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| WOMEN'S & CHILDREN'S HEALTH |
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| WOMEN'S & CHILDREN'S HEALTH |
CHRISTCHURCH WOMEN'S HOSPITAL
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Gynaecology Services - Menopause Voices of the Menopause, Questions & Answers
How will Menopause affect the rest of Your Life? The menopause is an important phase in every, women's life. Yet until recently, the subject was seldom discussed. Even among the closest of friends. Fortunately times are changing. Women are demanding more information about this important life transition. And about hormone replacement therapy. How will the menopause affect the rest of your life? Find the answers to some of your questions here. In Voices of the Menopause. And remember. If you have any unanswered questions or concerns regarding the menopause or hormone replacement therapy, discuss them with your doctor. The menopause itself is defined as that point in a women's life when periods stop. This happens at the average age of 51. For some women, it happens earlier For others, later The time preceding and following the last menstrual period is called the climacteric. Why all this talk about the Menopause? Women are talking. The menopause has finally come out of the closet. Part of this has to do with the fact that it simply affects more women than ever before. Because women are living longer. 100 years ago, the average life. expectancy was 50 to 55 years. Today, it is 78. Which means a women can expect to live up to 1/3 of her life with the consequences of the menopause. This, combined with changing attitudes, means that the menopause can be discussed freely. What happens to your Body during the Climacteric? As a woman enters puberty, her ovaries produce 2 sex hormones: oestrogen and progesterone. Oestrogen is the most important of all sex hormones. It signals the transition into adulthood, for example, by, stimulating the growth of the breasts and creating a fertile environment in the womb. While oestrogen prepares the womb for a fertilized egg; progesterone sustains and supports the egg. During each monthly cycle, the levels of these two hormones rise, then fall. A menstrual period results if the egg is not fertilized. When a woman enters the climacteric, the production of these hormones slow, until they stop. The ovaries stop producing oestrogen and progesterone. That's when women stop menstruating, and can no longer become pregnant. Even before a woman has her final period, the ovaries start slowing the production of progestogen. Periods become irregular. Oestrogen production slows. When this occurs, women may experience a number of symptoms: night sweats, hot flushes, anxiety, or fatigue. Many women also complain about an inability to concentrate and problems with memory Clearly, this can affect a woman's job performance, or her relationships with others. Later on, oestrogen deficiency can dry out the moisture in the vagina. This condition, which we call vaginal dryness or vaginal atrophy in medical terms, may cause itching, or pain during sexual intercourse. Fortunately, help is available. Common Symptoms caused the Loss of Sex Hormones
About 1/4 of women never have problems, or at most, only minor symptoms. But about 1 /3 of women will experience symptoms so severe that they disrupt the quality of life. Women should not hesitate to seek medical counselling if it interferes with their sense of well-being. Or if they would simply like to know more about how the menopause will affect their health. The change of life doesn't have to be a change for the worse. The menopause itself will not change the essential you. In fact, like other life phases, it too can be a period of emotional and intellectual growth. But it can also be a time of turbulence and emotional uncertainty. Children pass though their own life changes puberty, or perhaps leaving home. A parent may die. The menopause, together with life events such as these, can profoundly affect a woman's emotional well being. Mood may be affected. Many women complain about difficulties concentrating, which can affect job performance or relationships with others. A woman may become depressed, or lose her sense of self esteem. But you don't need to become a victim of circumstances. Your doctor can help you select an appropriate healthcare strategy for you. How long can I expect symptoms to last? It is impossible to predict how long symptoms will last. It is very individual. In some women, symptoms disappear within a matter of months. For others, they may last up to 10 years or more. On the average, symptoms last about 2 to 5 years. Are there other consequences of the Menopause I should be aware of? See separate Osteoporosis section. Does the Menopause affect Heart Disease? More women die of heart disease than all cancers combined. It is the leading cause of death among postmenopausal women. The reason may be tied partly to the loss of oestrogen. Before the menopause, oestrogen protects women against heart disease by keeping cholesterol levels in the blood low. After the menopause, women lose this protective benefit. When should I seek Counselling or Treatment? You should seek medical counselling if menopausal symptoms are creating problems in your life. Treatment is available, and advisable for women who find the quality of their life disrupted either emotionally or physically during the climacteric. It is also a good time to find out if you are at risk for osteoporosis, also called porous bones. The problem with osteoporosis is that it is a silent disease. Osteoporosis starts developing early in the menopause, even though you may not feel it. That is why an examination is recommended after menopause. For general screening purposes, we recommend a bone density test at age 65 years. Assessing your risk factors for fracture can be done with your GP. The earlier you can find out if you are at risk the better your chances for preventing it. The menopause. It's a quality of life issue that deserves to be taken seriously. What choices of Therapy are available? Your doctor's foremost concern is helping you select the safest and most effective therapy possible. The choice of therapy will depend on the severity of symptoms, your age, and your own personal wishes. Here are some of the Therapies Available Today
