This article was included in issue 49 (Summer 2011) of The Menopause Exchange newsletter.

Currently about 10 million adults in the UK smoke cigarettes and approximately 21% of women are smokers. Most women know smoking can cause lung cancer, heart disease and premature death, but the effects on your menopausal symptoms and bones are also important. The good news is it’s never too late to quit smoking and the sooner you do it, the greater the benefit.

Menopause risk

Research shows that women who smoke can undergo menopause two years earlier than non-smokers. The more cigarettes smoked, the greater the risk. If you’re a smoker who has already reached menopause, you’re more likely than a non-smoker to have menopausal symptoms such as hot flushes, sweats and insomnia. Women who smoke may be up to twice as likely to have more frequent and more severe hot flushes. Stopping smoking can reduce the length and severity of flushes.

Long term health

Evidence suggests smoking causes low bone density in post-menopausal women. So quitting will reduce your chances of developing osteoporosis, which causes thin weak bones that may break easily.

Women who smoke increase their risk of heart disease, whatever their age, and are also more likely to develop diabetes, high blood pressure and cancer of the uterus and breast. Smoking and passive smoking cause nine out of ten lung cancers. The number of women with lung cancer is increasing, and lung cancer is now the second most common form of cancer after breast cancer.

Time to quit

If you quit now, your body will repair itself over time. A year on, your risk of heart attack drops to half that of a smoker.

To be successful, you have to want to stop and you have to be ready. You can increase your chances of success by up to four times if you have the right support. Consider using a nicotine replacement product (speak to a pharmacist) or joining a stop smoking group.

Help and advice

A free QUIT guide, Women and Smoking, is available from www.quit.org.uk. For advice about smoking and the menopause, contact the Quitline on 0800 002200 or email stopsmoking@quit.org.uk. QUIT counsellors are happy to answer any sensitive questions you may have and help you through the quitting process.

Created Summer 2011

Copyright © The Menopause Exchange 2012

This article was included in issue 49 (Summer 2011) of The Menopause Exchange newsletter.

The skin is a tremendous indicator of a person’s health and vitality. Maintaining healthy skin is incredibly important for boosting self-esteem and projecting confidence.

Post-menopausal skin

Before the menopause, skin ageing is largely due to external factors, such as sun exposure, pollution, smoking and poor nutrition. However the onset of the menopause results in declining levels of oestrogen and is associated with a startling acceleration of the ageing process. Skin thinning, loss of elasticity, dryness, increased wrinkling and poor wound healing are all associated with post-menopausal skin.

The skin is made up of three layers: the epidermis (outer layer); the dermis (middle layer); and the subcutaneous layer. Each layer has specific properties and functions and contains important hormone receptors.

The epidermis is an important external barrier and should be flexible, resilient and waterproof. When smooth and hydrated, it reflects light and looks healthy and radiant. But declining levels of oestrogen lead to thinning and dryness. Reduced activity of the oil-producing sebaceous glands may also contribute to the dryness and cause a dull, lacklustre complexion.

The dermis is responsible for the skin’s thickness, strength and elasticity. It contains fibroblasts, the cells that produce collagen, elastin and hyaluronic acid. Collagen provides tensile strength, while elastin provides elasticity. Hyaluronic acid has remarkable water-holding properties and conveys a ‘plump’ appearance when present in abundance. Declining levels of oestrogen lead to poorly hydrated skin, with increased wrinkling and decreased elasticity. Women may lose up to one third of all collagen in the first five years of the menopause. Given that the dermis is 70% collagen, this is highly significant.

The subcutaneous layer contains hormone receptors in its fat cells. As oestrogen levels decline, residual male hormones predominate and fat shifts from the skin (where it gives fullness and volume in the mid-face) to the central abdominal area.

Improving menopausal skin

There are many treatment options available to rejuvenate skin, but a combination approach usually works best. A good skincare regime, combined with sensible lifestyle measures and perhaps the judicious use of procedures, will ensure the most positive outlook.

Good skincare

Avoid aggressive cleansers, which deplete the skin’s natural oils and exacerbate dryness. Cetaphil cleanser leaves the skin clean without tightness. Astringent toners, which can be very drying, should also be avoided. Your regular moisturiser may need to be swapped for a richer formulation to improve skin hydration.

