3.

Menopause Management

Menopause is a natural phase in a woman’s life characterised by the end of menstrual cycles and reproductive function, typically occurring between ages 45 and 55. Menopause officially begins when you’ve gone 12 consecutive months without menstruating.

If you’re experiencing unusual symptoms and aren’t sure if they’re related to menopause, blood tests can be performed to measure levels of FSH and estradiol, a form of estrogen. Depending on your symptoms and overall history, your doctor may be able to confirm menopause and rule out other underlying conditions.

Peri-menopause

occurs before menopause. During this stage, menstruation becomes irregular and menstrual flow may be heavier or lighter. You may experience symptoms such as hot flashes and night sweats.

Menopause

is when menstruation has not occurred for one full year. Hot flashes and other symptoms may persist

Post-menopause

refers to the years after menopause. During these years, menopause symptoms usually taper off, but other health conditions may begin, such as osteoporosis.

Everyone's menopause experience is unique

Some people experience severe and wide-ranging symptoms, while others may barely notice the change.

Treatments aim to ease symptoms and prevent or manage ongoing conditions that may happen with aging.

63% of Women
Describes Their Menopause Experience As "Nightmare" and "Awful"

Physical Symptoms:

vulvovaginal atrophy, which can cause vaginal dryness
pain during penetrative sex (dyspareunia)
changes in breast size or shape
sore or tender breasts
increased facial or body hair (hirsutism)
increased heart rate (palpitations)
dry eyes
flushing
headaches
hot flashes
increased urination
muscle or joint pain
weight gain
night sweats
insomnia
itching
hair loss

Mental & Emotional Symptoms:

anxiety
decreased sexual desire (libido)
depression
difficulty concentrating (brain fog)
irritability
fatigue
forgetfulness
unpredictable shifts in mood

Reference: Rawan A., Samantha P., and Joyce C H., An online survey of postmenopausal women to determine their attitudes and knowledge of the menopause in Post Reproductive Health, Volume 29, Issue 2, https://doi.org/10.1177/20533691231166543

Physical Changes During Menopause Can Increase Risk Of...

Heart Diseases
Osteoporosis
Urinary Incontinence
Urinary Tract Infections
Vaginal Infections

Conditions We Treat

Hot Flushes / Night Sweats (Vasomotor)

Hormone Replacement Therapy (HRT): Evaluating and prescribing estrogen or combined estrogen-progesterone therapy to alleviate vasomotor symptoms. The urogynaecologist will assess risks and benefits based on individual health profiles.
Non-Hormonal Medications: Offering alternative treatments such as selective serotonin reuptake inhibitors (SSRIs), gabapentin, or clonidine, which can help reduce the frequency and severity of hot flashes.
Lifestyle Modifications: Advising on strategies to manage symptoms, including dietary changes, stress reduction techniques, and regular exercise.
Pelvic Floor Therapy: Addressing any associated issues with pelvic floor health that may be impacted by vasomotor symptoms, such as urinary incontinence or dryness.

Dryness, Irritation, Itching (Vulvovaginal Atrophy)

Hormone Replacement Therapy (HRT): Prescribing local estrogen therapies such as vaginal creams, rings, or tablets to directly address dryness and irritation. This can help restore vaginal tissue health and alleviate symptoms.
Non-Hormonal Treatments: Offering lubricants and moisturizers specifically designed for vaginal use to provide temporary relief from dryness. Non-hormonal prescription medications like ospemifene may also be used.
Pelvic Floor Therapy: Utilizing physical therapy to improve pelvic floor muscle function, which can help with associated symptoms like discomfort during intercourse.

Urinary Urgency

Behavioral Therapies:
• Bladder Training: Techniques to gradually increase the time between urinations and improve bladder control.
• Pelvic Floor Exercises: Kegel exercises to strengthen the pelvic muscles and improve bladder support.
Medications:
• Anticholinergics: To reduce bladder contractions and urgency.
• Beta-3 Agonists: To relax the bladder and increase its capacity.
Non-Pharmacological Treatments:
• Dietary Modifications: Advising on fluid intake, avoiding irritants like caffeine and alcohol, and managing dietary factors that may contribute to urgency.
Minimally Invasive Procedures:
• Botulinum Toxin Injections: To reduce bladder overactivity in cases where medications are not effective.
• Nerve Stimulation: Techniques like sacral nerve stimulation to help control bladder function.
Lifestyle and Behavioral Adjustments:
• Fluid Management: Educating on optimal fluid intake and bladder habits to help manage urgency.
• Stress Management: Techniques to reduce stress, which can exacerbate urinary symptoms.

