The lowdown on going through this major life transition
Menopause is inevitable but suffering is not. By clarifying some of the myths, fears and confusion around menopause and related health issues and by offering advice and in some cases treatment, your doctor can assist you through menopause with a minimum of apprehension, unpleasantness or distress. Being informed helps you make better decisions so it’s worth being aware of the following facts:
1. The length of menopause varies for each individual
While ‘menopause’ is defined as ‘the last menstrual period’, the time between onset of menopausal symptoms and the actual final period is known as ‘perimenopause’. Perimenopause can last five or six years during which time the periods may be regular or irregular. It is during the perimenopause that the symptoms of hot flushing, night sweats and disturbed sleep may be the worst.
‘Post-menopause’ is the term used to describe the phase that starts one year after the last menstrual period. While for many women the hot flushes and sweats will resolve within three years, for others they may go on far longer. Certain other symptoms like vaginal dryness tend not to resolve at all, except with treatment. The variability between individuals is such that while some women breeze through menopause with nary a care, others may suffer for five years or more before the periods stop and may continue to suffer troublesome symptoms well into their 70s and beyond.
2. You may still need contraception, even when you are
perimenopausal
While obviously your fertility declines significantly with age you can still fall pregnant in your perimenopausal years. The possibility of pregnancy at age 45-49 years is estimated to be 2-3% and after age 50, less than 1%. In addition, you still need to protect yourself against sexually transmissible infections by using condoms for all sexual encounters (unless you are in a long-term monogamous relationship and have both had full STI checks). Current advice is that women aged under 50 should continue to use some form of contraception until they have had no periods for two years and women aged over fifty should continue to use contraception until one year after their last period.
3. There are various methods for delivering HRT
(some may be associated with lower risk)
Hormone replacement therapy (HRT) is when medications containing female hormones are administered to replace those the body no longer makes after menopause. While most people are familiar with the oral tablets, many women may be unfamiliar with the alternative modes of delivery of hormone replacement therapy. Oestrogen replacement comes in the form of tablets, patches and gels while progestogens (taken along with the oestrogen to offset the increased risk of endometrial cancer that taking oestrogen alone can confer) can be delivered via tablets, patches or the hormone-secreting intrauterine system (Mirena). While progesterone is also available in the form of creams, these are not recommended as they are not considered sufficiently effective in protecting the endometrium.
If you have had a hysterectomy you can use HRT containing just oestrogen (as opposed to combined oestrogen and progestogen).
Vaginal symptoms can be managed with local administration of oestrogen creams, pessaries and tablets that are administered vaginally around twice a week (or less) depending on the severity of symptoms and are associated with much lower risk than other forms.
4. The benefits of HRT (in terms of quality of life) often
significantly outweigh the risks
While HRT was once routinely prescribed long-term to women experiencing menopausal symptoms (and was commonly recommended even to those not suffering any symptoms), following the release of study results highlighting the dangers and risks of HRT, many women became fearful of using any HRT at all, even for short periods. While long-term use (over 7 years) of combined HRT (oestrogen and progestogen) is associated with an increased risk of breast cancer, blood clots and stroke, short-term use (less than 5 years duration) in women aged under 60 is considered low risk in most cases. The risk is also lower when oestrogen gels or patches are used rather than oral tablets.
HRT containing oestrogen alone is not thought to be associated with increased breast cancer risk. It is however associated with increased risk of blood clots and strokes.
If you suffer severe or debilitating hot flushes and other distressing symptoms of menopause and these are not relieved by non-hormonal treatments, HRT is usually by far and away the most effective treatment. In addition to improving quality of life, it may also reduce your risk of osteoporosis and fractures. Before being prescribed HRT, you need to see your doctor for a full assessment of your individual risk profile, taking into account your medical history, smoking, weight, blood pressure, family history and other risk factors before making any decisions and the decision to continue HRT needs to be reconsidered annually.
5. Non-hormonal treatment options are effective for some
women
There are many non-HRT treatments that your doctor may recommend you consider. Non-prescription herbal remedies like black cohosh may be beneficial for some women although long-term safety is unknown especially for women with hormone-dependent cancers. Talk to your doctor before taking any treatments including over the counter ones.
In addition there are a number of prescription medications such as certain anti-depressants, anticonvulsants and a drug usually used to treat blood pressure that may all have beneficial effects on hot flushes. These may be very useful for women who are assessed as being unsuitable for HRT (due to health risks) or who wish to explore other options.
Some studies have shown some improvements in sleep and hot flushes with hypnosis however data is limited. Acupuncture has been found to give mixed results. Stopping smoking and avoiding alcohol may help alleviate symptoms in some cases. Simple measures such as keeping the room cool, wearing layered clothing and avoiding triggers such as stress or spicy foods may also assist.
Source: http://www.bodyandsoul.com.au/
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