Women with MRKH undergo the process of menopause in the same way and at the same time as other women, with the only difference being that there will not be any sign that the periods have stopped.
The menopause literally means the stopping of periods (meno=menstruation, pause=stop). It is a normal and natural event. The average age of the menopause is 51, but the menopause is actually the end of the ovaries functioning, so the end of periods is only one sign that it has occurred.
The menopause occurs because the ovaries no longer produce eggs or the hormone oestrogen. Oestrogen is produced from a developing follicle in the ovary which contains the egg each month. In a woman with a uterus, oestrogen causes the lining of the uterus to grow. This growth stops after the menopause, so bleeding stops. Apart from periods stopping, the menopause is the same for women with or without a uterus.
Symptoms of the menopause vary – some have no symptoms whilst others may find them quite severe.
Most common symptoms are:
- hot flushes
- night sweats which may interrupt sleep and lead to tiredness and mood swings
- vaginal dryness
- low libido (sex drive) may also sometimes be noticed.
The ovaries do not suddenly fail – there can be a gradual lowering of the amount of oestrogen produced in the months or years leading up to the menopause. This is known as the peri-menopause. During this time, some women may be sensitive to the reduced amounts of circulating hormones and start to notice the symptoms described above. Many women will not be aware of these changes or have any effects but this doesn’t matter at all.
If you develop menopausal symptoms as described above you can see your GP who would be able to test hormone levels.
If you are in the menopause, you don’t necessarily need hormonal treatment. However all women should ensure they always eat a healthy, well-balanced diet, drink plenty of water and take regular exercise. After the menopause, weight-bearing exercise and adequate calcium in the diet is helpful for bone strength. Calcium supplements can be taken, especially if your diet is low in dairy products.
The advice regarding HRT (Hormone Replacement Therapy) is the same for all women – this is not routinely given and should only be considered for those with very severe symptoms that they cannot cope with. If HRT is considered, this needs careful discussion regarding the advantages and risks associated with treatment. A woman who does not have a uterus that takes HRT only needs to take oestrogen. She does not need to take progesterone as well, as this is only necessary to protect the lining of the uterus. Some women have side effects from the progesterone part and the risks of breast cancer are reduced in oestrogen-only treatments, so this is an advantage.
Some women with MRKH going through menopause may notice increasing vaginal dryness with the menopause and may begin to find sexual intercourse or use of vaginal dilators uncomfortable. It is possible to use lubrication or consider using vaginal oestrogen HRT.
For more information, you can see your specialist who will be able to advise.