The physical changes occurring at menopause can put your mind and body into a real
spin. This health report presents a practical guide on why it's so important to
remain fit and healthy long before you hit the time.
Society tends to treat menopause as a time of negativity and depression. How wrong
is that perception? The female is a complex being - she reaches menarche (puberty)
in her teens, is able to conceive after this and then finally reaches menopause,
usually between the ages of 45 and 55. All these physiological stages are normal.
It's a personal choice between you and your physician whether you treat period problems,
pregnancy problems or even problems with menopause. It's time to consult a doctor
when the changes start interfering with your day-to-day life. Just like puberty,
menopause is not an illness - it's a form of gearing down. Not an ending, a beginning.
Yet, even if menopause comes as a sort of blessing and doesn't interfere with your
daily life, it's a good time to seek advice as to how to prevent some of the problems
that may eventuate.
Physical symptoms
Menopause is caused by a gradual decline in the function of the ovaries with a fall
in the level of the two hormones they produce, oestrogen and progesterone. The symptoms
are due to the drop in oestrogen. These include the signs we have all heard about:
hot flushes, night sweats, disturbances in the periods themselves and dryness of
the vagina.
Management and exercise
The emotional side of reaching menopause can be just as unsure. There are the so-called
'soft' symptoms - irritability, depression, insomnia, loss of concentration, poor
memory and headaches. Some women even describe a sensation like ants crawling under
their skin. This is when stress management techniques will need to come into play.
Adrenaline is a hormone produced by the adrenal glands, which causes the heart to
speed up and blood pressure to rise under stress. Because the adrenal glands also
produce some oestrogen, it's important to assist them to work effectively and help
diminish stress. Regular exercise plays a key role. While exercise is beneficial
for people of all ages, it's particularly important for women reaching menopause.
Exercise can provide protection against cardiovascular disease and osteoporosis,
reduce stress, help maintain a healthy weight and naturally relieve some of the
symptoms associated with menopause.
Severity of symptoms
15% of women have no symptoms at menopause, 15% have severe symptoms and the majority,
70%, fall between these two extremes.
It's important to remember that vasomotor symptoms (caused by effects on blood vessels),
such as the hot flush or the night sweats, will resolve in time.
Osteoporosis
Another consequence of a lack of oestrogen may be osteoporosis (thinning of the
bones). This manifests itself eight to ten years after the cessation of periods
and is a major cause of ill health in older women. One point to keep in mind is
that some women are more at risk of developing osteoporosis than others. These risk
factors include:
- Race - Anglo-European and Asian women are more at risk than the black races of Africa.
- Family history - a fracture in a woman over 50 years suggests osteoporosis, so women
with a female relative in this category are at risk.
- Early menopause - menopause before the age of 45, whether it be natural, due to
chemotherapy or surgery, means that osteoporosis develops from an earlier age.
- Lack of calcium in the diet.
- Lack of regular exercise.
- Cigarettes, coffee and alcohol also increase the risk of osteoporosis.
Hot tips
A diet high in fruit, vegetable, cereals, legumes and regular exercise is important
for women reaching menopause. Soy protein is advertised as relieving some of the
immediate symptoms.
Studies show that women using Hormone Replacement Therapy have better dental health
than women who have not used HRT.
Post-menopausal women with recurring bladder infections should also be considered
for HRT. Bladder walls thin after menopause and post-menopausal, non-HRT users are
more prone to bladder infections than HRT users.
HRT patches are particularly suited to women who have had a hysterectomy, especially
the newer type of patches, which last for one week. Check with your doctor on what
will best suit you.
HRT treatment
Hormone Replacement Therapy was designed to alleviate the symptoms of menopause.
It is oestrogen, with or without progesterone, taken in various ways to replace
or make up for the oestrogen the ovaries are no longer producing.
If menopause is such a normal physiological process that all women go through, why
is there such an emphasis on HRT? There are several key reasons:
The first one is that women are now living longer. Did you realise at the beginning
of the century only 30% of women reached menopause? Now women outlive men and life
expectancy is over 80 years of age.
Second, the lifestyles we lead have put pressure on us to be self-sufficient and
free of family/community support.
