2017 HCHB_digital

CONTINUING OTC EDUCATION
sweats are also common and may interfere with sleep. Other physical and
psychological symptoms that may be experienced include:
• aching legs/cramps
• body hair growth
• breast tenderness
• fluid retention (eg, swollen ankles, weight gain, bloating)
• forgetfulness
• increased anxiety and stress
• irritability and mood swings
• itchy skin
• joint and bone pain
• low sex drive
• migraines/headaches
• more noticeable skin ageing (ie, wrinkles)
• tinnitus (ringing in the ears)
• vaginal dryness (can result in painful intercourse)
• vertigo.
Urinary tract infections (see Cystitis) and incontinence (see Urinary
Incontinence) are also more common due to thinning of the vaginal and bladder
walls. Women are at greater risk of medical conditions such as osteoporosis, heart
disease (see Heart Health), and breast cancer after menopause. Perimenopausal
symptoms may last anywhere from a few months to several years (average three
to five years).
Initial assessment
Not all women have problems during perimenopause and many who seek advice
may just require information about possible symptoms and duration of the
transition. Some may wish to try complementary therapies. Some evidence of an
effect has been found for black cohosh, eicosapentaenoic acid (EPA), flaxseed,
pycnogenol, soy and St John’s wort. Many other complementary therapies such as
dong quai, evening primrose oil, panax ginseng or wild yam have less convincing
evidence although some women may obtain benefit.
Lifestyle changes (see Advice for customers) may go some way to
alleviating menopausal symptoms and pharmacy staff should advise women to
undergo recommended screening tests and Heart Health assessments.
Advise all women to talk to their doctor about their symptoms at their next
visit as other medical conditions can cause heavier periods or an absence of
periods (amenorrhoea). Bleeding that occurs after periods have been absent for
a year is not normal and medical investigation is warranted.
Treatment
Treatment for perimenopausal symptoms is not routinely offered or needed as
individual symptoms vary markedly. The decision to treat should be a collaborative
one made between doctor and patient after a thorough discussion of the relevant
risks and benefits.
Prescription medicines, including hormone replacement therapy (HRT) and
Refer to
PHARMACIST
Always refer any woman with particularly severe symptoms to the
pharmacist. Also refer:
• any woman who is aged less than 40
• women on HRT who are experiencing unusual uterine bleeding
• women with irregular periods who do not seem to have any other
menopausal symptoms.
non-hormonal treatment products (eg, SSRIs, venlafaxine, clonidine, gabapentin)
may be considered by a doctor for women who are suitable candidates for these
types of therapy.
Vaginal dryness is an uncomfortable and a common occurrence in menopausal
women and is due to a thinning of the vaginal wall (vaginal atrophy) brought
about by lower oestrogen levels. Local (vaginal) oestrogen treatments are
very effective at relieving this dryness while having a minimal impact on other
tissues of the body. Vaginal moisturising gels and use of lubricants during sexual
intercourse are non-hormonal options for managing vaginal discomfort.
Advice for customers
• Dress in light clothing and in layers to help with the hot flushes.
• Eat a balanced, healthy diet.
»»
Falling oestrogen levels shift fat storage in women from the hips to the
waist (truncal obesity) which increases their risk of cardiovascular disease.
»»
Women going through menopause should begin weight control (see
Weight Loss) before it becomes a problem. Eating frequent, smaller meals
throughout the day may satisfy appetite better than eating three large
meals.
»»
Women should partake in regular, weight-bearing exercise (ie, walking,
dancing, tennis, aerobics, golf) on most days of the week. Exercise is also
beneficial for reducing the risk of cardiovascular disease and osteoporosis
and in aiding sleep.
• Avoid foods which exacerbate menopausal symptoms or decrease sleep (eg,
caffeine, fatty or spicy foods and alcohol).
• Practise pelvic floor strengthening exercises (Kegel exercises) to help with
urinary incontinence.
• Use vaginal lubricants or moisturisers to help with vaginal dryness.
• Some women find yoga, massage, acupuncture or meditation beneficial.
• Stop smoking (see Smoking Cessation).
• Women going through early menopause may like to consider joining a local
support group (see www.earlymenopause.org.nz).
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