Menopause
Updated July 2021The menopause is sometimes called 'the change of life' as it marks the end of a woman's reproductive life. At menopause, eggs are no longer produced by the ovary and production of oestrogen and progesterone ceases. The word "menopause" refers to the last or final menstrual period a woman experiences. When a woman has had no periods for 12 consecutive months she is considered to be “postmenopausal”. Most women become menopausal naturally between the ages of 45 and 55 years, with the average age of onset at around 50 years. Peri-menopause refers to the time from the onset of menopausal symptoms (some or all of symptoms such as irregular periods, hot flushes, night sweats or sleep disturbance) to the last menstrual period. This can last on average 4 to 8 years.
Menopausal Symptoms:
Typically women first notice a change in their menstrual cycle. They may also notice a range of other symptoms including hot flushes, mood changes (depression, anxiety or irritability) and night sweats interrupting sleep. Not all women require treatment for their symptoms, and unfortunately there is no way of knowing how long those symptoms may last. For many women they last 2-5 years, but a significant proportion of women have symptoms that continue for many years.
Other symptoms that may suggest perimenopause include join pains, new facial hair, dry skin, crawling feelings under the skin, vaginal dryness and passing urine more frequently. This score card can help identify which symptoms you may be suffering from, and any response to treatment.
Please don’t hesitate to make an appointment with your GP to discuss any of these symptoms, and possible treatment options.
Lifestyle:
Lifestyle changes such as healthy diet and regular exercise are important for general health and wellbeing, but there is limited evidence for their benefit in the modification of menopausal symptoms. Be aware of your own personal "hot flush triggers" and avoid or minimise these. The most common easily modified triggers are hot drinks, spicy foods, alcohol, caffeine and air conditioning.
Relaxation therapy and meditation may be helpful.
Smoking increases hot flushes and the risk of osteoporosis, so consider speaking to your doctor if you’re ready to quit. Adequate dietary calcium, vitamin D (sunlight) and regular weight-bearing exercise are also important factors in preventing osteoporosis.
Menopausal Hormone Therapy (MHT), also known as Hormone Replacement Therapy (HRT):
MHT is the most effective way to control menopausal symptoms, whilst also giving other health benefits. MHT is safe to use for most women in their 50s or for the first 10 years after menopause. The risk of blood clots, stroke or breast cancer while taking MHT is very low.
The largest study looking at the benefits of HRT, the Women’s Health Initiative (WHI) study was conducted in 2002, and assessed the risks associated with synthetic oestrogen and progesterone. MHT available now uses body-identical MHT which contains oestrodiol and progesterone with molecular structures similar to those of our own body.
Further evaluation has shown that there is no increased risk of breast cancer for women taking oestrogen only MHT (eg those who have had a hysterectomy). In fact, these women had a lower risk of breast cancer compared to women not taking MHT. They also had a lower risk of developing heart disease, osteoporosis, dementia and diabetes.
There is a small increase in breast cancer when taking combined MHT, which equates to 4 extra cases of breast cancer per 1000 women after 5 years of use. This risk is less than that caused by smoking 10 cigarettes per day, drinking one glass of wine per day, or having a BMI over 30. This is well illustrated in this link.
MHT is available as tablets, patches or gel, and the choice of the best form of treatment for you will depend on your age, other health conditions you may have, and whether or not you’ve had a hysterectomy.
Tibolone (Livial):
This is a medication with that has some oestrogen, progestogen and testosterone effects. Many women find it helpful for management of symptoms and improvement of sexual function It has no risk of heart disease or blood clots, and may reduce the risk of osteoporosis.
Topical Vaginal Therapy:
In women with mainly genito-urinary symptoms, vaginal oestrogen may be beneficial. It is effective for vaginal dryness and painful intercourse, though its benefit in relieving incontinence is less convincing. There is very little systemic absorption of these medications, and it is safe to use long-term.
"Natural" or Complementary Therapy:
Naturopaths, herbalists and Chinese medicine practitioners use various herbs to treat menopausal symptoms, including ginseng, dong quai, evening primrose oil, motherwort, liquorice and vitus agnus castus. Unfortunately there is little evidence in regards to their clinical efficacy, and due to poor regulation of the industry, their safety cannot be guaranteed. This link provides clear guidance as to the different complementary therapy options available, and the likely benefit.
Bio-identical Hormone Therapy (BHT):
The claim is that the active ingredients in these preparations are produced from completely natural ingredients, however, they are still chemically synthesised in a laboratory, and should not be considered safer than prescription MHT. Although there is no doubt that many women obtain relief from menopausal symptoms while using this therapy, limited evidence is available for the efficacy or safety of these preparations. The Australian Menopause Society advises against the use of BHT.
Antidepressant Medication:
These may be useful for the control of hot flushes in women who choose to avoid oestrogen therapy, or have contraindications to its use (eg previous breast cancer). Fluoxetine and Efexor reduce the incidence and severity of hot flushes by up to 70% in clinical trials. These medications have their own side effects, even in lower doses.
Prior to an appointment with your GP to discuss any concerns you may have in regards to menopausal symptoms and management options, it may be worth reading through this link, and completing the second page, to help guide the consultation. Please note it may take more than one consultation to cover all the issues that are likely to arise.
Websites:
Books:
The Menopause Manifesto. Dr Jen Gunter
The M Word: How to thrive in menopause. Dr Ginni Mansberg
Article:
Australian Journal of Pharmacy - July 2021 - MHT: Timing is Critical
Podcasts:
No Filter with Mia Freedman. 9th March 2020 - The M Word: Why so many women are angry and weepy
Written & collated by Dr Denise Ierino