The decrease in hormones associated with menopause can play havoc on our bodies, both emotionally and physically, but Dr Anna Fenton, a renowned gynaecological endocrinologist, and Dr Nikki Carey, a GP with over 25 years’ experience (21 years of which have been specialising in women’s healthcare) are determined that women should be armed with accurate information and know the treatment options available so they can manage menopause in the best possible way for them. ‘I am passionate about making sure that women are aware they have choices,’ Dr Fenton says.
‘Women want knowledge,’ Dr Carey says of menopausal women, ‘knowledge is power. If they have knowledge, they can manage it.’ Menopause itself is defined as the time in a woman’s life when a decline in the hormones oestrogen and progesterone lead to a gradual decrease in the frequency of her menstrual periods, and when those periods have been absent for 12 months consecutively, then a woman is no longer ovulating and has entered menopause. The average age for women reaching menopause is 51, but the stage prior to this, called ‘perimenopause’ usually begins around the mid-forties, and can last 6–10 years. Perimenopause can begin as early as a woman’s mid-thirties, with around a third of women aware of symptoms at that age. Perimenopause itself comes with its own challenges. In its early stages, it can present itself as sleepless nights and heightened anxiety, symptoms which can be easily overlooked or misdiagnosed in GP visits. As the frequency of a woman’s menstrual cycle decreases or becomes more erratic, periods can become heavier and problematic. Hot flushes and night sweats can also begin around this time, as well as vaginal dryness, loss of libido, and aches and pains. Longer-term effects can include an increased risk of heart disease and osteoporosis.
Symptoms can vary from woman to woman, as can the age of menopause commencing. Some women glide through menopause almost symptom free, while for others, without treatment, menopause can hinder their quality of life significantly. How a woman will experience menopause individually is difficult to predict. ‘The younger a woman is when she hits menopause, the worse the symptoms are,’ Dr Fenton says. ‘We know that genetics of menopause are probably only relevant to the age of menopause – it does tend to run in families, but the experience is entirely personal to that woman, so we can’t predict it. The things we do know that make menopause worse is that if it happens suddenly – if a woman has had surgery to the ovaries, and they have been removed, or she has had cancer treatment such as chemotherapy where the ovaries have died, that tends to make the symptoms worse. Genetics have an effect, and smoking has an effect.’
While all this can seem more than a little daunting, menopause can be managed effectively with hormone prescription and complementary treatments, and by seeking guidance from health professionals specialising in hormone (known as the endocrine system) and gynaecological and menopausal issues. They have up to-date knowledge of what options are available, and can work with you for a treatment plan that works best for you as an individual. Hormone Replacement Therapy (HRT) is perhaps the most well-known treatment for menopause, and is now known as Menopause Hormone Therapy (MHT).
MHT is designed to counteract menopause symptoms by providing low doses of the hormone oestrogen, or, in the case of women who have not had a hysterectomy, oestrogen combined with progesterone (combined MHT) to prevent the uterine wall from thickening. MHT can be taken as a tablet daily, a patch, or daily gel, or vaginally as a tablet, cream, pessary or implant. HRT has had its share of controversy, much of which stemmed from a study known as the Women’s Health Initiative (WHI) that was hastily released in 2002, which cited an increase in breast cancer and stroke in women taking MHT. The study has since been found to have been flawed and open to misinterpretation. ‘There has been an enormous amount of controversy around MHT over the last 20 years,’ Dr Fenton says. ‘It would be nice to put some of that into context.’ The final data from the WHI showed a 20–25 per cent decrease in breast cancer diagnosis, and 45 per cent decrease in mortality, with estrogen-only MHT. No increase was seen among women taking combined MHT for up to seven years.
The duration a woman is on MHT, as well as the age at which she commences treatment, are risk factors. To provide perspective though, lifestyle factors can have a similar increase in risk of breast cancer: 2–3 units of alcohol per day is thought to increase risk by 1.5 times, and while post menopausal obesity will increase risk by 1.6 times, most of us who would feel nervous about MHT would still happily reach for wine and chocolate. The study found there is no increase in heart disease with any MHT in women of any age. In fact MHT halves the risk of heart disease for women within 10 years of menopause. Risks of stroke have been found to increase in women over 20 years post-menopause in the first year of MHT use, but otherwise risks are minimal. MHT is certainly not thought to be suitable for every woman but is an option that women should consider exploring under the guidance of a health professional. In many cases, the benefits far outweigh the risks.
There are complementary therapies available as well, providing options for women who cannot take MHT, or whose symptoms are milder in nature. These therapies include hypnosis, reflexology and acupuncture, as well as exercise such as yoga, and various over-the-counter supplements. ‘There are clear benefits from hypnosis, there are clear benefits from cognitive behaviour therapy and mindfulness,’ Dr Fenton says. ‘In terms of what people can buy over the counter – Wild Yam doesn’t work. Maca is an extract used quite widely, particularly in Asia, for menopausal mood issues and again, there is reasonable evidence supporting that. St John’s wort does have an effect, and interestingly it does have a chemical structure that is virtually identical to Prozac, but the flipside of that is that because it is pharmacologically active, it does interact with quite a range of prescription medicines, so it’s very important that a patient who is taking it discusses it with a doctor.’
Dr Carey recommends that regular exercise, maintaining a healthy body weight and following a healthy diet similar to the Mediterranean diet will help symptoms, and overall health. ‘There is good evidence,’ says Dr Carey, ‘that when we exercise to levels that the Health Department in New Zealand recommends, we either tolerate the mood swings and hot flushes of menopause better, or we get less symptoms.’ Although Dr Carey always works through dietary and lifestyle factors with patients first, and believes that lifestyle factors are vitally important, lifestyle changes alone often aren’t enough to alleviate menopausal symptoms, and Dr Carey still cites MHT as the most effective treatment, working alongside a healthy lifestyle. ‘It does an incredibly good job,’ she says.
Whatever route women choose to navigate their journey with menopause more comfortably, with the treatment options available, and medical professionals like Dr Fenton and Dr Carey on hand to help guide women in the direction best suited for them, there is no need to fear menopause, and no need for women to suffer. The future for menopausal women looks a lot brighter.
For more information, visit oxfordwomenshealth.co.nz.
WORDS Claire Inkson