Skin texture can be improved with the regular use of alpha-hydroxy acids, which gently dissolve the surface layer to reveal brighter, more youthful layers beneath. Start with a gentle product like Neostrata Ultra Daytime Smoothing Cream SPF15.

Topical prescription retinoids at night are the gold standard of anti-ageing skincare. They are scientifically proven to improve collagen production and reduce fine lines and wrinkles. Alternatively, retinol can be found in many high-street brands like RoC Retinol Correxion. These should always be used with a broad-spectrum sunscreen during the day.

Peptides and rhamnose are newer agents. These can be found in Olay Regenerist and Vichy Liftactiv Derm Source ranges respectively. Topical Vitamin C is also beneficial, as it promotes collagen production and gives a protective anti-ageing boost.

Procedures

Dermal fillers replace declining collagen, fat or hyaluronic acid. The most commonly used fillers are made from synthetic hyaluronic acid. Well-established, safe choices include Restylane (for mild to moderate wrinkles) and Perlane (for deeper wrinkles). Dermal fillers can also be used to help replace the diminishing fat layer in the mid-face, which can have a rejuvenating effect.

Medical needling is an effective, safe minimally-invasive way of stimulating collagen production. It creates thousands of microscopic injuries in the skin, which triggers a healing response leading to increased collagen. This can improve skin texture, firmness and fine lines, although it does take some time to have an effect.

Fractionated lasers can be helpful in treating superficial and deep wrinkling. However, if these are used for deeper lines, the treatment needs to be more aggressive. Infrared or radiofrequency devices can be useful for treating skin laxity, as long as the deeper layers of the soft tissues aren’t involved. These devices seem to work by delivering energy to heat collagen, causing it to remodel and contract with a tightening effect in selected patients. This can be helpful around the eyes, jaw-line and neck. However the scientific evidence backing the use of these devices is limited.

Lifestyle

An inside-out approach to skin health will always deliver better results. Boost your intake of omega-3 fatty acids, which help increase the water-holding capacity of the epidermis. These can be found in salmon and other fatty fish. Flaxseed oil will help to improve skin hydration and radiance.

A diet rich in antioxidants is also important. The so-called ‘rainbow diet’ means eating at least five measures of different coloured fruit and vegetables each day and will ensure you get vital supplies of vitamins A, C and E. Green tea and the odd glass of red wine are also beneficial. People taking cholesterol-lowering drugs called statins are advised to take supplements of coenzyme Q-10.

Avoid high-impact exercise like running, as this can increase skin sagging due to gravitational forces. Choose a lower impact activity like swimming instead. Finally, stop smoking and sunbathing as both are disastrously ageing. To avoid those difficult-to-treat cheek creases, try not to sleep on your side.

About the author

Dr Sam Bunting is an anti-ageing expert featured in the popular press and fashion publications. She is based at 10 Harley Street.

For more information, visit www.drsambunting.com

Created Summer 2011

Copyright © The Menopause Exchange 2012

Become a member of The Menopause Exchange before the end of January 2012 to receive our special offer. This includes one free back issue of The Menopause Exchange newsletter and two free fact sheets.

(Individual UK membership entitles members to quarterly issues of The Menopause Exchange newsletters, quarterly fact sheets, use of our information service and use of our ‘Ask the Experts’ panel).

Membership: http://www.menopause-exchange.co.uk/join_us/index.htm

I read the article on ‘Coping with mood swings’ in The Menopause Exchange newsletter (issue 48) with interest. I am 52 and have severe mood swings which have worsened since the menopause. Anti-depressants and counselling haven’t helped. I have also tried HRT but it didn’t agree with me. What other options can I try?

This question was answered by Dani Singer, specialist menopause counsellor and psychotherapist.

Thank you for such a challenging question. I note that you have tried several different treatments, none of which seems to have helped. Some research suggests that Cognitive Behavioural Therapy (CBT) can be helpful in this situation. You may wish to speak to your GP about this or if you are able to or prefer to go privately, you may be able to locate a practitioner through the British Association for Behavioural and Cognitive Psychotherapies (BABCP) at this website (www.cbtregisteruk.com).

