exhausted and depressed. The menopause tends to develop in the age range 45 to 55.

When a woman has had her ovaries removed surgically or undergoes radiation or Chemotherapy, menopausal symptoms can be induced.

There are a number of symptoms which may or may not be experienced in the lead up to, and following the menopause. These can include:

• Premenstrual tension may be quite severe or there may be none at all.
• Onset and duration of the Period can change on each occasion. Periods may be early or late, may last fewer days than before or more.
• An inconsistent period may occur - alternating between heavy Discharge on one occasion and light on another.
• Hot flushes may be experienced lasting from seconds to minutes. They may be felt as a minor annoyance or may be severe enough to interfere with normal activity.
• With the reduction in the oestrogen being produced, thinning of the tissues of the Vaginal wall may result, as well as decreased lubrication. Vaginal dryness may be accompanied by irritation and itching. Pain may be experienced during Intercourse as a result of these changes - known as dyspareunia.
• Vaginal changes and changes to Urethral tissue can result in increased frequency of Urinary tract Infections, painful or frequent Urination (dysuria) and some degree of urinary Incontinence.
• General aches, fatigue, forgetfulness, Depression, Insomnia, irritability and Anxiety are symptoms which have also been reported in association with the menopause. In the longer term, the reduction in oestrogen production removes the protection which women enjoyed against the development of heart disease. By the age of 65, they are reported to be on a par with men with regard to risk. Reduced oestrogen production can also lead to a deterioration in bone mass, leading to the development in later years of osteoporosis (also known as ‘brittle’ bones).
• The psychological response to the end of the menopause can also vary. Some women, freed from the fear of Pregnancy, the tribulations of monthly periods, and perhaps the continuous use of Contraception, feel liberated and may even experience a flush of sensuality and interest in sexual adventure. Others lose any interest in continuing sexual activity, whether the passage through the menopause was difficult or relatively easy. Vaginal dryness accompanying the menopause can be off-putting too, especially if sexual activity results in pain. 

Difficulties with Arousal are discussed more fully at the Sexual Difficulties section of this web site.

The most common treatment for post-menopausal difficulties is Hormone replacement therapy (HRT), the main aim of which is to replace the oestrogen now no longer available. As with any treatment, there seem to be both advantages and disadvantages. The possible advantages include a reduction in urinary incontinence, a reduction of infections and  a reduction in vaginal irritation. In the longer term, osteoporosis may be reduced and some protection provided against developing heart disease.

Disadvantages of using HRT may include increased risk of developing breast cancer, although this risk remains quite small. HRT has also been linked with a small risk of developing blood clots in the legs and lungs. Some existing conditions would exclude the use of HRT. The use of HRT is a complex decision which should only be undertaken after extended consultation with your doctor. It is not the only option available and alternatives are available which are appropriate to personal circumstances. Ask your GP or pharmacist about these.