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Sample Personal Action Plan
You will receive an information pack from Menopause Health
A good diet becomes increasingly important. At the menopause, a varied and balanced diet can help symptoms and weight control, it can also be significant in protecting against heart disease and osteoporosis, such as adequate calcium is vital in helping to prevent brittle bones. Calcium-rich foods The Department of Health and the National Osteoporosis Society advise adult women to take 700mg of calcium daily and women known to have osteoporosis to take 1200mg of calcium daily. However scientific research seems to show that women after the menopause that are not on HRT, need about 1500mg daily and those taking HRT should aim at taking 1000mg daily. These higher levels of dietary calcium have shown to reduce the long term risk of having a fracture. A higher calcium intake will not prevent osteoporosis but it may slow the rate of bone loss, which may ultimately make the difference to whether you have a fracture or not. Record the amount of calcium that you are having in your diet over a few days and then consider realistic ways of including more in your diet if necessary. Calcium is absorbed best from food but if there is a shortfall in your diet then it would be wise to take a calcium supplement. These can be bought over the counter at the chemist but do look the level of calcium content in the tablets so it meets your needs. Some calcium supplements also contain vitamin D. Although this is probably not absolutely necessary for all women, particularly those who spend time outside in day light as part of their normal lives, vitamin D is also essential for healthy bones and some doctors think it is wise to add it. Key action points
Our relationships change over the years with new and different demands from partners, parents and children. Roles within relationships change as children become more independent and parents become more dependent. Relationships with partners too naturally change and many things may contribute to these changes, including the menopause. Sex and menopause A combination of complex factors can influence your experience of sex. Sexual desire and activity can be affected by the menopause. The changes that women experience are individual and will vary but they may include reduced sexual feelings, discomfort, less or no interest in sex or in your partner. Low sex drive is linked to many things - how you feel about yourself, your relationship, mood, general health, fitness, medication and so on. Some changes in sex drive can be directly due to menopause symptoms. Physical contact, such as a cuddle, can trigger a flush or sweat, making you feel uncomfortable and embarrassed. Weight gain may make you feel unattractive, insomnia and tiredness also contribute to low libido as you'll just want to go to sleep. Vaginal dryness can mean that intercourse is painful and this too is off putting. It is essential to get dryness sorted, vaginal dryness has the greatest impact on libido of all the menopause symptoms. Some women notice physical changes to their vagina and vulva at the menopause. The blood supply gets less and the labia (the folds of skin around the entrance to the vagina) become thinner. The clitoris may become smaller and pubic hair reduces. The mons pubis, the skin behind the pubic hair may become less plump. Regular intercourse can help slow these changes. Attitudes towards sex have changed in recent decades. The use of oral contraceptives has partly been responsible but the greater freedom and openness to discuss sexual matters has also contributed. Today we expect to continue a healthy sex life beyond the menopause. The media frequently shows images of sexy and glamorous older women but sexual activity does naturally go down after the menopause. There are several reasons for this and not just the changing hormone levels. Half of women in their middle years live alone and do not have a partner. Also ill health may make intercourse impossible or low libido may be a side effect of medication (such as antidepressants or blood pressure tablets). Many men too suffer from impotence perhaps due to depression, high blood pressure, diabetes, prostate cancer, smoking or excessive alcohol. Sexual interest is very dependent on the health of the relationship. Usually a happy, fulfilled sexual relationship before the menopause will continue afterwards. However arousal may take longer, so foreplay becomes more important. Often couples have got into a routine with love-making and the menopause may be the time to introduce some variations. If you are too tired at night, consider making love in the afternoon. If arousal is an issue, then consider a vibrator to assist clitoral stimulation or manual stimulation. Some women find fantasizing or watching an evocative film helpful. There are some useful books to help understand your sex drive better. Menopause Health has copies of books to look at and find ones that are suitable for you. Recent studies have suggested that a small dose of the male hormone testosterone is helpful for improving sex desire in women. Women have small amounts naturally in their bodies. The effects seem very variable between women and at the moment in the UK, female doses are only available as implants which need a small surgical procedure to insert them. Testosterone patches will become available in the near future. Another hormone, DHEA (dehydroepiandrosterone) is a popular supplement in the US, However there is no evidence that it helps sex drive and it is not licensed in the UK. Little is known about DHEA, it may enhance mood but there are concerns about safety. Key action points
