1. How to survive your menopause David Griffiths Consultant Gynaecologist Christine Pearce Consultant Nurse 3 rd Sept 2014

2. What is the menopause? Normal, natural event. Defined as the last period confirmed after 12 months of no bleeding

3. When is the menopause? Average age 51 Medical/surgical intervention can cause early menopause Impaired ovarian function eg anorexia, family history

4. A new phase of lifeBeginning of the end

5. The Perimenopause The time leading up to the menopause 10-15% no signs or symptoms 10-15% disabling symptoms Approx 90% varying physical and or emotional levels of distress

6. Signs and symptoms Changes in menstrual cycle Vasomotor symptoms, night sweats, hot flushes Vulvovaginal symptoms, discomfort with sex Sleep disturbance Poor memory/concentration Mood changes, anxiety, depression

8. The Postmenopause The years after the last menstrual period With current life expectancy 1/3 to 1/2 of your life in the menopause

10. Stress Anxiety Exhaustion Depression Aging – physical symptoms of menopause General health Energy Loss of libido

11. Relationships Self confidence Appearance

12. Diet & Lifestyle HRT Alternative therapies Prescribed non HRT Testosterone

13. Diet & Lifestyle Healthy diet and exercise Who’s for the gym? Smoking and alcohol. Vitamins and minerals Eat less, move more, smaller plate, slow but sure.

14. HRT (hormone replacement therapy) Continuous combined Sequential Mirena intra uterine system Local oestrogens. Patches. Tablets. Creams. Vaginal ring Vaginal cream

15. Alternative therapies Acupuncture. Aromatherapy Homeopathy Hypnosis. Yoga Reflexology. Red clover Agnus castus Sage leaf

16. Prescribed non HRT Clonidine Dixarit Venlafaxine Paroxetine Gabapentin Progestogens Natural progesterone cream. Testosterone

17. Improve mood and sense of well being Improve sexual function. Only available as a gel Must be titrated accordingly as licenced for men. Testosterone.

18. Is it hot in here? Regular exercise Light clothing. Cool Bedroom. Reduce stress levels. Avoid triggers – spicy food, caffeine, smoking, alcohol

19. Does it work and is it safe? Does it work for the symptoms I have? What are the side effects? What are the long term risks? Is the treatment licenced? Talk to your GP. Do your research. My advice?

20. Sexual health Sexual problems 45-64 years Decreased oestrogen, reduced lubrication and elasticity – vaginal atrophy Decreased testosterone, waning of sexual desire/sensation Risk of sexually transmitted diseases

21. Urinary symptoms 50% of women over 50 have bladder problems Frequency, urgency, leakage Weight loss, pelvic floor exercises Medication

22. Osteoporosis Compromised bone strength Increases fracture risk 13-18% over 50 have osteoporosis of hip Low oestrogen accounts for 2/3 of bone loss around menopause

23. Risk factors for osteoporosis Advanced age Family history Smoking Prolonged steroid use Excess alcohol

24. Cardiovascular Disease Heart disease/stroke Leading cause of death for women over 65 Rates increasing in 35-54 age group Obesity, diabetes, and blood pressure

25. Cancer Menopause not associated with increased risk But cancer rates increase with age and Ca is the second leading cause of death in women

26. Screening for Cancer Breast Ca - three years from 50-70 Colorectal Ca - biannual from 60-69 Cervical Ca – 5 yearly until 65 Endometrial Ca – urgent assessment of any bleeding Ovarian Ca – no programme

27. Maximise your health! Eat well – healthy balanced diet BMI 19-25 Drink less alcohol Stop smoking Exercise

28. Be happy

29. Thank you Questions?