References: Hunter MS, Bio-psycho-socio-cultural perspectives on menopause, Psychological Issues in Obstetrics and Gynaecology, Best Practice & Research Clinical Obstetrics & Gynaecology. Volume 21, Issue 2, April 2007, Pages 261-274 .

Sheryl M. Green, Randi E. McCabe, Claudio Soares, The Cognitive Behavioral Workbook for Menopause: A Step-by-Step Program for Overcoming Hot Flashes, Mood Swings, Insomnia, Anxiety, Depression and Other Symptoms.

What causes menopausal fatigue and how can its effects be reduced?

This question was answered by Mr Michael Dooley, consultant gynaecologist.

Menopausal fatigue is often associated with poor sleeping patterns. This can be caused by hot flushes/night sweats leading to disturbed sleep and therefore tiredness. Anything that can help night sweats is beneficial. This includes lifestyle changes, avoiding alcohol and caffeine and using non-synthetic bedclothes. A fan may also help. Sometimes over-the-counter natural remedies can help. You can also discuss the role of HRT with your GP.

Will vaginal oestrogens give me a bleed?

This question was answered by Dr Diana Mansour, consultant in community gynaecology.

No, vaginal oestrogen shouldn’t make you bleed. Vaginal oestrogen preparations come in the form of vaginal creams, pessaries and tablets or as a ring. Creams, pessaries and vaginal tablets are normally used every night for 14 nights and then twice weekly. The vaginal ring is changed every three months. Their action is local, helping to relieve symptoms like vaginal dryness and soreness. They are also short-acting and the symptoms can return if you stop using the products. Very little oestrogen is absorbed into your body; oestrogen blood levels in women who use these products are similar to other postmenopausal women. If your periods have stopped for more than 12 months but you start to bleed again when using local oestrogen, speak to your GP.

I am 55 and have been through the menopause. For the last few months, I have had very dry eyes. What could be the reason for this? And which products may be able to help?

This question was answered by Lila Thakerar, community pharmacist.

Dry eyes is a common symptom of the menopause, as natural hormone changes result in decreased tear production. Tears protect and lubricate your eyes, so dry eyes should be treated to avoid infections and visual problems. You can buy eye drops and ointments from a pharmacy. The pharmacist can recommend the most appropriate one for you. GelTears, Isopto Plain and Liquifilm Tears are eye drops, whereas Lacri-Lube is an eye ointment. These products should be thrown away one month after opening. Single dose products (e.g. Celluvisc and Oculotect) are convenient as these are thrown away after each use.

I have osteoarthritis. Can any foods help?

This question was answered by Angie Jefferson, consultant dietitian.

Maintaining a healthy body weight is probably the most effective dietary approach to improving osteoarthritis because it will relieve excessive strain on the joints. Studies show that some specific nutrients such as vitamins C and D may help to slow the progression of osteoarthritis. The best way to ensure that you are eating sufficient levels of these nutrients is to eat plenty of fruit and vegetables, aiming for at least five portions every day. For maximum vitamin C, choose fresh or frozen fruit and vegetables and freshly squeezed juices. Avoid canned or dried varieties. Eating oily fish (e.g. salmon, mackerel etc) once or twice a week will top up omega-3 fatty acids and vitamin D intakes. Some foods such as margarines and certain breakfast cereals are fortified with extra vitamin D. Making sure you are exposed to sunlight (without suncream) for 10 to 15 minutes each day will also help to top up your vitamin D levels. [Editor’s note: Cancer Research UK recommends using suncream during prolonged or heavy exposure].

Please can you give me some information about pelvic floor exercises?

This question was answered by Dr Nicola Mullin, consultant in sexual and reproductive health.

Pelvic floor exercises strengthen your pelvic floor muscles. Your pelvic floor is the layer of muscles at the back of your pelvis that support your bladder and uterus and control the passage of urine. All women should try to keep their pelvic floor muscles healthy because these can become weak or damaged like any other muscle. If this happens, the muscle won’t work properly and you will leak urine. The best way to learn pelvic floor exercises is with a physiotherapist, but you can get an idea of which muscle to exercise by trying to stop passing urine when you are on the toilet. Don’t use your tummy muscles or squeeze your bottom during the exercise.

