Menopause: everything you need to know

Every woman’s experience is different so menopause treatment is not a one size fits all – it has to be tailored to your needs says Professor Kerryn Phelps
Flushing? Awake at night sweating? Cranky?
One of the great medical controversies of the past decade has been the debate over the best and safest treatment for women trying to find relief from these and some of the other, perhaps less obvious, effects of menopause.

Since long term research raised concerns that HRT increased the risk of heart disease, stroke and breast cancer, women have been in the difficult situation of searching for the safest and most effective way to improve their quality of life and state of health into older age.

Gone are the days when most women were told to take hormone replacement therapy (HRT) with the promise of staving off the ravages of ageing.
It seems that it takes more then a little white pill or a hormone-laced patch to ensure a healthy older age for women. Who would have thought?

So with the pendulum swung well away from the widespread use of hormone replacement, what is the best way to manage your menopause?

In my opinion you need to start by deciding on the goal you are trying to achieve. I try to encourage women to think not just of the immediate symptoms, but of the broader health issues they potentially face.

If menopause symptoms are really troublesome, then that becomes the immediate priority.
Symptoms of Menopause

  • periods stopped, infrequent, or irregular hot flushes
  • night sweats
  • irritability
  • uncharacteristic emotional outbursts
  • loss of interest in sex
  • fatigue or lack of motivation
  • incontinence (leaking urine)
  • trouble concentrating and memory lapses
  • aches and pains
  • sleeplessness

Hormone therapy is available in oestrogen and progesterone singly or in combination in a range of doses, as pills, patches, implants, gels and creams. Testosterone and DHEA are sometimes added.

Troches and “bio-identical hormones”
Many women have been attracted by the promise of “natural HRT”, “compounded troches” (like lozenges) or “bio-identical hormones”, believing them to be lower risk than other forms of hormone therapy. However this could be a case of “out of the frying pan, into the fire”.

There are no long-term safety studies of individually compounded HRT combinations. Like other forms of HRT, it will help symptoms in the short term but there is no proven difference in safety compared with regular HRT.

Other medications are sometimes prescribed, depending on the nature and severity of symptoms. These include clonidine and gabapentin (for flushes), SSRI antidepressants (for irritability and flushes) and tibolone.

Managing hot flushes

  • Quit smoking
  • Avoid or reduce foods or substances that may trigger flushes, such as spicy foods
  • Reduce caffeine and alcohol
  • Lower your stress levels
  • Exercise daily. Wear loose clothing and dress in layers
  • Herbal medicines such as black cohosh
  • Medication including HRT
  • Acupuncture

If you are one of those lucky women who barely noticed the transition, then the focus will be on optimising your health and wellbeing into the future. For some, menopause is a wake up call.

Older age increases the incidence of chronic disease, with many having a preventable component including heart disease, osteoporosis, osteoarthritis and diabetes.

It helps bone and muscle strength, heart health, mental state and general wellbeing . It can also improve your sleep.

Healthy eating is important throughout life. Around menopause and beyond principles of low fat, plenty of water, a variety of fresh fruit and vegetables and grains, plenty of soy foods, fish and other sources of protein apply.
You will need a source of calcium from food or as a supplement. Supplements will not replace whole foods. However, many people do not consume the necessary amount of micronutrients in their diet so a daily multivitamin and mineral supplement can help.

Lignans may help menopause symptoms and are found in most cereals, seeds, vegetables and fruits, rye, millet and legumes with high concentrations in oils seeds, especially linseed and flaxseed.

Hot spicy food, coffee, tea and alcohol can all trigger hot flushes. As a general rule, lower intake of alcohol and caffeine is a good thing.

Overweight contributes to sweating and flushes as well as contributing to chronic diseases of ageing, so keep your weight in the healthy range.

Stress management
We all have pressures in our lives. If you can take control of stress, it makes it easier to cope with the physical and emotional challenges of menopause. Try some of these strategies:

  • Time management
  • Professional counselling
  • Fostering a network of supportive friends
  • Techniques such as meditation, T’ai Chi or Yoga
  • Slow deep breathing (“paced respiration”)
  • Relaxation training.
  • Regular exercise
  • Refuse to accept negative stereotypes of ageing

Herbal medicines
A variety of combinations of herbs can help symptoms of menopause. Make sure you get expert advice (including doses and combinations).

Two examples are black cohosh and St John’s wort. Black cohosh, also known as Cimicifuga racemosa, has a beneficial effect on hot flushes, anxiety and vaginal dryness, said to be similar to or better than the effect of oestrogen.

You can expect improvements after about 4 weeks.

St John’s Wort is known to be effective for treatment of depression and irritability, in some cases it has been found to be as effective as pharmaceutical antidepressants with fewer side effects.

Regardless of how well you have looked after yourself up until now, the big take-on-board message is that investing in healthy lifestyle now will make the difference in things like mobility, independence, and ultimately longevity.

The current state of play means that if you are planing ahead for menopause, going through menopause symptoms or wanting the best for your health and wellbeing as you prepare for getting older…you will need to do some homework.

There is no one-size-fits-all answer, and while the array of options might seem bewildering, there are some safe and simple strategies.

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