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/

WOMEN - 5 things you didn’t know about menopause

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/

WOMEN - All about menopause

For many women, the "change in life" 

comes much earlier than expected, 

sometimes leading to traumatic consequences.

Menopause occurs when a woman's periods have stopped for more than 12 months or follicle-stimulating hormone levels are highly elevated.

During menopause, levels of oestrogen, progesterone and testosterone decline as ovulation ceases. The average age for menopause to occur is 51.5.

Perimenopause, when hormone levels begin to fluctuate, can occur up to four years before menopause, producing symptoms such as hot flushes, sleep disturbances, low libido, weight gain and mood changes.

We look at the two most common symptoms and how to treat them.

Hot flushes

These are due to small blood vessels in your skin dilating and you may also feel your heart race and become dizzy, sweaty and anxious. Hot flushes can occur as little as once a week or as often as every five minutes. They can be worse at night.

The first step is to cut out caffeine, alcohol and spicy foods. Caffeine activates the adrenal glands, which results in a surge of the stress hormones, adrenaline and cortisol. This will exacerbate hot flushes and deplete your body of nutrients such as magnesium and B vitamins. Alcohol also puts a strain on your liver, which is responsible for breaking down fats.

You can also take herbs to support your body, such as zizyphus, shatavari and sage. Homeopathic remedies such as lachesis, sepia and ignatia can help.

Low libido

As levels of testosterone decrease your libido can take a nose dive. Your skin can become thinner and drier, which often results in vaginal dryness and painful intercourse.

The first step is to increase your intake of omega-3 fatty acids. Take fish oils and evening primrose oil daily and eat avocado regularly.

The herb Tribulus terrestris is my favourite for increasing libido and zinc supports your hormones.

Try using a natural lubricant for sex such as coconut oil or eggwhite.

There are also key things you can do for a symptom-free menopause:

• Ensure you have good stress-management techniques. As your ovaries stop producing oestrogen, the adrenal glands become your reservoir for oestrogen production. If your adrenals are exhausted, you're more likely to experience menopausal symptoms.Beginresistance exercise.
• Eat smaller, low-GI portions.
• Eat a Mediterranean diet.
• Eat more menopause-friendly foods such as fish, natural yoghurt, quinoa, broccoli, cabbage, tahini, almonds, pomegranate and oats.

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

WOMEN - Coping with menopause

The symptoms of menopause can often be quite debilitating, but relief is not far away.

 

(Q) I've had severe menopausal symptoms for seven years. I'm 57, had a hysterectomy at 36 and DCIS mastectomy at 46. I experience chronic insomnia (only four hours sleep a night) and have gained 23kgs. I attempt to exercise regularly but can't get the weight off. I'm now insulin resistant. The hot flushes were unbearable.

After trying acupuncture, sleep therapists and natural remedies I decided to try bio-identical hormones oestrogen and progesterone for six months then DHEA testosterone. Hot flushes ceased but insomnia and weight remains. Can you help? 

(A) I would suggest that you talk to your GP about referring you to a dietitian to help you with your weight loss. Your GP may also refer you to a gynaecologist and endocrinologist to ensure there is not some ongoing hormonal imbalance and also to review the combination of hormones you are taking to ensure it is optimal for your situation.

You should also let your breast cancer doctor know what you are taking to ensure this is all right in regards to the cancer.

Talk to your GP too about sleep hygiene measures to assist with your insomnia as well as simple relaxation exercises and progressive muscle relaxation exercises. Meditation, yoga, walking and regular physical activity may all help with both your weight loss and your sleep difficulties.

Your GP is your first port of call and is the best person to assist you in dealing with all the different problems by assessing you fully, referring you appropriately and then coordinating your care under the different health professionals who may be called upon to help you.

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

WOMEN - Early menopause

Early menopause explained, from the diagnosis 

to the physical and psychological effects

Almost one in 10 women will go through early menopause before the age of 40, robbing them of the choice of starting or completing a family, and playing havoc with their bodies. Before the age of 40, this is called premature menopause. For women aged 40 to 45, it is early menopause.

For one in 100 women, their ovaries will spontaneously fail but the figure climbs to eight in 100 once surgery and chemically induced menopause (due to chemotherapy or radiotherapy) are taken into account.

For up to 80 per cent of women whose ovaries spontaneously stop working, the cause is unknown, says Melbourne endocrinologist Dr Amanda Vincent, a council member of the Australasian Menopause Society.