Copyright © The Menopause Exchange 2011

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“I should like to thank you for obtaining the advice from your ‘Ask the experts’ panel regarding my problems in managing the menopausal symptoms I have been experiencing since reducing my intake of HRT. I now feel more in control of my life because of this positive advice, as I was particularly concerned about herbal remedies interacting with other medication I take.” CL, London

HERBS AT THE MENOPAUSE

By research associate Alyson Huntley PhD.

Over-the-counter (OTC) herbal products are one of the most popular choices of complementary therapies for women who are experiencing menopausal symptoms. However, it’s important to consider certain factors before taking herbal products. Whilst the regulation of OTC herbals has improved recently, it’s still possible to buy products of unknown quality, particularly over the internet. It’s advisable to buy herbal products from trusted sources and to follow the manufacturer’s instructions.

Most importantly, you should speak to your GP if you are considering taking any herbal products. There is a general recommendation that herbal products shouldn’t be taken for longer than six months without a break. A herbal remedy is manufactured as a ‘standardised’ preparation, which means that there is a standard amount of a specific compound (considered to be the active ingredient) in every product. However, for many herbs, the active component is still unknown.

Black cohosh

Black cohosh (Cimcifuga racemosa) is a member of the buttercup family and is a perennial plant native to North America. Traditionally it was considered to have oestrogenic properties, but levels of naturally occurring plant oestrogens are actually very low in black cohosh. How black cohosh works is yet to be confirmed and research is ongoing.

Recent research has suggested that the use of black cohosh may lead to a 26% improvement in hot flushes in some women. There are no well-documented side effects or interactions with conventional drugs. Recently a series of hepatic (liver damage) adverse events with black cohosh were reported. These cases were investigated by the UK Medical Health Regulatory Authority (MHRA) and it was concluded that these cases couldn’t be proven to be due to black cohosh.

Recommended dose

Clinical studies suggest that you should take 40 to 80mg of a standardised black cohosh product per day. (1mg of 27-deoxyacetein per 20mg.)

St Johns wort

St John’s wort (Hypericum perforatum) is a perennial plant native to Europe but is also found throughout the USA and Canada. It’s well known for its effectiveness in mild to moderate depression. There is general agreement that the active ingredient is hyperforin.

Over recent years, researchers have become increasingly interested in the role of St John’s wort in the treatment of menopausal symptoms. Several randomised controlled trials have shown benefit in using St John’s wort for reducing the severity and frequency of hot flushes as well as improving quality of life issues such as sleep.

A combination of St John’s wort and black cohosh has also been investigated and again the results are promising for relief from hot flushes and mood changes during the menopause. There is less evidence for the combination of St John’s wort and Chaste tree/berry, and therefore it’s difficult to make firm conclusions about this combination for the treatment of hot flushes.

Unwanted side effects with St John’s wort are generally mild and transient (last a short time) if used properly. However, St John’s wort may interact with several medicines, such as anti-viral drugs used in HIV treatment, immunosuppressant drugs such as cyclosporin, oral contraceptives and conventional depression treatments.

Recommended dose

Menopause trials have used the same dose of standardised St John’s wort as the depression trials, which is up to 900mg (total dose) of standardised dried extract  (0.3% hypericin) per day over three divided doses.

About the author

Alyson Huntley PhD is a research associate in the Academic Unit of Primary Care at the University of Bristol.

Created Summer 2011

If you would like to read the full article why don’t you subscribe to The Menopause Exchange to become a member? http://www.menopause-exchange.co.uk/join_us/index.htm

Copyright © The Menopause Exchange 2011

References:

Shams T, Setia MS, Hemmings R, McCusker J, Sewitch M, Ciampi A. Efficacy of black cohosh-containing preparations on menopausal symptoms: a meta-analysis. Altern Ther Health Med. 2010 Jan-Feb;16(1):36-44.

Huntley A. The safety of black cohosh (Actaea racemosa, Cimicifuga racemosa). Expert Opin Drug Saf. 2004 3(6):615-623.

http://www.mhra.gov.uk/home/groups/es-herbal/documents/websiteresources/con2024279.pdf accessed May 2011.