Painful Urination
(Dysuria)

Medications:
• Antibiotics: Prescribing antibiotics for bacterial infections identified through urine culture.
• Pain Relief: Offering medications like nonsteroidal anti-inflammatory drugs (NSAIDs) or phenazopyridine to relieve pain and discomfort.
Treating Underlying Conditions:
• Addressing Infections: Targeted treatment for any identified urinary tract infections or sexually transmitted infections.
• Managing Chronic Conditions: Treating chronic conditions such as interstitial cystitis or bladder inflammation with specific therapies.
Non-Pharmacological Treatments:
• Bladder Instillations: Using treatments where medication is directly introduced into the bladder to reduce inflammation and pain.
Lifestyle Modifications: Advising on changes such as increased fluid intake, avoiding irritants (e.g., caffeine, spicy foods), and practicing good hygiene.
Lifestyle and Behavioral Adjustments: • Dietary Recommendations: Suggesting dietary changes to avoid potential irritants and improve bladder health.
• Stress Management: Techniques to manage stress, which can sometimes exacerbate symptoms.

Frequent Urinary Tract Infections

Treatment Approaches:
• Antibiotics: Prescribing a targeted antibiotic based on urine culture results to effectively treat the current infection.
• Long-Term Antibiotic Therapy: In some cases, a low-dose, long-term antibiotic regimen may be used to prevent recurrent infections.
• Post-Coital Prophylaxis: Recommending a single dose of antibiotics after sexual intercourse for patients who experience UTIs related to sexual activity.
• Alternative Therapies: Using non-antibiotic treatments such as cranberry supplements or probiotics, although their effectiveness may vary.
Addressing Underlying Causes:
• Pelvic Floor Dysfunction: Treating any pelvic floor issues that could contribute to recurrent infections, such as pelvic floor exercises or physical therapy.
• Anatomical Abnormalities: Managing or correcting any structural abnormalities found during diagnostic testing that may predispose the patient to infections.
Lifestyle and Behavioral Recommendations:
• Hydration: Advising on adequate fluid intake to help flush out bacteria from the urinary tract.
• Hygiene Practices: Providing guidance on proper hygiene to reduce the risk of infection, such as wiping front to back and avoiding irritants like douches or harsh soaps.

Sleep problems

Hormone Replacement Therapy (HRT): Evaluating the potential benefits of HRT for managing menopausal symptoms such as hot flashes and night sweats that may be disrupting sleep.
Non-Hormonal Medications: Prescribing medications or supplements to manage specific symptoms affecting sleep, such as selective serotonin reuptake inhibitors (SSRIs) for mood changes or medications to reduce night sweats.
Sleep Hygiene: Providing guidance on sleep hygiene practices, such as maintaining a regular sleep schedule, creating a comfortable sleep environment, and avoiding stimulants like caffeine before bedtime.
Stress Management: Recommending relaxation techniques such as deep breathing, meditation, or yoga to reduce stress and improve sleep quality.
Cognitive Behavioral Therapy for Insomnia (CBT-I): If insomnia is a significant issue, suggesting CBT-I, a structured program to address thoughts and behaviors that impact sleep.
Addressing Hot Flashes and Night Sweats: Utilizing treatments like local estrogen therapies, lifestyle changes, or medications to alleviate hot flashes and night sweats that may be interfering with sleep.

Mood Changes
(Irritability, Anxiety, Depression)

Hormone Replacement Therapy (HRT): Considering HRT to alleviate menopausal symptoms and stabilize mood by balancing hormone levels. This might include estrogen alone or a combination of estrogen and progesterone.
Non-Hormonal Medications: Prescribing medications such as selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) to address mood symptoms. These medications can help manage depression and anxiety associated with menopause.
Dietary Adjustments: Suggesting dietary changes that may support mood stability, such as a balanced diet rich in omega-3 fatty acids, vitamins, and minerals.
Counselling & Support: Providing information about the emotional changes associated with menopause and normalizing the experience to reduce anxiety and stigma.