Welcome to the
Menopause refers to a single episode in a woman's life, her "last" period and the end of female reproduction . Menopause is confirmed when a woman has gone one full year without having a period. The day after that one-year mark, she's now postmenopausal yet people refer to it as menopause. Typically, this occurs around age 52 but the age range runs 40–60, with many who experience it earlier or later.
Although perimenopause is defined as the time before "the change," its starting point isn't so definitive. It's a nebulous concept and you enter into it gradually and come out of it gradually. So, there is no easy, identifying place of how or when it starts. It can last for 8-10 years
Perimenopause is a result of a woman's aging ovaries, specifically when the coordinated patterns of the hormones estrogen and progesterone begin to vary, throwing the delicate system out of balance. It may take a while to detect symptoms, with a period still evident (although possibly shorter in duration, not as regular for instance), and then you may start to notice other small changes or not until you suddenly do...
Perimenopause can start when a woman is in her 30s or 40s, but the 40s are more common. It typically lasts 6–10 years and the experience varies considerably for many.
Perimenopause is marked by a drop in estrogen which is the main female hormone produced by the ovaries. The estrogen levels can also go up and down more sporadically than they do in a typical 28-day cycle. This can cause irregular periods and other symptoms.
During the final stages of perimenopause, your body will produce less and less estrogen. Despite the sharp drop in estrogen, it’s still possible to get pregnant. Perimenopause can last for as little as a few months and as long as 4 years
.
Menopause officially kicks in when the ovaries produce so little estrogen that eggs are no longer released. This also causes your period to stop
.
Your doctor will diagnose menopause once you haven’t had a period for a full year.
You may enter menopause earlier than normal
if you:
have a family history of early menopause
are a smoker
have had a hysterectomy or oophorectomy
have undergone cancer treatments.
Can you tell by a blood test if I am in perimenopause?
Most people can tell by the symptoms that they've started menopause. If you have worries about irregular periods or hot flashes, talk with your healthcare professional.
Tests most often aren't needed to diagnose menopause. But sometimes, your healthcare professional may suggest blood tests to check your levels of:
Follicle-stimulating hormone (FSH) and estrogen (estradiol).
FSHgoes up and estrogen goes down during menopause. Because hormones go up and down during perimenopause, it can be hard to tell from these tests whether you're in menopause.
Thyroid-stimulating hormone (TSH). Overactive thyroid, called hyperthyroidism, can cause symptoms like those of menopause.
You can get home tests to check FSH levels in your urine without a prescription. The tests show whether you have higher FSH levels. This might mean that you're in perimenopause or menopause, But FSH levels rise and fall during your menstrual cycle. So home FSH tests can't really tell you whether you're in menopause.
When hormone levels begin to decline in the lead-up to menopause, every system that has hormone receptors registers the change, including your brain. Ongoing fluctuation in hormone levels during this time can cause a range of symptoms, which may vary greatly between women and even change over time. Symptoms can range from mild to severe, and while some women may not experience many symptoms, others may experience a variety of issues that can significantly impact their quality of life. Even minor symptoms can have a major effect, especially if they persist over time. The long-term effects of menopause include an increased risk of osteoporosis and cardiovascular disease. If you are experiencing symptoms, it is important to discuss them with your GP or gynaecologist to explore appropriate management strategies.
As estrogen levels drop, you might start experiencing symptoms of menopause. Some of these can occur while you’re still at the perimenopause stage.
night sweats
hot flashes
depression
anxiety
irritability and mood swings
insomnia
fatigue
dry skin
vaginal dryness
frequent urination
Perimenopause and menopause can also increase cholesterol levels. This is one reason why women in postmenopause are at an even higher risk for heart disease.
Continue to have your cholesterol levels measured at least once a year.
You don’t necessarily have to call your doctor to obtain a perimenopause or menopause diagnosis but you should see your your doctor if the symptoms of either perimenopause or menopause become severe enough to interfere with your daily life.