Abdali K, Khajehei M, Tabatabaee HR. Effect of St John’s wort on severity, frequency, and duration of hot flashes in premenopausal, perimenopausal and postmenopausal women: a randomized, double-blind, placebo-controlled study.Menopause. 2010 Mar;17(2):326-31.

Grube B, Walper A, Wheatley D. St. John’s Wort extract: efficacy for menopausal symptoms of psychological origin. Adv Ther. 1999 Jul-Aug;16(4):177-86.

Chung DJ, Kim HY, Park KH, Jeong KA, Lee SK, Lee YI, Hur SE, Cho MS, Lee BS, Bai SW, Kim CM, Cho SH, Hwang JY, Park JH. Black cohosh and St. John’s wort (GYNO-Plus) for climacteric symptoms. Yonsei Med J. 2007 Apr 30;48(2):289-94.

This article was included in issue 49 (Summer 2011) of The Menopause Exchange newsletter.

In  Greek, the word ‘menopause’  means the last menstrual period. The average age for a natural menopause is considered to be 51, but individually in women the menopause can occur at any time between the ages of 45 to 55. The menopause is a natural event and signifies the end of the reproductive phase.

Around a quarter of women go through the menopause without suffering any debilitating symptoms. However most of the other 75% will suffer from typical menopause symptoms, such as hot flushes and night sweats, erratic periods, emotional symptoms, bladder symptoms, and effects on libido (sex life). These women usually ask for help in controlling their menopausal symptoms. After a risk-benefit evaluation, many of these women are prescribed hormone replacement therapy (HRT).

Hormone replacement therapy

Hormone replacement therapy can be prescribed in two ways in women who have an intact uterus. If a woman hasn’t had a period for longer then 12 months (i.e. she has been ‘naturally’ bleed free for a year), then a continuous combined form of HRT can be prescribed. Women welcome this prescription as they know that after a settling-in phase of about six months, they are on a type of HRT that doesn’t cause monthly bleeds.

Women with some natural menstrual patterns (for example, women who have infrequent periods with gaps between them ranging from six weeks to three months or more) aren’t considered to be suitable for continuous combined HRT. Instead, they will be given a type of HRT that mimics the menstrual cycle (i.e. HRT that gives them a monthly bleed).

Continuous Combined/Period free HRT

Continuous Combined HRT (CCTs) supply oestrogen and progestogen continuously so that suitable women can have a bleed-free type of HRT. The first CCT to be licensed in the UK was Kliofem, way back in 1996. There was great interest in this product at the time, as many women had said that they wanted to take HRT but didn’t want to have periods again, especially after having gone through the menopause and experienced the relief of not having bleeds.

There are now over 12 different brands of CCT formulations licensed in the UK, available both as tablet or patch systems. CCT products with different oestrogen and progestogen choices are available, and recently, many have been formulated containing lower doses of combined oestrogen and progestogen.

In CCT formulations, the two hormones that make up HRT are given together for the full month. In a woman who hasn’t had a natural period for over a year, the lining of her uterus is atrophic (reduced in size) or static (not active). By giving progestogen continuously throughout the month with oestrogen, the uterine lining is kept in a static state, which means that the woman doesn’t have a bleed, as there is no ‘stimulated’ uterine lining to be shed.

Women need to be warned that it can take up to six months before they settle on a CCT formulation and that they should keep a bleed diary for review at their six-month appointment with their healthcare professional. Generally if the bleeding gets lighter over the six months, then it’s very likely that the woman will settle on her CCT formulation. If it’s not, however, then the healthcare professional will decide whether alternative formulations need to be tried or whether further tests are required to ensure that all is well in the woman’s pelvic area.

Benefits versus risks

A 1995 review paper looked at a number of clinical trials and reported that CCT HRT is well accepted by women in clinical trials, is effective at reducing menopausal symptoms and, after a settling in phase, the majority of women become ‘bleed free’.

CCTs have a favorable effect on lipid (cholesterol) levels and on bone mineral density. Researchers in a department of nutrition in the USA undertook some interesting work looking at the effect of CCT HRT on lipid (cholesterol) levels in women who had gone through the menopause and who had high cholesterol. Their research showed that CCT formulations can help to bring down levels of low density cholesterol, which can be of benefit in reducing the risk of heart disease and stroke.