In a minority of cases, it can be caused by a genetic disorder such as Turner's syndrome, an autoimmune disorders, inborn metabolic problems such as galactosaemia and rarely, as a result of viral infection.

"If you're a smoker or have a family history of early menopause, you're at greater risk. Having a hysterectomy or pelvic surgery can also be risk factors," Dr Vincent says.

The symptoms

The most common symptoms are hot flushes and vaginal dryness, says Dr Ted Weaver, president of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

Other symptoms include itching under the skin, reduced libido, urinary frequency, tiredness, depression and sleep disturbances.

"The loss of libido can have a devastating effect, not only on the woman but on her partner," sexual health expert and author Dr Rosie King says.

Diagnosis

Dr Vincent says diagnosis of premature menopause can take from six months to several years because women have such variable symptoms. "Often, doctors don't think about premature menopause as a possibility when a woman comes to them in her 20s or 30s and her period has stopped."

Other reasons a woman's period may have stopped need to be excluded, such as pregnancy, thyroid problems or prolactin issues.

"A lot of women have very few symptoms, so diagnosis might be missed," Dr Weaver says.

The effects

Early menopause affects young women physically and psychologically. One of the most devastating moments is when a young woman is told she won't be able to have children.

"Early menopause, particularly for women who haven't started their family, can be a catastrophe," Dr King says.

Dr Mandy Deeks, a psychologist with the Jean Hailes Foundation for Women's Health, says for these women, the issue is more that a choice has been taken away from them.

"There are impacts on sexual function and body image, and a woman who's had surgically induced early menopause is more likely to be anxious or depressed," Dr Deeks says.

"You're not going through menopause when your friends are and suddenly you're a young woman in an old body."

Dr King agrees it's a sign of ageing: "They're not prepared for it. It can be a tremendous shock and it affects your self-image."

Fertility

Women who undergo early or premature menopause can no longer have children. An egg donor is the only option and unless you have a willing sister or friend, they are hard to come by in Australia, where it is illegal to pay a donor.

Some women go overseas to buy an egg, says Professor Michael Chapman, IVF expert and head of Women's and Children's Health at the University of NSW.

"South Africa, Spain and Greece are reputable," he says. "It's $12,000 to $15,000 per cycle, with a better than 50/50 chance of pregnancy." The US is another option but it is more expensive.

One approach is putting a woman on the contraceptive pill for six weeks to suppress her pituitary hormones and when she comes off the pill, she can sometimes get what is called rebound ovulation.

"It's very ineffective, probably only a two to three per cent chance at best," Professor Chapman says. "But against nothing, it's an approach."

Women needing surgery or chemotherapy to treat cancer can undergo an assisted reproductive cycle, where their ovaries are hormonally stimulated and eggs collected. The eggs can then be fertilised with her partner's sperm and the embryos frozen. Women with no permanent partner can freeze eggs, but the technology is new and success rates unclear.

Ovarian preservation is where a woman is given a hormone called GnRH agonist to cause a chemical temporary menopause during chemotherapy, with the idea that once chemotherapy is complete and the hormone stopped, the menstrual cycle should return.

Other implications

Women who go through premature or early menopause are at greater risk of osteoperosis, which can lead to bone fractures. There is also a higher risk of cardiovascular disease, because they don't have the protective benefits oestrogen provides the heart.

Other treatments

The 2002 Women's Health Initiative (WHI) study reported increased risk of heart disease and breast cancer with combined hormone-replacement therapy (HRT) use.

But Dr Vincent says the average age of women in the WHI study was 63 and the benefits and risks of HRT are quite different for younger women.

"The general consensus of the menopause and endocrine societies around the world is that a woman with premature menopause, unless she has a contra-indication to oestrogen, such as breast cancer, should take HRT until the age of 50."

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

WOMEN - Why have my periods stopped?

If your periods stop or become erratic, and you're not pregnant, there might 

be are a few reasons why. We look into six causes of period problems.

The majority of women have around 500 periods before they reach menopause. But not everyone's cycle is the same, and periods can become irregular or stop completely well before a woman reaches this stage of life. If they do, and you know there's no risk of pregnancy, it should be investigated.

"If your periods are erratic or you haven't had a period for more than three months, see your GP," says Dr Elizabeth Farrell, a consultant gynaecologist at Jean Hailes for Women's Health in Melbourne.

