WOMEN - Surviving menopause

As "the change" approaches, the right lifestyle, treatment and attitude can help make this time of transition less fraught.

If the thought of menopause leaves you as panic-stricken as Samantha in Sex And The City 2, take a deep breath. It's a rite of passage for all women, but while some suffer distressing symptoms, others breeze through it. "We always focus on the worst-case scenario and in fact the majority of women don't have a difficult time," says Dr Elizabeth Farrell, president of the Australasian Menopause Society and director of The Jean Hailes Foundation for Women's Health. "Expectation is worse than experience and only a small number of women experience severe symptoms." But at least 20 per cent suffer severe symptoms such as mood swings, heart palpitations and chronic insomnia. It can also be an emotional time as it marks the end of fertility.

The Change of Life

In Australia the average age of menopause is about 50, although it can occur any time between the ages of 45 and 55, and even earlier in rare cases involving chromosomal and genetic disorders, hysterectomy, chemotherapy or surgery. During the first phase, perimenopause, the ovaries stop producing eggs, the body produces less oestrogen (which regulates menstruation) and progesterone (which helps prepare us for pregnancy). Menstruation becomes irregular, eventually stopping altogether.

For some this can happen abruptly, but for most it will be a gradual process over four to six years. You may find your period arrives every few weeks or not for several months, bleeding becomes lighter or heavier and you experience pain, premenstrual tension, hot flushes, night sweats or headaches.

There's no test to diagnose perimenopause, but you know you've reached menopause when you have not had a period for at least 12 months. Symptoms generally peak about a year after that, and 10 per cent of women experience symptoms for 10 more years.

Body Changes

As your hormone levels fall, the vagina walls become thinner and less elastic, the vagina shortens, the external genital tissue thins and lubricating secretions become more watery. This can cause dryness, irritation, itching and discomfort during sex and is known as vaginal atrophy. Dr Farrell says about half of women will experience vaginal dryness and it's one symptom that never improves.

Hot flushes generally occur in the first year of menopause and are a feeling of sudden heat that lasts a few minutes. Your skin may go red, you may sweat and your heart rate rise. Night sweats are hot flushes that can leave your sheets soaked and sleep disrupted.

You may also experience anxiety, moodiness, depression, trouble focusing, short-term memory lapses, urinary tract infections, joint aches, headaches, itching under the skin, thinning hair, reduced breast size and slower metabolism. Hormonal changes also increase your risk of osteoporosis, fractures, heart attack, heart disease, high blood pressure and stroke.

Lifestyle Changes

"The majority of Australian women have mild to moderate symptoms that they manage without any treatment at all," says Dr Farrell. Diet and lifestyle changes may be all you need. Avoid spicy food, caffeine, smoking and excess alcohol, drink plenty of water and eat a balanced diet. You might also find acupuncture, meditation, yoga, tai chi and pelvic floor exercises help.

Treatments

If your symptoms are so severe they're impacting on your quality of life, there are several options available. Hormone replacement therapy (HRT): This involves small doses of hormones such as oestrogen and progestin, which mimic natural hormones. It can be effective for vaginal and urinary problems, hot flushes and night sweats, and research shows it helps to prevent osteoporosis, lower colon cancer risk and reduce body fat in active older women.

In 2002, HRT's popularity plummeted after a US study found it may increase the risk of breast, ovarian and uterine cancers, heart attacks, strokes and blood clots, and slightly accelerate brain tissue loss in the over-65s.
While many experts have since disputed the evidence, Dr Farrell says the stigma remains. "The 2002 study had a major effect, with 40 per cent of women stopping their HRT. But it looks relatively safe."

Monitor your progress with a GP and have regular breast and pelvic exams and Pap smears. Avoid HRT if you have a risk of stroke, heart disease, blood clots or breast cancer. Bio-identical hormone therapy is compounded by pharmacists and marketed as being more natural, but has not had much research into its safety and effectiveness. It contains a mixture of hormones that are manufactured in the same way as preparations such as the contraceptive pill, and is custom-made for the individual. It has not been approved by the Therapeutic Goods Administration and neither Dr Farrell nor The Jean Hailes Foundation support its use.

Non-hormonal therapies: Not keen on HRT? Speak to your GP about alternatives such as clonidine (normally used for high blood pressure); antidepressants such as venlafaxine and paroxetine; and gabapentin (an anti-eplipetic and chronic pain medication). These have all been shown to reduce hot flushes. Vaginal oestrogen therapy in tablet or cream form may relieve vaginal and urinary problems.

Natural therapies: For hot flushes, Alison Bull, Blackmores naturopath, suggests phytoestrogens, which can be taken as supplements and are also found in legumes such as soy, chickpeas, beans and flaxseed.
For night sweats, she recommends drinking two teaspoons of dry sage soaked in lemon juice just before bed and Chinese herb zizyphus for insomnia.

If vaginal dryness is a problem, try a custom-made cream, water-based lubricant, moisturiser or evening primrose oil. Also try yams and vitex agnus-castus (chaste tree berry) for hormonal balance, calcium and vitamin D for general health, and St John's wort and omega-3 fats for anxiety and depression.

Source: http://www.bodyandsoul.com.au/