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Menopause is sometimes known as the 'change of life', and is defined as the ending of menstruation (when a woman's periods stop).

Menopause is the end of egg production (ovulation). This occurs as a result of declining levels of the female sex hormone, oestrogen, which regulates menstruation. The ovaries also start to make less of other hormones such as progesterone and testosterone.

A woman's periods usually become less frequent or irregular, rather than stopping suddenly. A woman is said to have reached Menopause after an absence of periods for one year. After this point, a woman is considered to be in her post-menopausal stage of life. The time leading up to Menopause is known as peri-menopause.
• Perimenopause: The hormonal changes associated with Menopause actually begin prior to the last menstrual period, during a three to five year period called perimenopause. During this transition, a woman may begin to experience menopausal symptoms and may lose bone density, even though she is still menstruating.
• Premature Menopause or premature ovarian failure is defined as a woman's last period occurring before the age of 40. In many cases no cause will be found. Medical conditions such as Addison's disease and hypothyroidism and medical treatments and procedures such as hysterectomy and chemotherapy can cause premature Menopause. In rare cases, infections such as tuberculosis and mumps can be responsible. In approximately 5 to 15 percent of cases a woman may still have intermittent ovarian function, which means that her ovaries still release eggs once in a while, and she may still be able to conceive.

The early stages of Menopause (perimenopause) cause fluctuating hormone levels. The following symptoms may occur;
• Menstrual cycles becomes longer, shorter or irregular
• Bleeding may become lighter
• Bleeding may become unpredictable and heavy (seek advice from your doctor).
Eventually hormone levels will fall to a point where menstruation will stop altogether and Menopause is reached. Although fertility after the age of 45 is low it is still possible to become pregnant and contraception is recommended until you have had one year without a natural period.

Other signs and symptoms
The most common symptom of Menopause is the hot flush. Women sometimes experience other symptoms, which may include:
• Night sweats
• Aches and pains
• Crawling or itching sensations under the skin
• Forgetfulness
• Headaches
• Irritability
• Lack of self-esteem
• Reduced sex drive (libido)
• Sleeping difficulty
• Tiredness
• Urinary frequency
• Vaginal dryness
• Long-term health risks

A decrease in female hormones after menopause may lead to:
• Thinning of the bones (osteoporosis) and an increased risk of fractures
• An increase in the risk of heart attack and heart disease, high blood pressure and stroke.

As with all medical conditions it is advisable to consult your Doctor for an accurate diagnosis and treatment. If you are having menopausal symptoms that are interfering with your daily life, there are treatments available that can help.

Medical treatment for symptoms of Menopause can include hormone replacement therapy (HRT) and other therapies. The kind of treatment your Doctor will recommend will depend on your symptoms, medical history and your own preferences.

Bone loss and osteoporosis are natural features of ageing, but declining oestrogen accelerates the process in post-menopausal women. Short, frequent sessions of weight-bearing exercise, eating plenty of calcium, giving up smoking and moderating alcohol consumption can all help to decrease the risk of osteoporosis. If your diet is inadequate, calcium supplements are available from your Pharmacy. See your Doctor for advice about nutritional supplements and any new exercise regime you may be considering.

A balanced diet is recommended. A low-fat, high-fibre diet, with plenty of fruit vegetables and whole-grains, will help you to achieve and maintain your ideal, healthy weight. The diet should be high in;
• Foods rich in calcium (such as low-fat milk, cheese and other dairy products) and
• Phyto-oestrogens (naturally occurring plant compounds chemically similar to oestrogen such as soy and linseed)

Nutritional supplements may be of use if dietary intake is inadequate.
• Vitamin D is crucial with Calcium as it can assist the body to absorb calcium from foods, and prevents
calcium loss in the urine.
• Calcium is necessary for maintaining strong bones and is commonly prescribed to prevent and treat postmenopausal osteoporosis (bone thinning).
• Black cohosh (Cimicifuga racemosa) can help alleviate a number of menopausal symptoms such as hot flashes, headaches, heart palpitations, insomnia, and depression.
• Magnesium is essential for assisting bone in creating new calcium crystals.
• Phyto-oestrogenic supplements such as Red clover has been shown in some studies to reduce the symptoms of menopause.
• St. John's Wort (Hypericum perforatum) can be beneficial in treating mild depression, which can occur with menopause.
• Sage can prevent sweating associated with hot flashes, which can be a common symptom of menopause.

Ask your MedAux Pharmacist for advice.
1. Follow the Diet Hints.
2. If you need help reaching an ideal weight ask your Pharmacist for advice.
3. If you have queries about your medication ask your Pharmacist.
4. Ask your Pharmacist about cholesterol checks and bone density tests.
5. Ask your Pharmacist for products, which may help, relieve the symptoms of hot flushes and vaginal dryness.
6. To help manage hot flushes and disturbed sleep; wear lighter clothing, keep your bedroom cool at night, try to reduce your stress levels, and avoid potential triggers, such as spicy food, caffeine, smoking and alcohol.
7. Consider some nutritional supplements if dietary intake is inadequate.

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