Menopause

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At around age 50, a woman’s ovaries start to produce less oestrogen and eventually cease producing oestrogen altogether. Oestrogen is the hormone that is normally responsible for female characteristics, including the regulation of normal monthly menstruation. It is still produced in small amounts by other parts of the body, so it does not disappear from the blood stream altogether. As the levels of oestrogen decline, monthly menstrual bleeding becomes irregular and eventually stops.  The last menstrual period is called "menopause".

When most people talk about menopause, however, they are usually referring to the time around menopause (the so called perimenopause, or climacteric), when bleeding is irregular and certain other symptoms may be experienced as a consequence of the declining oestrogen levels.

The actual age of menopause varies between different women, but it usually occurs at some time between the ages of 45 and 55 years.

Declining levels of oestrogen can cause some uncomfortable symptoms. Not all women experience these symptoms and some women have no symptoms at all. However, some of the more common symptoms include:

• Hot flushes and night sweats
• Irregular menstrual bleeding with heavier or lighter bleeds than normal
• A frequent or urgent need to pass urine
• Leaking of urine from the bladder on straining, e.g. when laughing or coughing, or picking up a heavy object
• Urinary tract infection or cystitis, resulting in discomfort when passing urine
• Thinning (atrophy) of the vaginal skin, causing vaginal dryness, discomfort and itching
• Discomfort or pain during sexual intercourse
• Changes in mood (anxiety, irritability), difficulty concentrating and decreased libido
• Headaches
• Non-specific muscle aches and pains

The most effective treatment for symptoms of menopause is oestrogen replacement therapy (hormone replacement therapy, or HRT), either through tablets or a patch that is stuck on to the skin. Oestrogen replacement is normally continued for a few years until the symptoms subside.

However, some women may prefer not to use oral oestrogen replacement tablets or patches. For distressing vaginal symptoms, such as dryness, itching and discomfort, oestrogen may also be applied directly into the vagina.

Vagifem vaginal tablets contain an oestrogen that is identical to the oestrogen that is naturally produced in a woman’s body. Unlike vaginal creams, vaginal tablets are not messy, will not stain clothes and, using a preloaded, disposable applicator, are simple to administer.

On contact, Vagifem vaginal tablets adhere to the vaginal wall and gradually dissolve, releasing oestrogen throughout the vagina for several hours, which relieves vaginal dryness and other symptoms associated with vaginal atrophy. They are applied once daily for two weeks and then 2 times weekly thereafter. Because there is minimal absorption of oestrogen from the vagina,

Vagifem vaginal tablets are not associated with the side effects that may occur with long-term use of oral oestrogen replacement tablets or patches. Vagifem is available without a prescription, from your pharmacist.

If you have any questions about symptoms of menopause, HRT or vaginal oestrogen tablets, have a chat to your doctor, clinic sister or local pharmacist.

Dr David Webb BSc(Hons) MBBCh

April 2011

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