However, there is a need for more research to understand their long-term benefits or risks for the heart. Research published in 2001 reported that one of the advantages of CCT HRT is that this isn’t associated with the development of endometrial hyperplasia or carcinoma (the stimulation of the uterine lining, which if not shed as a bleed, could then convert to cancerous cells). CCT HRT may also help to bring back to a normal state the uterine lining of women who have developed complex hyperplasia (complex stimulated lining) on monthly bleed types of HRT.

Tibolone

Tibolone, marketed in the UK as Livial, is another type of ‘bleed free’ product that is available in the UK. Tibolone is a synthetic derivative of norethisterone. It breaks up into three distinct types of molecules (called isomers) when it is swallowed: one isomer has oestrogenic activity; one has progestogenic activity; and the other has androgenic (male hormone) activity.

Tibolone is an alternative ‘no bleed’ type of HRT preparation that women can use after the menopause if they have been bleed free for 12 months and would prefer to have a no-bleed form of HRT.

Choosing CCT

If you would like to try period-free HRT, you need to discuss with your doctor whether it is suitable for you. Then he or she can help you decide which product is best for you, for example whether you should try the CCT HRT or Tibolone.

About the author

Dr Nuttan Tanna is a pharmacist consultant. She runs the menopause and osteoporosis medication management clinics at Northwick Park Hospital, Harrow, Middx. Her research interests include new NHS service models to improve patient care.

Created Summer 2011

Copyright © The Menopause Exchange 2011

References:

1. K Feeley and M Wells. Hormone replacement therapy and the endometrium. J Clin Pathol. 2001 June; 54(6): 435–440.

2. Denke MA. Effects of continuous combined hormone-replacement therapy on lipid levels in hypercholesterolemic postmenopausal women. Am J Med. 1995 Jul; 99(1):29-35.

3. Udoff L, Langenberg P, Adashi EY. Combined continuous hormone replacement therapy: a critical review. Obstet Gynecol. 1995 Aug; 86(2):306-16.

4. A.S Fak, M Erenus, H Tezcan, O Caymaz, P AtagündüZ, S Oktay and A Oktay. Effects of simvastatin only or in combination with continuous combined hormone replacement therapy on serum lipid levels in hypercholesterolaemic post-menopausal women. Eur Heart J (2000) 21 (3):90-197.

Does life begin at 50? Well, it certainly did for me. When I reached 51, the average age of the menopause, I changed direction and achieved new goals. Having worked as a pharmacist for several years, I obtained a Master’s degree in health promotion. I then began giving talks and seminars on all aspects of the menopause to both women and healthcare professionals. In 1999, I founded The Menopause Exchange, which is an independent organisation for anyone with an interest in menopausal issues.

I am highly attuned to the concerns of women facing the menopause and their families and friends. I enjoy meeting women at the talks that I present, interacting with them and hearing about their menopausal experiences. I am often interviewed by journalists for newspapers, journals and magazines.

Since I founded The Menopause Exchange, my life has become more hectic than ever. I am married with two daughters and three grandchildren, so I also enjoy spending time with my family.

Going through the menopause certainly hasn’t stopped me enjoying life. And I hope my story will inspire and encourage women to ‘have a go’ and take opportunities as they arise.

Edited by Norma Goldman

Hammersmith Press

http://www.hammersmithpress.co.uk/

£12.99   ISBN: 978-1-905140-24-4

The Menopause – ask the experts has been compiled and written by the founder and director of The Menopause Exchange, pharmacist Norma Goldman. Members of The Menopause Exchange have benefited from the expertise of its unique Ask the Experts panel for many years. The panel is currently made up of 11 members: consultants and doctors specialising in gynaecology, the menopause and sexual and reproductive health, pharmacists, a senior nurse specialist in the menopause, dietitians and a menopause counsellor and psychotherapist. Now Norma Goldman has chosen the questions answered by the Ask the Experts panel that cover the key issues. She has put them into book form, so that other women can benefit from them too. The Menopause – ask the experts is an extensive practical guide to the menopause and its management, using real-life questions from women going through the menopause. It includes chapters on different menopausal symptoms (e.g. hot flushes and night sweats, bladder and vaginal changes, joint problems and emotional symptoms), osteoporosis, hormone replacement therapy (HRT), complementary therapies, nutrition and women’s health issues (e.g. breast cancer, hysterectomy and fibroids). Each chapter has a general introduction followed by the Ask the Experts questions and answers in an easy to read format. The information has been updated to reflect the latest guidelines, recommendations and medical opinions. An appendix discusses HRT and the risk of breast cancer, looking at the main research studies in this area. There’s also a glossary, index and useful help list of organisations and charities at the back of the book.

