A pause for thought about menopause
A recent court decision in the United States has once again brought into question the hormone replacement treatment of post menopausal symptoms.
Menopause, which is defined as the permanent cessation of menstruation, normally occurs in a woman’s life between the mid-forties and mid-fifties; so most women will now live at least a third of their lives after menopause.
Beginning some years before menopause there is a slow and usually (but not always) steady decline in the secretion of the female hormones – oestrogen and progesterone.
These hormones have an influence on mood, appetite, skin appearance, body weight and shape, bladder and sexual functions, and blood vessels and bones. Not surprisingly, therefore, many women face menopause with some degree of apprehension; and with the knowledge (indeed the hope, despite the possible problems), that this post-menopausal time might last for many years.
It seems reasonable that replacing the diminishing levels of hormones would also replace the protective effects against disease that these hormones previously provided. However, the Women’s Health Initiative (WHI) Study, which involved over 160,000 post-menopausal women, showed that there could also be significant risks.
So, taking hormone replacement (HRT) is a balance between risk and benefit. The decision whether to take HRT, and if so, the form, the dose and duration, will depend on just what symptoms are most troublesome and their severity. As women age their risk of some adverse events will increase; and the balance of risks and benefits will change. Nevertheless, non-smoking women in their 50s are likely to experience only small absolute increases in risk.
There are various types of HRT and various methods of delivery. Oral treatment is convenient, inexpensive and usually well tolerated, while transdermal therapy (by patch or gel) allows for a smaller dose of oestrogen and thus fewer adverse effects; although skin irritation with both patches and gel can occur in a minority of cases. Topical vaginal therapy may be more suitable for women whose symptoms are predominantly urogenital – urinary frequency or vaginal dryness.
HRT is certainly a valuable therapy. A number of uncomfortable symptoms and disease risks are reduced by HRT. So, in many women HRT is suitable for the short term relief of moderate to severe menopausal symptoms. For long term use and for women with mild symptoms the risks appear to outweigh the benefits – treatment is generally recommended for no more than five years.
There is also interest in so-called natural alternatives to HRT. These ‘complementary’ medicines are perceived to be safe but there is little real evidence for benefit. And, in any event, some are associated with side effects and toxicity concerns.
Whether or not HRT is chosen for short or longer term treatment of symptoms, and whether or not an alternative therapy is chosen, most women will definitely benefit from lifestyle modifications.
If a smoker, a woman should stop smoking. Hot drinks, spicy foods, alcohol and caffeine are often triggers for hot flushes; so these triggers should be avoided or at least intake reduced. Adequate sleep, relaxation techniques, pelvic floor exercise (and regular exercise as well) can all help; as can a balanced diet including a daily intake of 1300mg calcium and 400-800 IU vitamin D.
More evidence-based information is provided on the Menopause fact card which is available from pharmacies around Australia providing the Pharmaceutical Society’s (PSA) Self Care health information. You can find the nearest location from the PSA website www.psa.org.au/selfcare.
There are some related cards, too, which will be helpful – Fat and Cholesterol, Osteoporosis, Relaxation Techniques, Bladder and Urine Control .