Menopause

Menopause is the cessation of menstruation or last period. It marks the end of a woman’s fertile years when the ovaries produce lower levels of the reproductive hormones oestrogen and progesterone. The average age for menopause in New Zealand is 51.5 years but it can occur anytime between the ages of 42 and 56. Perimenopause is the period of five or so years up to the last period when menstruation becomes irregular or occurs less often and eventually ceases. During this time hormone levels change and changes begin to occur in the body. After menopause the body achieves a new hormonal balance, however during the transition phase, the changes in hormone levels can have a number of effects on women.

The medicalisation of menopause

Over the last fifty years western medicine has increasingly defined menopause as a condition that must be treated. The redefinition and medicalisation of menopause was initially promoted by the makers of hormone replacement therapy but has also been used to advantage by people who manufacture other products. However, menopause is not an illness. It is a natural phase in life, like puberty, pregnancy and childbirth. Even though menopause is not an illness, some of the symptoms of the hormonal changes can cause temporary discomfort.

Symptoms

How menopause affects individual women is influenced by biological and social factors, including genetics, physical and mental health, diet, lifestyle, and social and cultural attitudes toward older women. Menopause experiences vary among individual women, and among different cultures.

Some of the common reported symptoms are:

  • Irregular periods (when periods come closer together or further apart), and when blood flow becomes lighter or heavier
  • hot flushes
  • night sweats
  • headaches and migraines
  • disturbed sleep patterns
  • vaginal dryness
  • joint pain
  • fatigue
  • short-term memory problems
  • dry eyes
  • dizziness
  • itchy or ‘creepy’ skin
  • mood swings
  • anxiety and irritability
  • lower libido or sex drive
  • difficulty concentrating and making decisions

Managing Menopause

Adequate exercise, a healthy, balanced diet, taking time for rest and relaxation, and smoking cessation can all help address the symptoms of menopause.

Hot Flushes and night sweats

Up to 80% of women experience hot flushes but they tend to go away within one to two years. . Common triggers for hot flushes are caffeine, alcohol, and spicy food. Traditional or natural remedies that women have reported to be useful include a diet rich in legumes, grains, nuts and seeds, sage tea, black cohosh, or acupuncture.

Hormone Replacement Therapy

After menopause it is normal to have lower levels of oestrogen and progesterone.   Hormone replacement therapy (HRT) (usually a combination of progesterone and oestrogen) may be prescribed for women during perimenopause; following surgically induced menopause; and sometimes post-menopausally. Hormone replacement therapy artificially boosts hormone levels with the aim of alleviating some of the conditions caused by diminished levels of oestrogen and progesterone. While hormone replacement therapy is effective at addressing some symptoms, it also carries serious risk. Many studies suggest that HRT should be taken at the lowest dose for the shortest period of time necessary to control symptoms, and the need for continuing treatment should be reviewed at 6-monthly intervals. HRT use for prevention of chronic disease is not recommended.

HRT Effects

  • HRT is effective at reducing or stopping hot flushes and night sweats.
  • HRT can also help with vaginal dryness, reducing pain during sex.
  • HRT is not effective at improving psychological symptoms, general wellbeing and mental functioning.

HRT Risks

  • Even short-term use of combined HRT (oestrogen and progesterone) is associated with an increased risk of breast cancer, melanoma, lung cancer (in current smokers), ovarian cancer, stroke, blood clots, and a doubled risk of dementia for women over 65.
  • There is an increased risk for heart attacks when a woman is more than ten years past menopause. Oestrogen alone carries an increased risk of stroke, blood clots and dementia. It increases the risk of ovarian cancer. It may increase the risk of breast cancer. Oestrogen alone increases the risk of cancer of the lining of the uterus.

The Women’s Health Initiative trial

The Women’s Health Initiative (WHI) trial of 161,808 healthy women aged 50 – 79 is the largest and most rigorous scientific study ever done on the long-term health effects of HRT. The study was stopped on July 7, 2002 after an average of 5.6 years follow-up because of increased risks of cardiovascular disease and breast cancer in women taking HRT compared with those taking placebo (dummy pills). The study showed that the risks exceeded the benefits, with women taking HRT at higher risk for heart disease, blood clots, stroke, and breast cancer, but at lower risk for fracture and colon cancer. The trial investigators advised that within 5 years, 1 in 100 women using HRT would have a serious adverse event.

A 2008 follow-up of participants from the WHI trial found that three years after women stopped taking HRT the increased risk of heart disease was diminished, but overall risks, including risks of stroke, blood clots, and cancer, remained high. It also found that the death rate among women who had been most regular with their HRT during the trial was 53 percent higher in the hormone group than in the placebo group.

NZ Medsafe Guidelines recommend that

  • HRT should only be used where menopausal symptoms are troublesome and women are fully informed of the risks.
  • HRT should be used at the lowest dose and for the shortest time possible. The continued use of HRT should be reviewed by women and their doctors at the time of the next prescription or within 3 months whichever is sooner.

Coming off HRT

If you have been on HRT for some time stopping suddenly can be stressful on the body, which may have become dependent on the artificial supply of hormones, and can cause symptoms to return. The body’s reliance on HRT will probably be higher for women who are on a high dose of HRT, and for those who have been taking HRT for a long time.

Many studies recommend gradually weaning off HRT over a period of 2-4 months, unless there are health factors that require a more immediate cessation. This will give your body time to increase its own production of hormones it has been relying on HRT for. Talk with your doctor if you have concerns or would like advice on coming off HRT.

You can support yourself through the process of coming off HRT by looking after yourself, ensuring you are eating right, exercising regularly, and finding time for sufficient rest and relaxation.

Bio-identical hormones

Bio-identical hormones include progesterone, DHEA, testosterone, and the oestrogens estradiol, estriol, and estrone.

Bio-identical or ‘natural’ hormones are produced in the laboratory. Plant hormones are used as a base from which to synthesise hormones that are found in the human body. Bio-identical hormones may be compounded in individually tailored doses and combinations and come as capsules, creams, patches, gels, lozenges, suppositories and under-the-tongue drops.

There is no evidence to confirm that bio-identical hormones are safer than standard HRT and whether they carry the same risks for breast cancer, ovarian cancer, endometrial cancer, heart disease and stroke. Until reliable clinical evidence proves otherwise, it must be assumed that the risks of bio-identical hormones are similar to the risks of hormone replacement therapy.

Useful links

Family Planning »
Bio-Identicals: Sorting Myths from Facts »
Mayo Clinic – Menopause »
Menopausal hormone therapy (MHT) »