The amount and types of activities that fill our working lives and leisure time can contribute to menopause symptoms and longer term health. For example the amount of exercise, stress, alcohol and smoking can make your menopause experience worse and damage long term health. Alcohol and the menopause The daily recommended amount of alcohol for women is 2-3 units daily and a total of no more than 14 units per week. A unit of alcohol is the equivalent to a small glass of wine (125ml), a single measure of spirits or half a pint of beer. It is also recommended that everyone has one or two alcohol free days each week to reduce the problem of addiction. Alcohol has many effects on different parts of the body; some are good but others not. At the menopause, it is particularly important to understand the effects of alcohol, to be able to enjoy it without exposing yourself to any unwanted effects. Alcohol can have an impact on the menopause symptoms. Alcohol is well known as a trigger for making flushes and sweats worse. It may be worth avoiding alcohol for a few days to see whether night sweats and flushes improve. Remember alcohol contains many calories and may be contributing to unwanted weight gain. Alcohol can have a negative effect on sleep. Although alcohol will help you to go to sleep more easily, as the effects wear off, you may wake up feeling wide awake unable to drop off again. As alcohol has a diuretic effect, it can contribute to urinary problems such as having to go to the toilet at night and urgency to get to the toilet in time. If urinary problems exist, then pelvic floor exercises can help, Menopause Health can provide information on these. Pelvic floor exercises need to be done regularly and in the long term and they can dramatically improve urinary symptoms. Within the recommended limits, alcohol particularly red wine does appear to protect against heart disease. The Mediterranean diet seems to be heart protective because of the olive oil, fruit, vegetables, legumes, fish etc that it contains. It also includes moderate amounts of alcohol, mainly wine. So alcohol, specifically red wine can help protect against heart disease but only if drunk within the recommended limits and as part of a varied balanced diet, containing at least five portions of fresh fruit and vegetables daily. Alcohol in larger quantities can raise blood pressure which in turn increases the risk of heart disease rather than reducing it. Alcohol, within the advised limits, does not seem to be detrimental to bones after the menopause but it can be harmful in larger quantities. This is because a high alcohol intake is often associated with a poorer diet which is less likely to contain all the vital nutrients that bone need. Alcohol can affect balance increasing the risk of falling, which could result in a fracture. Alcohol can have an effect on memory and for longer term protection against memory loss, a moderate intake is advised by the Alzheimer’s Society. Another health problem linked to alcohol is breast cancer and this is significant reason for controlling your intake. Scientific studies have linked an increase in breast cancer risk in women that regularly consume more than 14 units of alcohol per week. Your risk of breast cancer may be doubled with more than the weekly recommended amount. Key action points
Your menopause experience will be unique to you. There are a number of symptoms that are commonly associated with the menopause but flushes and sweats are the most common. Hopefully this sample fact sheet will be helpful to many of you. Coping with flushes and sweats Whether you are on HRT, coming off it or wanting to avoid it, it can helpful to know what makes flushes worse. Even though we do not know what it is that causes some women to flush while others remain flush free, there are some well recognised trigger factors that make them worse such as
It makes sense to reassess your diet and life style to try to eliminate anything that could be making flushes worse, such as alcohol, smoking and hot drinks. Try to identify if there is a pattern and if anything is a trigger for you. Try too, to minimise the effect of the flushes and sweats. As soon as you feel a flush coming on, try taking several slow deep breaths, keeping your shoulders down and relaxing. Think also about the way you dress. Wear layers of clothes that can be removed and replaced easily. Keep your rooms well ventilated with minimal heating. Ask other people to wear warmer clothes if necessary. Light bed linen may be helpful. Some women have separate duvets from their partners, so that they can have a lighter weight one. Some women find sleeping on a towel or keeping a fan by the bed helpful. Exercise is very important. Studies have shown that women who exercise regularly are less likely to flush than women who don’t. Exercise can make you feel hot, so you need to gear your exercise and clothes around this. It is always important to build up gradually if you are unused to exercising. You will need to plan how to fit exercise in during your day. Being ‘ busy’ does not usually provide enough exercise to be helpful. Probably the most common dietary supplements that women take to control flushes are phytoestrogens. These are weak plant based oestrogen and if eaten in sufficient quantity can be helpful. Some societies, such as the Japanese, traditionally consume larger quantities in their diets, than in a typical western diet. To increase your intake, you can either try eating lots of phytoestrogen rich food (soy, seeds, beans, lentils, grains, vegetables and fruit) or take it as a food supplement such as red clover. See the separate fact sheet. Black cohosh is the only herbal remedy that has been shown in proper clinical scientific studies to help hot flushes. There have been recent reports linking its use to liver problems, so check with your GP before starting it. It is recommended that women only take it for 6 months and the recommended dose is 40mg. As with any herbal remedy, buy a well known brand from a reputable supplier. Anecdotally, a multi vitamin and mineral supplement can reduce flushes particularly if your diet is limited or if you have digestive problems. There are lots of preparations available, such as Menopace. Studies have been done over decades looking at the effects of vitamins such as C and E on flushes, but no vitamin alone has proved helpful. Alternative therapies that can help flushes and sweats include acupuncture, homeopathy, relaxation techniques and reflexology. Some are helpful because they reduce stress which has a knock on effect on flushes and others have a direct effect. See the separate fact sheet on ‘Alternative therapies’. Flushes can also be linked to premenstrual tension, low mood and chronic disease. Key action points