"Many women tend to let this situation go and simply put it down to stress. But don't just leave it. Have a check-up," Dr Farrell says.

Here we look at some reasons behind missing periods.

1   Polycystic Ovary Syndrome (PCOS)

PCOS is the most common hormonal disorder, affecting 12 to 18 per cent of Australian women of reproductive age. And around 70 per cent of women aren't aware they have it. 

The main symptoms of PCOS include irregular periods, excess facial and body hair, acne, weight gain and ovarian cysts. If left unmanaged PCOS can lead to long-term health problems, including type-2 diabetes or difficulty conceiving.  

There's a genetic link to developing PCOS too. "We don't know exactly why some women get PCOS but if you have a close female relative with the disorder you have up to a 50 per cent chance of having it, too," says Dr Farrell. 

What to do: If you suspect you may have PCOS see your doctor. There is no single test to diagnose the disorder but you may be referred to have an ultrasound to detect ovarian cysts, a blood test to check hormone levels or a glucose tolerance test. PCOS treatment may include the pill and medication to manage hormones or a diet and exercise regime to lose weight.

2   Premature menopause

Almost one in 10 women will experience premature menopause before the age of 40. Also known as premature ovarian failure, the condition occurs when a woman's suddenly stops ovulating, tragically leading to infertility. 

For the majority of cases it's still not known why premature menopause occurs. "Periods become irregular and then stop and for 60 per cent of women, we have no idea why," says Dr Farrell.

While it can take up to six months to diagnose premature menopause there are a number of symptoms to look out for. "Women may experience hot flushes, night sweats, sleep disturbance and vaginal dryness," Dr Farrell says. 

Maintaining a healthy diet and lifestyle, keeping cool and avoiding spicy foods and smoking, are recommended ways to manage the symptoms.

What to do: Women who go through premature menopause are at greater risk of health problems such as osteoporosis and cardiovascular disease. Therefore a doctor may advise treatment, at least until women reach menopausal years. "If there are no contra-indications, hormone replacement therapy (HRT) is the treatment of choice," Dr Farrell says.

3   Thyroid Dysfunction

An overactive thyroid (or hyperthyroidism) can lead to irregular periods, increased heart rate, sweating, difficulty sleeping, weight loss, hair loss and muscle weakness. It's most common in women from 20 to 40 years of age. 

"Sometimes it just happens. Sometimes it's due to a nodule in the thyroid that causes the gland to be overactive and produce excess thyroid hormone. Some auto immune disorders also trigger it," says Dr Farrell. 

What to do: If you experience any of these symptoms, see an endocrinologist. A blood test will confirm an overactive thyroid, and if so, medication will be prescribed to reduce thyroid hormone production.

4   Weight loss and over-exercising

While obesity can have a negative affect on menstruation so can weight loss. A sudden loss of weight, due to illness, an eating disorder or unhealthy dieting, can cause a woman's menstruation system to shut down. Weighing 15 per cent less than the normal body weight for your age and height causes a reduction in the body's fat stores. This then reduces thyroid levels and increases the stress hormone, cortisol which has a direct affect on the reproductive hormones in the body, disrupting or stopping periods.

"Periods may return to normal if you regain weight, but the longer the periods have stopped the more difficult it is for them to come back," says Dr Farrell.

"Intense exercise can also affect periods because hormone levels are disrupted in a similar way."

What to do: If periods are affected after an extreme or sudden weight loss medical advice should be sought as soon as possible.

5   Medications

Some medications to treat depression, hizophrenia and taking the pill for long periods of time can stop periods.

"If you skip the sugar or placebo pills and just take the active pills your period can stop immediately, but there are no ramifications with that," says Dr Farrell.

"Once you come off the pill, it can vary as to when your period comes back regularly but for most women, periods return within six months."

What to do: If you stop taking the pill and your periods haven't returned within six months, see your GP for a check-up. Don't stop taking medication prescribed for any mental health issues. Again, talk to your specialist about any side effects, such as irregular periods.

6   Stress

While there's no hard evidence to support the idea that stress disrupts periods, Dr Farrell believes it can happen. "My gut feeling is that in some women who experience major stress, their periods can change," she says. 

What to do: Recognise what's causing you stress and work out ways to relax. Try meditation, exercising regularly or see a counsellor or find some stress management that works for you.

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