What is the benefit of Sequential Therapy? The benefit of sequential therapy is that it adds hormones to your body which it no longer produces. It relieves or stops menopause symptoms, usually within 2-6 weeks. Periods become regular. As the lining of the womb returns to its pre-menopausal state, women will have regular periods every 4th week. Some women will find they are lighter than those they were used to. However, it is reassuring to note that you can not become pregnant again if you were past the menopause when you started HT Then again, if you were not past the menopause when you started HT remember, this is not a form of birth control! You will still need contraception. If I don't want periods any longer, is there an alternative? A therapy is available for postmenopausal women who prefer not to have periods. Oestrogen and progestogen are combined in such a way that women do not have periods. This therapy is called continuous combined oestrogen progestogen therapy. It is only available to women about 1 year after the menopause, when we know a woman's own oestrogen production has decreased sufficiently. Like other therapies, a woman can expect a few minor side effects in the beginning. These include breast tenderness and initial irregular bleeding. Some women will experience these bleedings/spottings the first 4-6 months as the body adapts to the therapy. What are the advantages of Continuous Combined Therapy? Continuous combined therapy replenishes the body with essential hormones to relieve menopausal symptoms, both physical and emotional. We also know that it can help prevent osteoporosis. But the difference between this and other therapies is that postmenopausal women do not have to worry about having periods. What if I have had a Hysterectomy? Women who have had their womb removed (a hysterectomy) will also experience menopausal symptoms. Sometimes earlier than other women. Women who have also had their ovaries removed tend to experience menopausal symptoms shortly after the surgery. Women who have had a such an operation do not need to worry about menstrual periods. Nor do they need to worry about the risk of cancer of the lining of the womb. For these women, oestrogen only therapy will be recommended. No progestogen is needed, because there is no lining of the womb that needs protection. The therapy regimen is simple. One tablet is taken once a day. Everyday. There are alternatives, but tablets still need to be taken part of the month. One is called the patch. It contains oestrogen. You put it on the skin, and change it every third or fourth day. If your womb is intact, you need to take progestogen tablets at least 10 days every month. Some women prefer oestrogen gel or inhaled oestrogen. Again, supplementary progestogen is needed 10 days during each monthly cycle if the womb is intact. For women with vaginal irritation of dryness? The decline in oestrogen levels may cause severe vaginal dryness or irritation. The term for this condition is called vaginal atrophy. In addition to dryness or irritation, women may also experience pain during intercourse, or urinary tract problems which can sometimes, but not always, cause infections. Both oral and local vaginal therapies can relieve the symptoms. Are there any side effects to Hormone Therapy? With today's low dose therapies, side effects are rare, and usually temporary in nature. For example, some women have breast swelling or tenderness, bloating, headaches, or leg cramps. Others might feel a little dizzy or nauseous. The symptoms usually disappear within 3 months. If not, talk to your doctor. And in any case, if after 3 months notice note irregular bleeding patterns, tell your doctor. Another therapy or dosage strength may be recommended. More than 50% of women put on weight after the menopause. 20% of these will gain more than 10 kgs in weight. HT actually prevents weight gains like these. However, during the first months of therapy, some women may retain water in their body. This condition (oedema) usually disappears within the first 3 months of therapy. Does HT increase the risk of getting Blood Clots? HT increases the risk of blood clots, especially in women over 60 years and those who are overweight. The risk is small but you should discuss this with your doctor. Doctors recommend that women who have had blood clots associated with the use of oestrogen (like birth control pills) be examined extra carefully before starting HT If your doctor has any reason to believe it is not safe for you, he/she will not prescribe it. What about the Risk of Cancer? Cancer is understandably the biggest concern of women. What we know is that if pure oestrogen is taken for a long period of time, the risk of cancer of the lining of the womb increases. This is why progestogen is added. The addition of progestogen eliminates this risk. Recent information shows that oestrogen used alone does not increase the risk of breast cancer. Using oestrogen and progestin together increases the risk of breast cancer after 5 years of use. Just under 6 extra woman per 1000 taking HT may be affected (this risk is seen after more than 5 years use of HT). Does HT increase the Risk of Heart Attacks and Stroke? New information from the U.S.A shows a small increase in Heart Attach and Stroke risk in older women (>65 Years) taking HT. Younger women in their 50s appear to have a reduced risk of heart attacks if they take HT. It's Your Life - Live it your Way Women today have more choices than ever before. But before a woman chooses, she has a right to know as much about the menopause and HT as possible. The more you learn about your body and your healthcare options, the more control you'll be able to have over your change of life. Let it be a change for the better. |
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