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Scenario

Debbie Hall is buying some hair dye on her way home from the school where she teaches. Technician Vicky notices that she is fanning herself and asks if it has warmed up outside. "To be honest, the weather seems to bear no relation to my body temperature these days," sighs Debbie.

"I guess that at my time of life, hot flushes are par for the course. I could do without waking up during the night drenched in sweat though! I've had to change the sheets a few times, and my sleep is sometimes so disturbed that I struggle at work the next day."

"Have you seen your GP about this?" asks Vicky. "No, I think I manage OK on the whole, and I don't really want to take HRT or anything like that, which I think is what the doctor would recommend," replies Debbie.

"But that reminds me, I read an article that said some herbal supplements can make a difference, but some of the claims that were being made seemed a bit too good to be true. What do you think? Or is there anything else I can do that might help?"

Answer

Alternative remedies for the menopause ranging from evening primrose oil, black cohosh, soy and red clover to St John's wort, aromatherapy and acupuncture are widely marketed, but the evidence base is mixed. The Royal College of Obstetricians and Gynaecologist (RCOG) states:

"The full effects of every available treatment are not always completely understood. Many of the treatments have not been studied scientifically and some of the benefits of the treatments that have been studied may be due to the placebo effect." This means these products are not recommended. Self care strategies that Debbie could implement include:

• Wearing layers of clothing so she can easily remove and replace items as her body temperature fluctuates
• Reducing her level of stress, perhaps by using relaxation techniques such as meditation or yoga
• Avoiding triggers for hot flushes and night sweats such as alcohol, caffeine, spicy food and smoking.

The bigger picture

Menopause symptoms are thought to be experienced by around 80 per cent of UK women, but few seek medical help despite nearly half finding them distressing. The hot flushes, night sweats, mood swings, sleeplessness, vaginal dryness, urinary problems, heart palpitations and decline in sex drive and concentration associated with this time of life are down to declining levels of oestrogen, which are in turn due to the ovaries stopping their monthly release of eggs.

This period of change, known as the perimenopause, usually starts at the age of 50 years and continues for four years, though some women suffer for more than a decade. In medical terms, the menopause itself is considered to have happened once a woman has had her last menstrual period, after which she is regarded as post-menopausal. Medication is an option for those who feel their symptoms are having an impact on their day to day life.

Hormone replacement therapy (HRT) and the synthetic hormone tibolone are the main pharmacological agents used, and although they can be very effective, they are not without their side effects. For women who prefer not to take a hormonal product, clonidine is sometimes prescribed to reduce hot flushes and night sweats, but can cause problems such as dry mouth, fluid retention, constipation and drowsiness.

Extend your learning

• Bladder control and sexual enjoyment can dwindle during and after the menopause due to the hormonal changes in the body causing shrinkage of tissues in the genitourinary tract, but pelvic floor exercises can help. In order to be able to explain these to customers, read the information here
• Having a good diet and undertaking regular exercise is hugely important for menopausal women, not only to stay healthy but also to protect the bones, which can suffer as a result of declining oestrogen levels. Find out more about what to eat around the menopause here
• All HRT products contain oestrogen, but only some contain progesterone. Discover when each is appropriate by reading the information in chapter 6.4.1.1 of the British National Formulary under the heading 'Hormone replacement therapy'.