For a checklist on what to ask and discuss with your doctor, refer to our website at "What to discuss with your GP"
For details on Treatment options to ease your symptoms refer to our website "Treatment options"
There are various ways to treat the symptoms of menopause, again often depending on the severity of the symptoms. Lifestyle changes outlined on this website including strategies such as exercise, nutrition, stress reduction techniques, sleep help strategies often help many menopause symptoms but, subject to obtaining your own independent medical advice, the following prescription and over-the-counter (OTC) treatments may available for perimenopause and menopause.
Menopause treatments aim to ease symptoms and prevent or manage ongoing conditions that may happen with aging. Any treatment will depend on the person, their family history and medical background, the medication they are already having, their mental health, the severity of their symptoms and their own independent doctor's advice.
Below however are some of the more common treatments used to ease symptoms:
Hormone therapy.
Estrogen therapy works best for easing menopausal hot flashes. It also eases other menopause symptoms and slows bone loss.
Your healthcare professional may suggest estrogen in the lowest dose and for the time needed to relieve your symptoms. It's best used by people who are younger than 60 and within 10 years of the onset of menopause. If you still have your uterus, you'll need progestin with estrogen. Estrogen also helps prevent bone loss. Long-term use of hormone therapy may have some heart disease and breast cancer risks. But starting hormones around the time of menopause has shown benefits for some people. Talk with your healthcare professional about whether hormone therapy may be safe for you.
Vaginal estrogen.
To relieve vaginal dryness, you can apply estrogen to the vagina using a vaginal cream, tablet or ring. This treatment gives you a small amount of estrogen, which the vaginal tissues take in. It can help ease vaginal dryness, pain with intercourse and some urinary symptoms.
Medications to help prevent bone thinning osteoporosis.
Your healthcare professional might suggest medicine to prevent or treat osteoporosis. Several medicines can help reduce bone loss and risk of fractures. Your healthcare professional also might prescribe vitamin D supplements to help strengthen bones.
Oral contraceptives
Heavy or irregular periods and hot flashes may benefit from this medicine that evens out hormonal fluctuations.
Menopausal hormonal therapy
: (Formerly known as HRT) Like oral contraceptives, this is a low dose of hormones to supplement estrogen levels. It helps with hot flashes, night sweats, insomnia, emotional issues and vaginal dryness.
Low-dose antidepressants
Selective serotonin reuptake inhibitors (SSRIs) like Prozac may relieve hot flashes, mood swings and irritability by modifying the brain signals.
Counselling, Menopause Coaches, Psychologist
Brain fog, anxiety, depression, dependence on alcohol, sleep issues - cognitive behaviour and other talking therapy with a qualified psychologist
Lifestyle changes
A healthier diet with less animal fat and processed sugar, exercise, relaxation techniques such as meditation, yoga, and a consistent sleep schedule may relieve some of the symptoms, including weight gain, irritability and insomnia.
Vaginal lubricants
For vaginal irritations, use water-based vaginal lubricants or prescription vaginal creams
Allied health services and holistic integrative therapy
Acupuncture, naturopathy, breathwork, nutritionists, psychologists, counsellors, hypnosis, dermatologist, pelvic floor exercise support, yoga, thi chai mindfulness techniques and massages.
Talk with other people
Reach out and be open about it with others in your life and stay connected socially with people. Don't forget this affects 50% of the population and we can openly chat about our labours, pregnancy, periods etc!
Various supplements may be of help but there is unfortunately little evidence to prove:
Ginseng
St Johns Wart
Melatonin
Hot Flushes
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Night Sweats
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Sleep Disorders
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Mood Swings
Irritability
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Vaginal changes
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Low Libido
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Fatigue
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Weight Gain
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Muscle Tension
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Memory Loss
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Breast Pain & Tenderness
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Bloating
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Lack of Concentration
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skin issues
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Irregular Periods
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Hormonal Headaches
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Heart Palpitations
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Hair Loss
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Osteoporosis
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Panic Disorder
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Dizziness/faint
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Digestive Problems
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Burning Tongue
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Increased Allergies
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Sleep Disorders
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anxiety/depression
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Sleep Disorders
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digestive issues
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tinnitus
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dry, itchy eyes, ears, skin
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loss of confidence/self esteem
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quickly angered/rage
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Separating? Update your Will and Enduring Power of Attorney ASAP!
