Menopause Resources

This clinical skills series — Think menopause — looks at menopause-related issues to help general practice nurses (GPNs) identify, assess and manage women whose day-to-day lives may be detrimentally affected by this stage in their life. Here, Sue Thomas, advanced nurse practitioner (ANP) based in Leamington Spa, looks at physical activity and the menopause. Sue is also the founder of a local menopause support charity, Action Menopause Warwickshire, which is free for ladies to attend  (https://actionmenopausewarwickshire.org.uk/).

Perimenopausal and menopausal symptoms are common and can, for some, have a devastating impact on both home and work lives. Peri/ menopause normally happens in
our 40s or 50s but can happen to anyone at any age. It can affect men undergoing certain cancer treatments and those going through gender affirmation or any other significant
hormonal treatment.

This clinical skills series — Think menopause — looks at menopause-related issues to help general practice nurses (GPNs) identify, assess and manage women whose day-to-day lives may be detrimentally affected by this stage in their life. Here, Sue Thomas, advanced nurse practitioner (ANP) based in Leamington Spa, discusses the complications that can arise with genitourinary syndrome of the menopause (GSM).

Conversations about menopause are finally happening. It is no longer the hushed whispers between women of a certain age, it is being talked about openly, honestly and at a national level. Healthcare professionals, education providers, employers and policy makers have woken up to the fact that adequate menopause health care for women has been sadly lacking for many years.

In a busy general practice setting, some women’s health issues are perceived by the patients to have been dismissed with a prescription for Prozac, or just played down and the woman told that there is nothing wrong. Wanting women’s health issues to be addressed fully and respectfully is why the Royal College of Obstetrics and Gynaecology developed its publication and campaign, ‘Better for Women’, with the aim of steering the UK away from providing a disease intervention service towards a preventative health service, which addresses the determinants of health throughout the woman’s life course. Without doubt, some women’s health issues can be helped with medication; but this should not be the first approach. Further, medication is more likely to work well if women’s health and lifestyle issues are also addressed. Top diet and lifestyle issues include excess weight, lack of physical activity, and stress; and many of these are intertwined. Addressing these issues when dealing with the three top women’s health conditions: menopause, polycystic ovary syndrome (PCOS) and premenstrual syndrome (PMS), is essential — to move straight into the medication option and ignoring lifestyle changes often means the problem may never truly be solved long term.

A woman’s average age for her periods to end, marking the menopause, is 51. Roughly, 80% of women suffer from some menopausal symptoms which last for two years on average. Lowered oestrogen levels are responsible for most menopausal symptoms; the most common in western culture being hot flushes, night sweats, vaginal dryness and sleep disturbance. Weight gain that is often associated with the menopause can further add to the development of health conditions, such as heart disease, and make certain symptoms, such as hot flushes, worse. The combination of a healthy diet, in particular with a low glycaemic load, keeping active, and avoiding weight gain can help alleviate or reduce severity of menopause symptoms. Some foods such as soya products, oily fish, oats, possibly probiotics, and milk products or their alternatives, can help with a number of symptoms. More evidence is gathering for how a Mediterranean diet can help with symptoms.

Recently it has become clear that hormone replacement therapy (HRT) is a safe option for many women. The National Institute for Health and Care Excellence (NICE) published a guideline in November 2015 which provides guidance as to when HRT can be used and what risks and benefits are associated with its use. HRT is the best treatment available for management of menopausal vasomotor symptoms. If started before the woman turns 60 and within ten years of the menopause, HRT has a good safety profile. The main risks associated with HRT use are venous thromboembolism (VTE), stroke and breast cancer. VTE and stroke risks are increased when oral HRT is used. The increased risk of breast cancer is linked to combined HRT use. HRT is bone protective and can prevent osteoporosis. It is recommended that HRT is used for the shortest time possible, and if used for five years or less serious side-effects are unlikely to occur.