Menopause: the essentials for non-specialists

While menopause itself is inevitable, its symptoms, the way they’re managed, and its impact on all aspects of life can vary hugely between individuals.

Nurses working in a variety of settings – including general practice, mental health and women’s health services – can help those experiencing this important event, including sharing evidence-based information and signposting to expert support. Here’s how.  

What is the menopause? How is it defined?  

Menopause is the point at which menstrual cycles stop and is usually diagnosed as not having had a period for 1 year over the age of 50, or 2 years under the age of 50.

Perimenopause is the transition period leading up to menopause, when someone may notice their periods getting lighter, heavier or more irregular, and there may be other symptoms, such as hot flushes, mood swings, brain fog and fatigue.  

What are the main symptoms? And how debilitating can they be?  

“There are so many women who are experiencing very severe symptoms of menopause,” says Ruth Bailey, Chair of the RCN Women’s Health Forum, and an advanced nurse practitioner in sexual health.

“They’re unable to sleep, they’re in pain from aching joints, and there may be an impact on mental health such as increased anxiety or low mood. I’m sad to say there are still barriers to women getting the specialist help and care they need. Access is patchy – and that means there are health inequities.”   

What are the possible treatments?  

“Every woman should have a comprehensive assessment of their symptoms and needs, with management that’s specific to them,” says Ruth. “We need to listen to what’s causing them the biggest problems and then find some potential solutions.

"Patients need evidence-based information and a discussion about their options, so they can make an informed decision about their management plan.”

Hormone replacement therapy (HRT) is the first line treatment, she says. It’s safe, effective and most women can take it, with some possible contra indications. These may include those with a history of breast, ovarian or womb cancer; untreated hypertension; or liver disease.

• Read next: Menopause passport: starting conversations at work 

Risks of side-effects are usually very low, says Ruth, but may include changes in bleeding pattern, breast tenderness and headaches. Patients should also be advised of potential risks which include a slight risk of breast cancer and venous thromboembolism. If taken orally they are usually outweighed by the benefits, including improving bone mineral density that can help prevent osteoporosis. “It can also have a significant positive impact on cardiovascular health,” she says.

Other treatments that may be suggested instead of, or in addition to, HRT include exercise, cognitive behavioural therapy to help manage stress or anxiety, or lifestyle changes. “Women should be offered alternatives if they can’t have HRT or choose not to have it,” says Ruth.  

What role can nursing staff play in supporting those going through menopause?  

“Nursing staff have enormous potential to make a difference,” says Ruth. “My top tip is always ask someone what’s going on for them. Listening to their experiences and acknowledging their difficulties is so valuable.”

She’s especially keen that nursing staff encourage women to talk about their genito-urinary symptoms.

“It’s very common to have a dry, sore vulva, which can lead to stinging when passing urine and discomfort having sex,” says Ruth. “These symptoms can be easily treated, but people can find this difficult to mention. Nursing staff are very good at starting these sensitive conversations, which can make all the difference to women getting the treatment they need.”

Mental health also needs to be considered. “The psychological changes can be profound,” says Ruth. “I often hear in clinic, ‘I don’t feel myself’ or ‘that’s not like me’. It can be very unsettling when you don’t recognise yourself. Nursing staff can offer support and reassurance, signposting as needed.”

How might nursing staff be affected by the menopause? 

“Around 90% of our profession is female, so we should be getting this right,” says Ruth. “You can’t pour from an empty jug, so if you’re in the nursing profession and experiencing menopausal symptoms, it’s vital to look at your treatment options and have an effective plan in place.”

At the outset, she advises finding out if your employer has a menopause policy and if they don’t, suggesting they adopt one. “Making reasonable adjustments at work can be really effective,” says Ruth. This might include changing shift patterns, adapting uniforms to better manage hot flushes, and offering opportunities for psychological support.