The lead up to and the period of menopause in our youth obsessed western culture is most often a time that many women fear. It is imbued with so many negative connotations – of ‘being old’, ‘dried up’, and no longer vibrant. In contrast the menopause in many other cultures around the world represents a time of great freedom, wisdom and respect within the community. The way we view menopause in our society is sadly outdated, awash with misinformation and in dire need of a sexy new makeover!
Menopause is also a time that may bring with it distressing physical symptoms for many women. While menopause is a natural part of life and almost fifty percent of women will breeze through the menopause with minimal symptoms, the other half may suffer considerably.
The perimenopause – the time in the lead up to the last period, can be a time of complete hormonal chaos. Symptoms can include irregular and heavy periods, muscle and joint aches and pains, depression, irritability and changes in libido.
Menopause itself is defined as the last period, and the post-menopausal period is defined as being 12 months after the last period. Debilitating menopausal symptoms due to a decline in oestrogen can include severe hot flashes, disrupted sleep, difficulty concentrating and a decrease in mental acuity, as well as depression, vaginal dryness, sexual pain and loss of libido. These symptoms can last up to 10 years post the menopause in some women and can obviously massively affect their relationships, work performance and general quality of life.
In a recent publication by Prof Sue Davis in Melbourne, it was found that 29% of menopausal women under the age of 55, 15% of women aged 55- 59, and 6.5% of women from 60 – 69 suffered from severe symptoms. Only a very small percentage of these women sought or were given effective treatment.
For a problem that affects such a large proportion of Australian women it is astounding that so many women are not treated with effective treatments that are proven to decrease symptoms and improve quality of life. Instead they think they simply must put up with it.
There is a broad misconception both amongst the general public and even still amongst some medical doctors that treatments for menopause such as HRT (hormone replacement therapy) are dangerous. This is because of the Women’s health initiative study published in 2002, now widely known to be flawed in its study design and reporting of data. It was reported in the media at the time that women who were taking HRT had a 26% higher risk of developing breast cancer and also that the risk of stroke or blood clot were higher in women taking HRT. The media reporting of this study resulted in huge numbers of women going off their HRT and now almost two decades of women being shockingly undertreated.
The fear around HRT also brought about a rise in women using ‘bio-identical’ hormone preparations under the impression that they are natural and must therefore be safe. These preparations are compounded in various pharmacies and the problem is that due to lack of regulation, standardization and rigorous testing, neither safety or efficacy of these hormones can be guaranteed.
The real facts about HRT are that increased rates of breast cancer were only seen with the use of synthetic progesterone not with the use of oestrogen alone, and only after 5 years of treatment. Even in the group of women given synthetic progesterone, the absolute risk of breast cancer was still only 8/10000 women per year. There is a new body identical form of progesterone available to Australian women now which is not associated with an increased risk of breast cancer at all, and has been show in large French studies over many years to be completely safe.
The study also did not take into account the route of treatment. While HRT taken in tablet form does cause an increase in blood clot/stroke in women over 60, patches and gels show no increased risk. In women under 60 there is no increased risk of stroke or blood clot whether HRT is taken orally or transdermal. In fact, the same study that scared so many women off HRT actually showed that there was a decreased risk of dying in women taking HRT under 60 compared to those not taking HRT!
Therefore, HRT is safe and effective for the vast majority of women under 60 years old and transdermal HRT is safe in women over 60.
Vaginal oestrogens are a safe and effective treatment for painful sex and dry vagina in the majority of women.
Transdermal testosterone has been shown to be effective and safe for improving libido.
For women who prefer non hormonal therapies or for whom hormonal therapies may be contraindicated, antidepressant medications are very effective in controlling hot flashes, and the mood symptoms of menopause.
Of the alternative therapies – black cohosh or remifemin has been shown to be better than placebo in a recent review. However, there is little evidence to support efficacy of other treatments such as phytoestrogens.
The oral contraceptive pill can be used safely and effectively for many women to help alleviate some of the symptoms of the perimenopause such as heavy, irregular periods, as can the Mirena intra-uterine device.
It is obviously important that any decisions about treatment for menopause symptoms be individualized for each woman, and also include a detailed review of other important lifestyle factors such as diet, physical activity, sleep, and stress relieving strategies. Treatment should always be holistic and take into account the full biological, psychological and social circumstances of each woman.
Although it can be a tumultuous time for many women, it can also be a time of reflection, and a time of opening up to new possibilities in life. Far from the idea of a dried up, over the hill old woman – menopause is more often a time when women are at the peak of their careers having amassed many years of experience in their chosen fields. They may have older more independent children or children that are leaving home, meaning that they suddenly have more freedom and time to do the things that they enjoy. Menopause can and should be a time where women are at their peak, where they come into their own, where years of experience turn into wisdom and confidence that many younger women simply don’t have.
When we give women the facts about the options available to them to help relieve some of the distressing symptoms of menopause we can turn the notion of menopause as something to be feared completely on its head.
As a gynecologist who is passionate about helping to inform and treat women during this time, I would love to see woman reclaim this incredibly important and transformative time in their lives.
If woman have the facts, and we can take away many of the debilitating symptoms, women can get on with seeing menopause as the great time for self-discovery and mastery that it should be, and become the confident, powerful women that they are. And there is nothing sexier than a confident, enlightened and powerful woman!
This blog was written by Dr Peta Wright of Eve Health. Whilst all of our specialists can help you, Dr Wright is particularly interested in helping women to better manage their menopausal symptoms. Please contact us on 3332 1999 for an appointment.