Understanding the 40-50 Woman


Our guest writer, Dr Tonye Wokoma FRCOG, MFSRH is a Consultant in Sexual and Reproductive Healthcare and Gynaecologist at Conifer House Sexual and Reproductive Health Service, Hull, United Kingdom. She is the Clinical Lead for Menopause Care and BME Outreach Services and is particularly interested in promoting better Sexual and Reproductive Health for Black and Ethnic Minority women and men with a commitment to reducing health disparities and inequalities.

Outside of work, she has served on boards of various charities and community groups. She graduated from the University of Ibadan in Nigeria.

What is the menopause?
All women are born with a limited number of eggs stored in the ovaries. The ovaries also produce oestrogen and progestogen.  When a young girl gets to puberty, which is initiated by hormonal changes from the brain to the ovaries, she starts menstruating.
Premenopause is the time from when a woman starts her period till when she goes through the menopause.
The peri-menopause or climacteric is from onset of symptoms until one year after the menopause. The timing of onset and duration is variable with the average age being between 45 and 55 years.
The menopause is a single point in time. It is the final menstrual period (FMP). The average age in the UK is 52 years. 80% of women would have gone through the menopause by age 54.
When women refer to menopause symptoms, often they are referring to symptoms that start in the peri-menopause.
Why is it important?
The average female life expectancy in the UK is 81.5yrs. Therefore more than a third of a woman’s life-time is spent in post-menopause.
45% of women in the menopause transition found it somewhat/fairly difficult to cope with work.
Ethnic variation
Ethnic variation exists.  Studies show Caucasian women experience more psychosomatic symptoms and African American women more vasomotor symptoms (hot flushes and sweats). Generally, all ethnic groups complain about feeling tense, depressed, irritable, as well as headaches and stiffness.
Factors that influence the menopausal experience include biological factors, psychological and cultural factors. Women with higher body mass index often report increased incidence of vasomotor symptoms. Lifestyle choices such as smoking and alcohol consumption can also affect a woman’s menopause experience adversely. Women with a negative attitude report more menopause symptoms.
Cultural factors are also important in how women perceive the menopause. African cultural attitudes include having a stoic attitude, denial, anxiety at stage in life, fear of risks and side effects of treatment and superstitious beliefs

Symptoms
Symptoms are experienced by 8 in 10 women and on average last 7.4 years. It may last for 12 years in 10% of patients. The symptoms can sometimes be very severe and affect a woman’s quality of life. These include:

  • menstrual cycle change
  • hot flushes and sweats (vasomotor symptoms)
  • mood changes and tiredness
  • vaginal dryness and urinary symptoms
  • loss of libido.
These have often been described as ‘Internal heat’, ‘things crawling all over my body ’, ‘pains in private part’, ‘pressure in my head’, ‘heart beating’, etc. by women of African descent.
What can be done to help?
You can complete a self-assessment menopause questionnaire:  
If a woman is over the age of 45, blood tests are not necessary. There are many online resources available and she would be advised to visit her family doctor or Gynaecologist.
Management would include advice and information:
  1. Diet and lifestyle modifications
  2. Hormonal – Hormone Replacement Therapy (HRT)
  3. Non–hormonal
    • Medicines for example drugs called SSRIs/SNRIs, Clonidine
    • Herbal remedies
    • Cognitive Behavioural Therapy

Lifestyle modifications include regular exercise and weight loss if needed, avoiding triggers like spicy foods, caffeine, smoking and alcohol; adequate sleep.

Risks with HRT
HRT is very good for menopausal symptoms, but there are small risks associated with taking HRT. These need to be put into perspective. These risks include the risk of breast cancer, clots and strokes. The relative risk of breast cancer with HRT is much less than with other things such as obesity, alcohol intake of 3 units/day, high intake of saturated fats, delayed menopause (5 years), eating a quarter grapefruit per day. The risks of clots and strokes is reduced to little or no risk, by using standard doses of HRT in a transdermal (absorbed through the skin) preparation.
Women with the following diseases should not use HRT; Acute phase blood clot (DVT or PE); heart attack or Stroke; current endometrial or breast cancer; undiagnosed breast lump; pregnancy; undiagnosed vaginal bleeding and acute active liver disease.
Caution with herbal remedies
The evidence for herbal remedies is not conclusive.  There is variable quality control and some should not be used in women who should not take oestrogen such as Ginseng, Black cohosh, Red clover. Some herbal products have serious side effects, for example liver damage with kava kava.

If you are a woman, over 45 years old and have the symptoms outlined earlier, there is no need to suffer in silence.  Visit your family doctor or gynaecologist. If you are the man in her life, please do not hurry to find faults with her behaviour. It just might be Men-Oh-Pause!

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Sounds of Menopause

Doctor Hector
KayHector Consulting Ltd

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