Top 3 questions - Menopause with Prof Alison McMillan & Karen Cook

ALISON: Hello, my name is Alison McMillan and I'm the Commonwealth Chief Nursing and Midwifery Officer, and today I'm joined by Karen Cook from the Nursing Taskforce. Can I first acknowledge the Traditional Owners on the lands on which we meet today. We're here on the lands of the Ngunnawal people and pay my respects to Elders past, present and emerging.

KAREN: Thanks Alison, it's great to be joining you today. Today, we're going to be talking about menopause. We're gonna talk about what menopause is, what some of the symptoms are and what some of the treatments are. And we recognise that whilst menopause is a natural process and a transition for all women, for some women, there are more difficulties in mental and physical health through that transition period, and we're hoping that we're going to be able to explore some of those and perhaps debunk a few myths about menopause. So Alison, I'd like to start by asking you what exactly is menopause?

ALISON: Thanks Karen. So each ovary contains about a million...

KAREN: Woah, stop right there Alison. A million?

ALISON: A million eggs. (LAUGHTER) And as we age, our ovaries begin to stop releasing those eggs and their viability becomes less until when menopause occurs, the ovaries stop producing eggs. Menopause often is considered in three stages. There's the perimenopausal state which leading up to menopause where the number of eggs being released decreases. Then there's menopause in itself when the final menstrual periods occurs and the ovaries stop releasing eggs. And then there's the postmenopausal, which starts, really, when it's been 12 months since you've had a menstrual period. But where that's not being caused by surgery or by contraception, or by something else. Menopause occurs because of changes in our reproduction cycle, as Karen has said. These are naturally occurring and some of the hormones progesterone, oestrogen and testosterone do begin to diminish. And these are the sort of things that begin to cause menopause. And that happens for all women, but at different times.

KAREN: So when exactly does menopause happen?

ALISON: Menopause generally occurs naturally and normally around the age of 45 to 55. It may happen earlier for some people or it may happen later for others, As we all know, each woman is an individual and so, it can be different for each of them. The diagnosis of menopause is based on the age of a person, their medical history, and usually includes where they have not had a menstrual period for more than 12 months, Karen.

KAREN: Oh, well clearly as a woman who's been through menopause, I'm quite interested in this process, and so, I'm just going to ask you, Alison, what are the symptoms of menopause?

ALISON: Well, Karen, as you and I both know, and for many women, menopause is different for us all. But there are some common signs

and symptoms that we all know. And some women are really lucky and don't actually have any symptoms whatsoever. And they should be really pleased about that. But we do often see a smooth transition where we do see both physical and mental changes. And these vary as to say from woman to woman, but generally, they are that, as we all know, that that hot feeling of feeling hot in the chest, night sweats, sweats to the extent that, your sleepwear, sleep attire or bedding may get wet and they really are really quite awful experiences, but they do pass. Other symptoms of menopause, certainly include vaginal changes, dryness and pain during intercourse, mood swings, low mood, irritability or anxiety.

KAREN: I think my children could attest to that.

ALISON: Joints aches and pains. As we get older, joint aches and pains are quite common. Crawly, itchy skin. Breast tenderness, headache, low libido and tiredness. Problems falling asleep, staying asleep or the quality of sleep and trouble concentrating or forgetfulness, which, obviously, is sometimes, will be associated with...

KAREN: Oh, Alison, I don't know about you, but I felt like I was in a fog for a couple of years, like there was just this cotton wool where my brain ought to be.

ALISON: And then to top it off, weight gain around the stomach.

KAREN: A new abdominal feature. So the only thing I can say about this is that you have to treat this as an opportunity to treat yourself to an entire new wardrobe. I did.

ALISON: We often hear that postmenopausal can increase the risk of fractures and that's, so we know that the changes in oestrogen and progesterone can mean that there are changes and this can lead to thinning bones, which is called osteoporosis. Changes experienced during menopause can lead to an increase in the risk of heart disease and high blood pressure, and stroke, Karen, as well, sadly. And all of these things, as we've said, natural processes of ageing, but do tend to challenge we women.

KAREN: I like the term 'we women' for you and I, Alison. But seriously, I've also heard that menopause can cause depression. Is that true?

ALISON: Menopause doesn't cause depression. People who have, perhaps individuals have a history of depression before menopause, are definitely more susceptible due to those changes in their emotional state and they may be more sensitive to those shifts and hormones that we know happen during and post-menopause.

KAREN: OK, OK. So what things can impact on menopause symptoms?

ALISON: I think that the sort of things that can impact on the symptoms are all of the things we know we really should be doing anyway, Karen. So we know we should try to have, eat a healthy diet, get regular exercise, try to get plenty of rest and limit the stress or anxiety, if we possibly can, general healthy living and healthy lifestyle is likely to help mitigate those symptoms and also, help if you need to, how to just deal with those symptoms.

KAREN: Oh, OK. Alright. So I mean, it's the same sort of health advice for generally anything?

ALISON: Yes.

KAREN: Really, isn't it?

ALISON: It is, yes/

KAREN: OK, and then, see your qualified health professional if you've got any particular concerns that you want to discuss.

ALISON: That's right. Yes, definitely. So if these symptoms of menopause that we've talked about, Karen, begin to really impact on your life and the mitigations we've talked about, about healthy living, is not, is still, menopause symptoms are still really causing you problems, definitely talk to a health professional about that because there are treatments available that can help with the management of those symptoms. So there's hormone treatments that can be prescribed by a health professional, but it really needs to work through what they might look like.

KAREN: So, I mean, in summing up, it's natural. It's going to happen to every woman at some stage, but the age at which it happens will vary. The range of symptoms is enormous. It affects every single body system. I think, until we go through menopause, we don't realise the impact of those hormones on our bodies. And so, even if your experience of menopause is difficult, if you're having night sweats to the point that you have to get out of bed and change the bedding, and you're having all of these difficulties, it is manageable. There is support that you can get. There's treatment that you can get. And there is light at the end of the tunnel because it's not forever.

ALISON: That's right Karen.

KAREN: That's great. That's really good. So thank you for that, Alison, and so, what we'd like to do is ask you to check back in for part two of our series on Menopause, in which we're going to find out a little bit more about perimenopause, the safety of menopause hormone therapy, and how menopause is experienced after hysterectomy or removal of the ovaries.