Awareness of menopause and all its associated symptoms has improved steadily over the years, but we still have a long way to go, according to top endocrinologist Dr Mary Ryan.

The average age for menopause in Ireland is 51, according to Dr Ryan, who explains that it usually lasts about seven years, but can go on for as long as 14 years.

"Perimenopause, the time when your ovaries gradually start to wind down, can begin in your 30s, but typically starts between the ages of 40 to 44," she adds.

Read more: Dr Mary Ryan opens up about losing her husband and the realities of grief

"Traditionally women felt they were not listened to when they visited a doctor about menopause, with education this is now changing, but there is more work to be done. A recent survey from 1,087 menopausal women in Ireland found that there was not enough understanding of menopause in the workplace," Dr Ryan says.

"A staggering 70% believed there was a stigma at work while 81% said they did not feel comfortable discussing menopause with line managers."

Symptoms

Aside from the lack of periods and hot flashes, there are many other symptoms like muscle pain, brain fog, lack of sleep, anxiety, vaginal dryness, weight gain, mood swings and night sweats, according to Dr Ryan. "Some women get extraordinarily anxious because the adrenal glands might be exhausted.

"Some women will sail through but the majority have issues at varying degrees. It is often the case that you will have a similar menopause to your mother in regards to age and symptoms and your daughter will be similar too. But it’s not all hereditary, and there are many lifestyle choices to make the transition easier."

Alcohol

Studies recommend limiting alcohol intake to between three and six drinks per week. Alcohol can cause weight gain thanks to its “empty calories”, it can also adversely affect your sleep and mood, Dr Ryan adds. "These are areas that are going to struggle through hormonal changes in menopause so it is important not to overindulge in alcohol."

Weight management

Perimenopausal and menopausal women are more prone to insulin resistance due to metabolic changes related to adrenal, thyroid and sex hormonal changes and increased difficulty in tolerating carbohydrates. As a result they can experience weight gain, higher blood pressure, inflammation and many other health issues, including diabetes.

"A good diet will help so avoid sugary foods and too much caffeine and alcohol, which can make some symptoms like hot flushes worse," Dr Ryan says. "If you want to be around for another 50 healthy years after menopause, healthy eating is everything. Normal weight affects our self-esteem, sleep, heart health and our overall wellbeing."

"You have to be more responsible about what you eat in perimenopause and menopause because your metabolism has slowed and your pituitary gland is more tired. Eat fresh organic meat, oily fish, vegetables, fruits – particularly berries, nuts, seeds, Greek yoghurt, porridge, extra virgin olive oil, coconut oil and green tea.

"Moderate exercise during and before menopause will not only help for weight management but is also good for your mental health. Approximately 30 minutes of aerobic activity such as walking, jogging, cycling or swimming four or five times a week is recommended. Yoga and meditation are good too."

HRT

Dr Ryan explains that in medicine, they give hormone replacement therapy (HRT) only to those who need it. "Women are practical and self aware and tend to have their research done. I like that directness in women and I listen to them. I want women to be well informed.

"Many come in with peripheral problems like restless legs and broken sleep, and feel they are coping and don’t need or want HRT, we talk about lifestyle changes and natural supplements. Others with more severe symptoms like extreme anxiety, continuous hot flushing, lack of sleep and mood swings want HRT for a while."

However, there is a cohort that HRT is not suitable for, for example those with a family history of breast or ovarian cancer.

Dr Ryan adds there is a lot of scaremongering about HRT that is not backed up scientifically and that is not fair on those who need it. "HRT is safe to take under doctor’s guidance and has changed many lives for the better. Women who are suitable for HRT can use it for three to five years and the less time they take it the better.

"In most cases after they come off it, they won’t have the difficult symptoms that they had previously. You typically won’t be on HRT after the age of 60 as it increases the risk of heart disease at that stage. In the very rare occasion a person needs to go on it at that stage their heart health would be monitored. Every woman’s menopause is different so we have to be careful of that."

Vaginal Dryness

Dr Ryan says vaginal pessaries are very safe for dryness, but if dryness is left untreated it can cause discomfort, yeast infections and problems with intercourse. "There are no health risks with the little pessaries that you insert twice a week, but a survey of 64,000 women last year found that 90% of sufferers don’t get help.

"Unlike other menopausal symptoms, which tend to pass, vaginal dryness won’t because it is caused by changes in the vagina."

• Dr Mary Ryan’s book It’s Probably Your Hormones is on sale now.

To read our full menopause special, pick up a copy of the October issue of RSVP magazine, out now.

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