Women’s Hea lth Menopause The hot truth By Dr Andrew Cary, Obstetrician & Gynaecologist Menopause is the time in a woman’s life when monthly menstruation stops, due to the ovaries ceasing the production of hormones, oestrogen and progesterone. This usually occurs between 45 and 55 years of age, with the average age being 51 years. Of course whilst this is natural menopause, medical or surgical treatment, such as removal of the ovaries or chemotherapy, may bring this on early. Some women will go through menopause without symptoms, except for the cessation of periods. Many have one or more of these symptoms: • Hot flushes – hot flushes are like a wave of heat that spreads often from the chest to the face and across the body. • Night sweats – hot flushes occurring during your sleep, making it difficult to achieve a good night’s rest. • Sleep issues – problems such as trouble falling asleep or staying asleep, with or without night sweats. • Vaginal dryness – a dry, sensitive vagina that can be uncomfortable and itchy, often making sexual intercourse painful. • Depression – symptoms such as sadness, losing interest in regular activities and sleep changes may be depression. • Poor concentration – poor performance and concentration may be caused by lack of sleep, but can also be due to lack of oestrogen. It is recommended that women seek advice from their GP and have regular checkups during menopause. A general health check and risk assessment will be performed, including your regular pap smear, breast assessment and mammogram, and cardiovascular risk will also be assessed. Your doctor will also emphasize and address lifestyle issues such as exercise, diet, smoking, alcohol and weight. Women often experience menopause symptoms that interfere with their quality of life. Any, or all, of the menopause symptoms may interfere with relationships, work performance or social life, and these quality of life issues must always be considered if treatment is being sought. Hormone therapy with oestrogen is the primary treatment considered to be most effective for menopause symptoms. The principle of treatments is to alleviate the symptoms of menopause in the short term. Long-term therapy is not the standard recommendation, and treatment review should be considered every few years with a typical treatment extending up to five years or at least considering cessation at age 60 years. Oestrogen hormone is the ideal treatment to relieve all symptoms of menopause. Progesterone hormone is added in various regimes to protect the lining of the uterus from buildup if only (unopposed) oestrogen was used. There are specific medical conditions that your doctor will check for, which rule out oestrogen use, such as history of breast cancer, cardiovascular disease, previous thromboembolism (or blood clot) or stroke and active liver disease. pm • Oestrogen is often given by tablet, skin patch or gel; it is also available in a vaginal-only treatment. • Progesterone can be administered via tablet, skin patch or uterine device (Mirena). • The specific style of oestrogen treatment, whether alone or combined with progesterone, will depend on the symptoms and the individual, and will be formulated by your doctor • Ceasing hormone therapy should be considered every few years and should definitely be considered after five years of treatment or when reaching age 60. • The best plan of cessation is to taper off the hormones to minimize the effect of recurrence of symptoms especially hot flushes. • The menopause years can be an exciting time of a woman’s life with many years of healthy living and excellent quality of life which often can be enhanced by appropriate use of hormone therapy. Dr Andrew Cary is an experienced obstetrician and gynaecologist specialising in obstetric care, infertility, all aspects of IVF, and hysteroscopic laparoscopic (keyhole) surgery. pindaramagazine.com.au Pindara Magazine 35
Pindara Private Hospital Magazine - Issue Four
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