Menopause: signs and symptoms with Dr Jana Pittman

Jana has represented Australia at three Olympic Games and is the first Australian woman to compete in both a summer and winter Olympics. A two-time World Champion and four-time Commonwealth Champion in the 400m hurdles, she is recognised as one of Australia’s greatest female athletes! 

Now a qualified medical doctor, specialising in women’s health, Jana is also mother to 6 children and was recently on SAS Australia where she experienced incontinence on air and spoke openly about it.  

A note from Jana to start: This blog is by no means exclusive. The topic of menopause fills books not just pages, therefore if you are having symptoms or want more information, please see your local doctor or women’s health specialist. Do not suffer alone or in silence!!

What are the signs and symptoms? 

There are several stages that lead to menopause, but a woman is considered to have entered menopause when she has not had a menstrual cycle for more than 12mths in a row. 

For many women, perimenopause is the annoying time which relates to the years leading up to the cessation of periods. While some will breeze through this time, others will be stopped dead in their tracks by the hot flushes, vaginal dryness, and sleepless nights.

Often one of the first signs is the vaginal dryness. This comes about due to less circulating estrogen overall but also to the vagina and vulva. Th effect is a decrease in lubrication and secretions which can lead to sexual discomfort.

Hot flushes and night sweats are one of the most reported concerns. The cause of these pestering personal heat waves is poorly understood. It is thought estrogen may have a relationship with thermoregulation, however research shows how levels of estrogen don’t directly cause the hot flushes, so the jury is out.

Sleep deprivation, stress and low mood are often linked to the other symptoms of menopause too, ie the hot flushes. Many women report throwing the sheets off in a sweaty mess, then awakening with chattering teeth only half an hour later. Trying to establish good sleep patterns is important but can be tricky.

Are there any unusual ones that women are not prepared for?

All women experience perimenopause and menopause in different ways. Some of the most import but less commonly discussed symptoms of menopause are the reduction in bone density, change in cellular metabolism (which leads to weight gain) and changes to your cardiac muscles (heart).

Estrogen has a lot to answer for. Another important consideration around the time of menopause due to the lower estrogen levels, is the weakening of the pelvic floor and thinning of the urethra (tube that removes urine from the bladder). This leads to an increase in urinary incontinence and prolapse. 

What is the general age women experience it? How long does it generally last?

For most women this is between 45-60yrs and lasts 4-5 years. Some woman do experience menopause in their late 30’s which is called ‘premature menopause’.

What is happening in the body?

During our reproductive years, the female body keeps a tight balance on its hormones. There is a remarkable sex-steroid negative feedback mechanism inside our bodies that operates like a highway for hormones. It is called the hypothalamic-pituitary-adrenal-gonadal axis. It is very complicated but, in a nutshell, it keeps the levels of circulating hormones in balance with the aim of producing a mature egg each month for reproduction. Perimenopause starts when the number of eggs retained in the ovaries declines.

Incredibly, at birth women have all the follicles (containing eggs) they will ever make already inside their ovaries lying dormant, about 500hundred thousand to 1million in total. As she ages this egg reserve slowly reduces. 

Perimenopause starts when the number of eggs retained in the ovaries starts to decline. Initially estrogen levels are preserved or slightly increased as the body tries to increase the stimulation to the ovaries (increased follicular stimulating hormone), this can result in shorter more frequent menstrual cycles. Following this in late perimenopause, there are marked periods of amenorrhea (no period) or anovulatory cycles (no egg released) before completely ceasing menstruation and entering the postmenopausal phase.

What areas do women often get more sweaty?

More than 50% of women report experiencing hot flushes and night sweats. The most common areas for sweat are generally under the breasts, around their neck and in their face. Often a lady reports it feels like the heats wave starts in her chest, flushes her face and then she feels perspiration dripping down her forehead.

Can you offer any management techniques?

I think the best advice that I can give, is to remember menopause is different for everyone!  There is so much debate around whether you should treat menopause or leave it (could write a whole blog just on this). So do what is right for you and let’s help each other and make no judgement. For some exercise helps, for others non-prescription options like CBT (cognitive behavioural therapy) does wonders. If your life is still not manageable, then it’s worth seeing your GP to discuss other options like non-hormonal medications or estrogen replacement therapy. If you continue to have debilitating symptoms your doctor can refer you to a gynaecologist that specialises in menopause. The big message here is seek help and get good quality information to map out a safe and effective plan for you.

How can we best support people going through it?

Accept and support each woman. Her journey will be different, but the outcome greatly influenced by the support and kindness she receives. Team up for activities and offer an ear. It all helps if we work as a team.