Whether you are going through the menopause or supporting someone who is, here is a truly authoritative source of facts and advice to see you through.

To buy The Menopause – ask the experts, visit http://www.hammersmithpress.co.uk /

Anaemia: reduction in the quantity of the oxygen-carrying pigment (haemoglobin) in the blood

Bilateral oophorectomy: operation to remove both ovaries

Body mass index (BMI): the weight of a person (in kilograms) divided by the square of the height of that person (in metres): used to indicate whether or not a person is over or underweight

Bone density: measurement of the bone’s mass in relation to its volume

Cervix: neck of the uterus (womb)

Climacteric: marks the transition from reproductive to non-reproductive state

Conjugated equine oestrogen: an oestrogen used in HRT which is obtained from mares’ urine

Corticosteroids: hormones produced naturally by the adrenal glands

Dual energy x-ray absorptiometry (DEXA): method of measuring bone density

Endometriosis: a condition in which fragments of the lining of the uterus grow outside the uterus

Endometrium: uterus lining

Endometrial hyperplasia: a thickening of the lining of the uterus, caused by overgrowth of the cells that line the uterus

Fallopian tubes: tubes which lead from the ovaries into the uterus

Fibroid: benign tumour of fibrous tissue and muscular tissue, one or more of which may develop within or attached to the outside of the uterus

Follicle stimulating hormone (FSH): one of the female hormones produced by the pituitary gland

Hormone assay: a test or trial to determine the strength of hormones

HRT: hormone replacement therapy

Hyperthyroidism: an overactive thyroid gland

Hyperparathyroidism: an overactive parathyroid gland

Hysterectomy: operation to remove the uterus

Implants: small pellets inserted under the skin

Laparoscopic hysterectomy: an operation to remove the uterus through four small cuts on the abdomen below the navel

Libido: sexual drive

Mammogram: a breast X-ray

Menopause: the occurrence of the last natural menstrual period

Oestrogen: a female sex hormone produced by the ovaries

Osteopenia: a degree of bone loss less severe than osteoporosis

Osteoporosis: loss of bone tissue, resulting in bones that are brittle and liable to fracture

Ovaries: a pair of female sex glands which produce sex hormones and release eggs

Ovulation: The process by which an ovum (egg cell) is released from the ovary

Pelvic floor: spans the area under the pelvis

Perimenopause: the time from the beginning of irregular periods until 12 months after your last period

Pessary: a device which fits into the vagina

Phytoestrogens: natural plant oestrogens

Post-menopause: the stage when menstruation has not occurred for a least 12 months

Premenstrual syndrome (PMS): a group of symptoms experienced in varying degrees by women of reproductive age in the week before menstruation

Progesterone: a female sex hormone produced by the ovaries during the second half of the menstrual cycle

Progestogen: the synthetic form of progesterone

Prolapse: downward displacement of an organ or tissue from its normal position

Rheumatoid arthritis: an autoimmune disease that causes chronic inflammation of the joints

Systemic: relating to or affecting the body as a whole

Testosterone: a steroid hormone formed by the ovary and adrenal glands

Unilateral oophorectomy: operation to remove one ovary

Urethra: the opening of the bladder

Uterus: a female organ which holds the developing unborn child. Also called the womb

Vagina: the lower part of the female reproductive tract

Vaginal atrophy: inflammation of the vagina and the outer urinary tract

Vaginitis: vaginal inflammation

Vasomotor symptoms: symptoms caused by the irregular function of the part of the brain that controls body heat (such as hot flushes and night sweats)

Vulva: the lips outside of the vagina

Withdrawal bleed: the breaking down of the lining of the uterus and shedding after stopping a course of progestogen

Womb: also called the uterus

Created January 2011

Updated June 2011

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