Living longer has shown us the consequences of changes due to menopause. Increasing
female independence - not just in the politically correct sense - has forced us
to recognise the need to deal with or prevent those consequences.
Nowadays there is a fourth (perhaps cynical) point: HRT is a gold mine for drug
companies that cynics might say are pushing to all the 'baby boomers'. Even if only
one-third of women decided to take HRT, large sums of money are involved. HRT comes
in various forms and combinations - tablets, creams, implants, patches and now gel.
Each individual can decide how she wants to take it, depending on what suits her
lifestyle. It can either produce a period or not produce a period. If she chooses
to have a period, then she must have oestrogen daily and progesterone (the artificial
progesterone) for 14 days of each month. If, on the other hand, she does not want
to have a vaginal bleed, then hormones have to be taken daily.
A key point to remember is if a woman still has her uterus, she may need to take
both hormones, but she should need only oestrogen if she has had a hysterectomy.
Women who can’t take HRT
Women who have had hormone dependent cancers, such as certain types of breast cancers,
and ovarian and uterine cancer, need to consult carefully with their doctor. The
evidence for avoiding HRT after breast cancer is not clear and new information is
coming out regularly.
Also there is a small group of women who have a tendency to clot easily and who
should not take HRT. These clotting disorders often run in families.
Side effects of HRT
Breast tenderness, nausea, headaches and fluid retention, which are called 'start-up'
symptoms, should subside after a few weeks. Irregular bleeding and weight gain are
two side effects that may persist for longer.
Findings of different research groups still vary on the risks of taking HRT and
conclusive evidence is difficult to find. Some people fear there is an increased
risk of uterine cancer and breast cancer after prolonged use but these risks are
unconfirmed.
All this confusion does not help women decide whether to take HRT or not and how
safe it is. At present all that can be said is taking HRT for five years or less
does not appear to carry any increased risks.
Australian data shows that one in 14 women will develop breast cancer. Today 97%
of women who are diagnosed have a tumour less than 1cm. These women survive 13 years
or more beyond the time of their initial diagnosis and with routine mammography
these figures continue to improve in Australia.
A menopausal woman should have regular mammograms. That is, two yearly from 50 years
of age and yearly from 40 years of age, if there is a strong family history.
What about the woman who has a history of breast cancer? Nowadays there are many
options. First she should be referred to a specialist menopause clinic for management.
Treatment would be something like local oestrogens to relieve vaginal dryness, progesterone
alone to relieve hot flushes or combined HRT after informed consent.
Weight gain and body image
Many misconceptions surround Hormone Replacement Therapy. For instance, contrary
to popular belief, it does not cause weight gain. Most women experience initial
side effects such as feelings of bloatedness, breast tenderness and fullness. These
should not be mistaken for weight gain and they should settle down with the correct
therapy.
A recently published, randomised, double-blind, placebo-controlled trial (the ones
scientists think give the best evidence) conducted in Brisbane found decisive evidence
that hormone treatment does not produce weight gain during the menopause transition.
Staying sexually active
You may hear women complaining about a loss of sexual drive when they reach menopause.
This can be associated with tiredness, stress, depression, relationship problems
and hormonal changes. This will naturally relate to menopausal changes such as a
dry vagina, formication (prickling sensation of the skin), a change in skin sensitivity
and drying out of the skin, tiredness due to night sweats and the sense of not wanting
to be touched. This is when a thorough psycho-social history will need to be taken
to discuss the patient's previous sexual patterns and current expectations and problems.
What about alternative treatment?
These days, with all the conflicting stories you hear about HRT, some women are
looking for other options. Hence herbal medicines or acupuncture have come into
vogue. Some women feel menopause is a natural progression and do not want to take
HRT. Women should be warned, however, that conclusive evidence is not yet available
about whether alternative therapy may provide any protection against osteoporosis.
There have been a number of clinical trials to date using soy protein or red clover
containing natural phyto-oestrogens and isoflavones, from which there has been limited
evidence to show they may produce an effect on menopausal symptoms in some women.
Menopausal women who choose to use complimentary remedies rather than Hormone Replacement
Therapy should be encouraged to have regular bone density tests and seek a doctor's
advice on their decision.
Women's experiences with menopause vary widely but it's worth remembering that it
is simply another natural stage of life. You are not alone and help is out there.