I know it is probably the last thing you are considering right now amongst all the other issues you are dealing with during your separation, but there are a number of key documents which you should seriously consider drafting and/or updating as soon as you reasonably can after you separate in order to ensure your wishes are correctly and respectfully fulfilled, your intended beneficiaries are legally protected and the appropriate executors and guardians are appointed. In particular, you need to update your personal details, wishes/intentions, trustee/executor/guaradians, general instructions and nominated beneficiaries under any Trusts, Life Insurance, Superannuation, Enduring/Power of Attorney, Will, and your Health Directives.
For the purposes of this blog, we will be specifically addressing your Will and Enduring Power of Attorney and the importance of drafting and/or amending these at the time of your separation (whether married or defacto).
Why do I need a Will?
Even if you don’t think you have a lot of assets to leave behind to anyone, having a Will is very important. The Will appoints an executor to administer your estate (ie to carry out the instructions in your will) and outlines who the beneficiaries will be, how your property and personal items should be distributed. The executor is normally someone who is trustworthy, financially responsible, organised and respected by the beneficiaries.
The Will also usually specifies who the guardians of any minor children or dependants would be.
Without a Will, your estate may not be distributed according to your preferences, and your loved ones could face a lot of added stress, time and costs in settling your affairs.
Potential tax and stamp duty benefits of an effective Estate Plan
You can obtain a number of benefits by having an effective estate plan for example setting up a Testamentary Trust within your Will which can have significant tax benefits and transfer of titles to reduce or avoid stamp duty being paid. We recommend you seek advice regarding this.
What if I have a Will but it is not updated?
• There can be unintended consequences such as your assets going to unintended beneficiaries, (including your former partner and their family) important details being left out, or taxes being higher than they need to be.
• Certain changes in laws and regulations could make certain provisions of your outdated Will or Enduring Power of Attorney invalid or ineffective.
• You want to avoid potential disputes among beneficiaries and delay the intended beneficiaries getting access to your estate and wasting huge sums on contesting the Will.
• You want to ensure the executor of your own Will and any trustee under a Trust, is someone you still trust to fulfil their duties and carry out your wishes.
Can a Separation affect my Will?
If you were married or in a de facto relationship and had a valid Will leaving some or all of your estate to your then spouse/partner, even if you are then later separated at the time of your death, the contents of your existing Will would usually still be valid and your former spouse/partner would still receive their entitlement under the Will.
If you are legally separated, but not yet legally divorced at the time of your death, your former spouse may also still act as your estate's executor (if you had appointed them as such under your Will), thus manging the administration of your estate, whether you wanted them to or not.
The situation is different where there is no Will. In that case, the laws of intestacy apply to determine whether or not a spouse (married or de facto) has an entitlement to any part of their partner's estate. Whilst not guaranteed, you should note that there is a strong chance that without a WIll, your former spouse will potentially inherit everything under the laws of intestacy.
Is my Will still valid after we are divorced?
In all Australian states and territories, except for Western Australia, a divorce order will not usually revoke all of your Will but it will in most instances revoke any appointments (executor, beneficiary, trustee) or clauses under the Will which refer to your former spouse. Therefore, if you had for instance appointed your spouse to act as your executor or you named them as a beneficiary, they will no longer be able to act as your executor, nor will they receive any gifts you left them, following a legal divorce.
