Managing Menopause

Posted Friday, September 14, 2007 to PROFILES > Obstetrics and Gynecology

Posted by The Original Anti-Aging & Cosmetic Surgery Magazine

Menopause can be a tumultuous time for many women. But they are no longer expected to suffer in silence, as Adrienne Garside discovered.

As any woman who has passed through menopause will testify, there is much more to it than the gradual exhaustion of a woman's egg supply. Traditionally, women were expected to endure the complex physical and emotional changes that often accompany menopause without deviating from their regular daily schedule. In recent years, more research and widespread attitudinal change in medical circles mean women have more choice with regard to the management of menopause and its often debilitating symptoms.

Associate Professor John Eden, Director of the Sydney Menopause Centre at Sydney's Royal Hospital for Women, says the fact that many of these symptoms aren't specific to menopause is a major stumbling block in finding a suitable treatment.

"[Patients are] often principally worried about mood swings, they'll be really irritable and depressed and anxious - is this menopause or is it the cat, the dog, the husband, work or something else?," he explains.

"That's a really tricky one because you can't tell just by talking to the patient."

Most doctors overcome this problem by prescribing a two month course of Hormone Replacement Therapy (HRT).These supplements are usually administered in the form of tablets or patches placed on the skin, with the results (or lack thereof) apparent almost immediately.

"It's usually spectacular actually," Professor Eden says."Quite often within a week or two they're much, much better or it has made no difference at all."

Following the initial trial, doctor and patient can assess whether or not to continue with the treatment. Women are increasingly reluctant to accept arbitrarily prescribed HRT, and should seek out a doctor willing to experiment with dosage levels and tailor the treatment to their individual needs.

However, Sydney gynecologist Bruce Farnsworth doesn't believe HRT is all it's cracked up to be.The Heart and Estrogen/Progestin Replacement Study (HERS) published in the USA in 1998 is the first and only randomized study of estrogen and progestin therapy in post-menopausal women. It found that although there is a large body of evidence suggesting HRT can provide protection against heart disease, in fact it does not benefit women with existing heart disease. The HERS study also showed there is a risk of breast cancer associated with HRT use.

Dr Farnsworth explained the basis on which to treat all menopausal symptoms: "Use the minimal treatment necessary, avoid tablets, use natural hormone sources and remember safety first." He regards education of utmost importance. "Read widely but avoid jumping to conclusions and believing the latest news headlines."

According to Professor Alan Husband, Research Director at Novogen Limited, resistance to traditional remedies for menopause stems in part from a possible link established between longterm HRT treatment and increased risk of breast and endometrial cancer. He says that while the danger is not significant, it makes many women think twice about HRT.

"Whatever it is, no matter how small, women perceive that as being important, and if they can find an alternative they would prefer it." Professor Husband says.

For women with severe symptoms of menopause, there are no alternatives endorsed by the wider medical community which have the same effects as HRT. But patients can be helped to varying degrees by simple dietary and lifestyle changes.

Those in the fields of research and development have established that menopause symptoms are an aberration of Western culture, with strong links to our heavily processed diet. Professor Husband suggests women over 40 seek out alternative sources of natural estrogens (called phytoestrogens) to fend off symptoms before they set in.

"Hot flashing just doesn't occur in Japanese women; osteoporosis is very rare," Professor Husband says.

"They don't have these sudden changes that Western women experience because their estrogens are coming from their food they eat a lot of legumes."

Food For Menopause

Aside from foods from the legume family (which include chick peas, lima and soy beans), many women have found relief from side effects using herbs such as dong quai, black cohosh, ginseng or Promensil, a plant hormone supplement made from red clover. Cutting back on stimulants such as spicy foods and coffee also reduces the occurrence of hot flashing and promotes relaxation.

Regular low impact exercise, such as walking and swimming, is also especially helpful for women over 40. It reduces the effects of hot flashing by stimulating the pituitary gland, which regulates the menstrual cycle. Remaining active also helps to prevent the incidence of secondary afflictions connected with menopause, such as osteoporosis.

The key to a smooth progression through menopause is taking an informed role in treatment. Coupling a healthy lifestyle with the advice of a sensitive doctor or specialist is the best course of action.

FAQs - Assoc. Prof. John Eden

At what age do most women experience menopause?

The last 2-3 years of menstrual life is called peri-menopause and that's when most of the symptoms occur. Most women will have their menopause between the ages of 45 and 55, with an average around 51. That's when their periods stop.

How long, on average, does menopause last?

For women who have the symptoms (around 80 percent), they typically last 1-3 years. Unless you're in that unlucky 10-15 percent of women (who have severe, ongoing symptoms).

What are the most common symptoms women experience?

Hot flashes are the most recognizable one. Often mood swings and irritability. About a third have a peculiar skin sensation - it's called formication, which literally means ants crawling on your skin. Some get generalized muscle and joint aches, some women get depression or insomnia. Many women develop bladder problems, vaginal dryness. Some are due to estrogen and some are due to other problems.

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