Your guide to living well with menopause

So you’ve heard that menopause sends your system haywire? Turns you into an overheated, cranky, wrinkly, old witch who doesn’t want to have sex, can’t sleep and cries at the drop of a hat?

If you’ve heard all the bad stuff from your friends you’re probably wondering how you’re going to cope, let alone live well, when hormones start signalling your body it’s time for menopause. But before you start preparing for the worst, remember there are many treatments and lifestyle changes which can help you cope with the changes and live well throughout the menopausal period. Not convinced? Read on.

Living well with menopausal hot flushes

You’ve probably heard from your friends about hot flushes, the sudden feelings of intense heat and profuse sweating that accompany menopause. They affect about 70% of menopausal women, usually for < 5 years. Hot flushes won’t kill you but they can disrupt your life and affect your emotions. To live well with menopause, you’ll need some strategies for coping with hot flushes.

To begin with, remember that hot flushes and other changes of menopause are normal and natural, even if everything feels different. Hormone replacement therapy (HRT) is an effective treatment and the most common reason menopausal women use HRT is to help them cope with hot flushes. However, if you’re worried about the side effects of HRT, such as an increased risk of breast cancer, you may like to try some other strategies first, such as:

Avoiding certain foods and beverages (e.g. spicy foods) which trigger hot flushes; and
Strategies to reduce body temperature (e.g. keeping the room cool).

If these measures fail and hot flushes occur, you may be able to cool off by:

Having a cold drink or shower or using a fan;
Breathing deeply and trying to relax;
Running cold water on your wrists;
Removing clothing: Dressing in many thin layers will make this easier;
At night, getting out of bed.

Living well with menopausal sexual changes

Expecting your sex life to take a turn for the worse during menopause? Think again. While the hormonal changes which occur at this time of life are likely to cause changes, for example reduce vaginal lubrication during sex, they certainly don’t mean the end of a good, satisfying sex life. Your emotions also play a considerable role in how you have sex and feel about it.

Worrying about problems in your intimate relationship or issues with your kids can also affect your sex life, and if this applies to you, the best treatment may be to deal with your emotional issues first. Before you start thinking about medicines for treating the sexual changes of menopause, treat any negative emotions that may be affecting your sex life. Begin by:

Loving your new menopausal body, despite its different shape and appearance. Remember that the changes are normal. Be positive about your body and keep it healthyby:
- Maintaining a healthy diet including minimising alcohol and caffeine consumption;
- Performing at least 30 minutes of moderate intensity physical activity every day; and
- Quitting smoking;
Having sex. Regular sex (either alone or with a partner) increases vaginal elasticity which typically declines and contributes to sexual problems in menopause.

If sexual intercourse doesn’t happen easily, try:

Using vaginal lubricants;
Practicing new sexual techniques, amongst which non-penetrative techniques like oral sex, cuddling and massage may be of particular importance;
Addressing socio-cultural factors which influence sexual function, for example social norms which portray sexual enjoyment as less acceptable for older women.
Thinking about sex. The brain is the centre of sexual desire, so it’s important to think positively. Having trouble? Erotic films or sex toys may help you focus your mind on sex;
Remembering that good sex takes two and you are not to blame if sex isn’t great;
Treating conditions affecting your partner’s sexual function, for example, low testosterone (hypogonadism) and erectile dysfunction;
Focusing on your sex life and not comparing. Focus on what feels right for you and your partner, not what your sex life used to be like or what your friends are doing.

If you need a little extra help, oestrogen-containing creams which are applied to the vagina or rings which are inserted into the vagina might be just the fix you’re looking for. There are many different products, which are more or less effective in treating different sexual complaints (e.g. dryness, itchiness). HRT is not usually used for treating sexual symptoms, however if you have other menopausal symptoms such as hot flushes, HRT might be a good option.

Living well with menopausal emotional changes

Sorting out your hot flushes and sex life will probably help you feel emotionally healthy and happy but if you’re coping with other stressful events like kids leaving home or relationship problems, your emotions might need a little extra TLC. While oestrogen affects the brain and its rapid decline at menopause is thought to contribute to emotional, concentration and memory difficulties, life events are also thought to be a considerable source of emotional distress for women in menopause.

An important aspect of living well with menopause and its emotional changes is simply to think positively. The brain is a powerful organ and negative feelings are associated with a greater likelihood of experiencing menopausal symptoms. Try to view menopause as the start of a new phase in life, rather than a negative interruption. It may also be helpful to:

Set aside personal time for relaxation, pursuing new interests or joining a hobby group;
Get support from friends, family, your partner and, if necessary, health professionals;
Ensure you get regular cognitive stimulation if you have memory/concentration problems;
Socialise which can increase mental function;
Identify and address stressors, including work, children and your intimate relationships;
Practicing relaxation and stress relief techniques to help you cope when symptoms arise;
Challenging beliefs which may reduce your self-esteem, such as unrealistic expectations about body shape and beauty;
Keeping a mood diary which may help identify triggers and subsequently help you to develop coping strategies.

If these strategies are not enough, other options include HRT and herbal remedies. HRT is effective in relieving emotional difficulties associated with menopause. As it also relieves hot flushes, it’s most appropriate for women who experience both emotional difficulties and hot flushes. There is also a range of herbal remedies, however, speak to your doctor before trying any of these. Red clover isoflavone phytoestrogens (for example Promensil), gingko, ginseng, kava-kava and St John’s wort have been shown to reduce psychological symptoms such as anxiety and depressed mood. However, while there is strong evidence for the use of red clover isoflavones, there are safety concerns regarding the use of ginseng and kava-kava, and St John’s wort is less effective than other available treatments.

Living well with other menopausal symptoms

If you’ve sorted out hot flushes, your sex life and your emotions, sleep disturbances which are common in menopause, are much less likely, and you’ll be more likely to deal with the skin changes like wrinkling and sagging which accompany menopause. But being proactive can reduce how much your skin is affected, so don’t forget to:

Wear broad spectrum sunscreen;
Avoid harsh soaps and other products which may exacerbate skin dryness; and
Use moisturising skin creams, amongst which those containing soy isoflavone phytoestrogens or vitamin A may be most effective.

Phytoestrogen containing tablets are also an option for treating menopausal skin symptoms. Cosmetic treatment like botulinum toxin injections (e.g. Botox and Dysport) and cosmetic surgery can temporarily change the appearance of skin. However, they are medically unnecessary and often do not improve self-esteem.

If you’re still having trouble getting a good night’s sleep, try:

Behavioural therapies targeted at improving sleep including sleep hygiene measures, ritualising sleep patterns and, in severe cases, sleep deprivation;
Practising relaxation or stress management techniques including biofeedback;
Avoiding stimulation and heavy meals immediately before sleep;
Using soy or red clover phytoestrogen supplements;
Using sleep medications which your doctor can prescribe if they’re needed.

Focusing on a healthy mind and body to live well with menopause

Despite all the bad things you’ve heard, it’s possible not only to cope, but to live well with the physical and emotional changes which accompany menopause. A healthy mind and body are the basis for a happy, healthy menopause, so measures like healthy eating, exercising and avoiding substances like nicotine and alcohol are all important.

However, even when body and mind are healthy, many women need to employ additional strategies to live well with menopause. Whether the symptoms are hot flushes, sexual changes, emotional difficulties or others, there are numerous strategies that can help you cope. It really is possible to live well with menopause.

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