However, it should be noted that if your Will was not updated following your divorce and you die, there can still be some exceptions to consider where the court may not revoke part of the Will and decide in favour of your former spouse if they can be convinced you clearly intended for a specific clause to still relate to a former spouse. The court will often also decide in favour of your former spouse if you have appointed them to as at the trustee of property you have left to your children as beneficiaries under the Will.
it is therefore highly recommend you update your Will to avoid any confusion, misinterpretation by the court, conflict or loss of intent. Get legal assistance.
Why have an Enduring Power of Attorney?
An Enduring Power of Attorney (EPA), is also a very important legal document as it allows you to appoint someone you really trust to legally act on your behalf, if you lose your mental capacity or ability to communicate. The EPA can make decisions about your personal matters, your health (including support services, treatments and health care, where and with whom you live), your finances (including paying expenses and taxes, making investments, collecting your income, selling property, carrying on a business etc). This is especially important in situations if you were unfortunately incapacitated due to dementia, a stroke, brain injury, an illness, or an accident. You may also want to choose a primary power of attorney and also name a backup person in case the primary is unable to fuflil their duties.
You appoint an 'Attorney' under a EPA but that does not need to be a lawyer. You can select a relative, friend, professional person such as your accountant, or someone else you trust and believe to have the necessarily ability to carry out your wishes and manage your affairs. This person's decisions will have the same legal power as if you had made them yourself, so choose wisely.
We often recommend to our clients to clearly set out with their Will specific instructions to help the executor and/or guardian including:
o what medical treatment you want to receive if you were to be incapacitated;
o where all your important family and financial documents are kept for the executor to access and contact details of any person they deal with including specific bank, finance, insurance, financial planner, financial advisor, stockbroker, accountant, lawyer;
o a wish list - setting out your hopes for the children in the future (for example, if my finances permit I would like them to attend x school, have continued contact with relatives y and z, to continue being raised in x religion etc)
Why have an Advanced Health Directive?
Another useful document is an Advanced Health Directive.
At some point in the future, you may be unable to make decisions about your health care, even temporarily. This might be due to an accident, dementia, stroke or a mental illness.
An advance health directive allows you to:
give directions about your future health care
make your wishes known and give health professionals direction about the treatment you want
appoint someone you trust (an attorney) to make decisions about health care on your behalf.
The best time to make an advance health directive is now, before any urgent health condition arises. However, it’s particularly important to make one if:
you’re about to be admitted to hospital
your medical condition is likely to affect your ability to make decisions
you have a chronic medical condition that could cause serious complications (e.g. diabetes, asthma and heart or kidney disease).
Before you complete an advance health directive, you should:
think about your views, wishes and preferences for your future health care
talk to your family and friends
talk to your doctor—they
will have access to your medical history
can help you understand how a particular illness may affect you
can discuss treatment options and the effects of those treatments
if you plan to appoint an Enduring Power of Attorney for health matters, consider who you want to appoint and talk to them about it.
Ongoing review of your Will and Enduring Power of Attorney
Having updated your Will and Enduring Power of Attorney and had it appropriately witnessed, (and destroyed the original one) it is always good practice to review them annually (we always suggest around tax time as a good reminder) as unexpected life events can continue to have flow on effects to your Will and the need to potentially amend it (for example if anyone mentioned in the Will changes their name, the executor or guardian is no longer able to fulfil their obligations, a beneficiary under the WIll passes or their family situation changes, any specific item mentioned in the Will has now been sold/lost or has changed in nature, you become involved in a new business, company or trust or change your residence to another State or country).
We also recommend you regularly review where copies of your most current Will and Enduring Power of Attorney are stored - ideally in a safe custody box and the executor is aware of where a copy of the latest Will is kept.
As busy and potentially overwhelmed as you may be feeling, these documents are really important to consider. If you need assistance preparing any of these documents, please reach out to make an appointment with our Wills & Estates specialist to ensure you have accurately protected your assets and can fulfill your wishes through an affordable Wills & Estates Package.
Email us today at [email protected]
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