There are a number of health issues that we should all be mindful of such as heart disease, osteoporosis and Alzheimer's disease. Alongside these, many of us have health issues that may range from facial hair, joint pain to diabetes or cancer. The menopause and oestrogen has an effect on many body systems. Heart disease and the menopause (abridged) Although many people associate heart disease with stressed, middle aged executives, in fact heart disease becomes more common in women than in men in later life and it is the greatest cause of death in older women. Throughout life, the heart is responsible for pumping blood around the body. Heart beats are usually regular and rhythmic. However at the menopause, it is common for women to get occasional palpitations, these feel like a pounding inside the chest. Fortunately they are harmless but if you are worried, then see your GP who will arrange a heart trace or ECG that will record your heart beat. This is easy to do and involves putting some little sticky pads over your chest and attaching them to the ECG machine, which records your heart beat onto a long narrow graph paper. There are different causes of heart disease. One cause of heart disease results from faulty heart valves due to rheumatic fever which was common before 1930. Ischaemic or coronary heart disease is caused by a reduced supply of blood to the heart muscle as a result of narrowed coronary arteries, the arteries that supply blood to the heart muscle. In this condition, the heart does not get enough blood and in severe cases, a blood vessel becomes completely blocked and this is a heart attack or coronary infarction. High cholesterol is a major risk for coronary heart disease. Cholesterol is a fat in the blood and excess amounts of it can block blood vessels and cause heart disease. It is estimated that half the population of the UK have a cholesterol level that puts them at risk of heart disease. The average cholesterol for women in the UK is 5.9mmol per litre and this rises with age. A healthy cholesterol level is below 5mmol per litre. Many people will have high cholesterol levels without knowing. High cholesterol can run in families, so if you know that a parent or sibling has high cholesterol, it would be worth asking for your level to be checked. High blood pressure can also be a cause of heart disease. Blood pressure tends to rise with age so if you are seeing your GP, and you haven’t had it checked for a while then ask for it to be taken. Smoking is the most significant risk factor for heart disease and many GPs run support clinics to help people to stop, with the aid of counsellors and medication, such as nicotine patches. The need to stop smoking can not be over emphasised. Medication may be advised for people known to be at risk of heart problems but it sometimes causes side effects. It is important not to just stop taking treatment without telling your GP. There are a number of ways to reduce your risk of heart disease
Key action points
Your menopause experience will be unique to you. Although most women will have a natural menopause there are different reasons for the ovaries to fail, resulting in other needs. The menopause after a hysterectomy Every week in Britain many women undergo a hysterectomy. This is the surgical removal of the uterus or womb. There are many reasons why women have their uterus removed - period problems, fibroids, endometriosis, prolapse of the uterus, pelvic inflammatory disease and cancer. There are different types of hysterectomy. The operation can be done through an incision across the abdomen (the lower part of the tummy just above the pubic hair line) or through the vagina. A total hysterectomy removes the whole of the uterus including the cervix. A total hysterectomy with bilateral or unilateral salpingo-oophorectomy involves removal of the uterus, cervix, fallopian tubes and both or one of the ovaries. A subtotal hysterectomy involves removing the uterus but leaves the cervix. After this operation, women still continue to need regular smears. A Wertheims hysterectomy removes the uterus, cervix, pelvic lymph nodes, upper third of the vagina, fallopian tubes and possibly one or both ovaries. If a hysterectomy is done in a young woman, who has not reached the menopause at the time of the operation, the remaining ovaries should continue to work. The ovaries will have a cycle, producing an egg each month, together with the female hormones oestrogen and progesterone. Many women are no longer aware of their cycle after a hysterectomy because of course they do not have periods acting as a guide. The monthly cycle is controlled by hormones produced by the pituitary gland in the brain. These hormones are follicular stimulating hormone (FSH) and luteinising hormone (LH). Towards the menopause few eggs remain in the ovaries and the ovaries respond less readily to FSH and LH, so the pituitary gland produces higher levels of them. At some point after the hysterectomy, the ovaries will stop working. For many women this will be around 50-51 years, the average age of the menopause. For some women, the ovaries will fail earlier. One in 4 women will have menopause within 2 years of the operation. The reasons for this are not properly understood. Sometimes the menopause is harder to recognise after a hysterectomy. Most women know that they are becoming menopausal by irregular and increasingly infrequent periods. Others will begin to experience menopause symptoms. So if you feel that you are having menopausal symptoms, particularly if you are younger than 45 years then ask your GP or practice nurse if this could be the menopause. Remember you are never too young to be menopausal. Blood tests are not routinely done in all women to diagnose the menopause. However, checking FSH levels can be useful in younger women, particularly after a hysterectomy just to confirm the diagnosis. However as the ovaries can have irregular bursts of activity around the time of the menopause, the FSH result can only indicate if there was ovarian activity on the day the test was done. Sometimes a series of FSH levels are done to confirm the diagnosis. The advice from the Committee on Safety of Medicines for HRT (the experts that advice on when medicines should be used), is that women who have had an early menopause should take HRT and so should women who are experiencing uncomfortable menopause symptoms. HRT is simpler following a hysterectomy and there are also alternatives to consider. The menopause is a good time to think about diet, exercise and life style as these can have an impact on the menopause symptoms and also your long term health and independence. Key action points
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