Case histories

Joanna was 49 when she contacted Menopause Health. Joanna admitted to have been increasingly moody over the past few months. Her cycle was still regular but she was experiencing increasingly severe premenstrual tension prior to each period. Joanna has been in the same job for about 15 years and feels in a rut. Her husband is a driver, sometimes returning very late. They were spending little time together as her husband likes go on long distance cycle rides at the weekends. Joanna feels that they were growing apart and in addition intercourse had become uncomfortable because of dryness. Both daughters are at university and she misses looking after them. Her elderly mother has diabetes which is a worry. She bought a small dog recently to keep her company but this has been restricting as she feels she should not leave the dog in the evenings as well as during the day. Much of the consultation was spent talking about the impact of Joanna’s present life style on her mood. I encouraged Joanna to think of ideas that would make work more interesting and how she could improve her working relationships.  Much of the discussion was very practical; we discussed how she could fulfil her need to care for others and her role of looking after her mother. She talked about how she could organize her evenings better, preparing the evening meal then go to the gym, see a friend or take the dog to see her mother and so on but still have time with her husband over a late meal together. Joanna also decided that she will arrange one activity with her husband each weekend such as a shorter cycle ride, watching a film etc. Joanna also learnt about the different vaginal lubricants available to make intercourse more comfortable and will decide which to opt for.

    

‘I found you very approachable and easy to share issues with. It gave me food for thought about my present life style – which I hope will prompt me into action. The information pack is great and your suggestions about how I can improve my life style are sensible.’

 

 

Sarah was 42 years old. She wasn’t sure what was happening to her cycle and was uncertain if she was going through the menopause as she had always had very irregular periods but had not had one for 4 months. She had married in her early twenties and had spent many years having fertility treatment. She had twin boys now aged 6 years. She was finding the boys increasingly hard work and was struggling to motivate herself. She was having very disturbed nights and felt tired all the time. She regretted that she had spent so many years trying to conceive and was aware that she was ‘no longer the woman that her husband had married’.  During the consultation, we discussed the significance of a menopause at 42 years and probable menopause symptoms that she was experiencing. We discussed the impact on her longer term health and the significance of a family history of thyroid disease that her mother and grandmother had. We talked about menopause treatment options. And also the importance of her diet and exercise. Sarah was reluctant to consider any medication because she had taken so much during the fertility treatment.  Practical issues of coping with the boys and the need to have time and energy for her husband were also discussed.

 

 

‘Many thanks, it was very useful. It was really helpful discussing my specific cycle problems and whether it was linked to the menopause. I now feel able to make sensible decisions about HRT. I’ve seen my GP and have had my thyroid checked. Since we met I am more disciplined with my time and more organized. I am enjoying the boys more and have arranged for them to stay with their grandmother for a night, a treat for all of us.’

 

 

Sue is 48 and works full time as a nurse and is single. She had a hysterectomy because of bleeding problems four months ago. She has a family history of breast and ovarian cancer so decided to have her ovaries removed as well.  As a result she was experiencing quite severe menopause symptoms, particularly hot flushes and sweats. Because of the family history of breast cancer she was reluctant to consider HRT. Sue had read that there was an increased risk of breast cancer with HRT. She wanted the opportunity to discuss the alternative treatment options to control these symptoms. During the consultation the risks of HRT after hysterectomy were discussed and Sue learnt about all the possible alternatives. Often flushes are made worse by stress and anxiety and it also became apparent that life issues were contributing to the way she was feeling. As a nurse she has a busy and responsible job that was being made more stressful by staff shortages. As a single daughter, her brothers expected her to take responsibility for the care of their elderly father. Having just returned to work following the hysterectomy, she was completely worn out. Menopause Health provided her with all the information on treatments that was specifically relevant to her, with all the benefits and risks explained so that she could a decision that felt right for her. She also had time to talk about her work and leisure balance in life, with thoughts about how she can begin delegating and even saying ‘no’.

 

 

'You are very comfortable to be with Jan and have a nice relaxed attitude. This service is invaluable for those going through the menopause and needing help, information and guidance in a non clinical setting. It is much less threatening than seeing a doctor'.