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The menopause trap

Why should women feel miserable during menopause, if they don't need to?

Why should women feel miserable during menopause, if they don't need to?

The onset of menopause is something most women dread. Along with their physical symptoms, their sex lives with their partners can often also be affected.

Years ago, every woman was prescribed hormone replacement therapy (HRT) as soon as they reached menopause.

It was the standard treatment for women with symptoms like hot flushes, night sweats, vaginal dryness and loss of sex drive (libido). It was also thought to have long-term benefits in preventing heart disease, osteoporosis and possibly dementia.

Oestrogen and progesterone are hormones that play an important role in a woman's body and when levels fall around menopause a range of physical and emotional symptoms is triggered. HRT helps to restore hormonal levels, allowing the body to function normally again.

For many years, HRT was even seen as a fountain of youth that would keep women healthy and sexy long after menopause.

This all changed in 2002 when a $1 billion Women's Health Initiative study in the US was halted when researchers noticed an unexpectedly high rate of breast cancer and heart disease among women taking part in the research.

This alarming finding frightened millions of women and their doctors away from hormone therapy at menopause.

Gynaecologist John Eden, head of the Sydney Menopause Centre at the Royal Hospital for Women, disputed the findings.

Dr Eden said the majority of the participants in the study had been over 60, were not newly menopausal and would not normally be treated. He was among clinicians around the world who believed the results of the study were exaggerated and widely misinterpreted.

A decade later, medical professionals agree that the 2002 findings were flawed and that hormone replacement therapy may not be as risky as once believed. Several studies have been undertaken and the latest, the Kronos  early estrogen prevention study was presented at the 23rd annual meeting of the North American Menopause Society in Florida in October.

In this study involving more than 700 women researchers concluded that oestrogen/progesterone treatment started soon after menopause appeared to be safe, relieved many of the symptoms of menopause, and improved mood, bone density, and several markers of cardiovascular risk.

Confusion persists among women and medical professionals about the best treatment for menopause.

I have spoken to many women who have been too frightened to take HRT but suffer from symptoms affecting their libido and their relationship with their partners.

Australasian Menopause Society president, Jane Elliot, says women should have easy access to HRT.

"A whole decade of women have missed out on this treatment," she says. "It is not for everyone. It's not a panacea, but it certainly should be something women feel they can consider."

Dr Elliott says the warnings on products are "extreme".

One in eight women do not receive treatment, according to Dr Eden, and experience severe flushing for many years.

He says he prescribes anti-depressants more frequently now than 10 years ago. "Having 10 to 20 hot flushes an hour, day and night, without relief, is enough make anyone depressed."

I've always suspected that medical professionals were worried about writing scripts for HRT because of the 2002 report and fears that amounted to a scare campaign.

This was confirmed in a recent Sun Herald article about Sydney GP, Ginni Mansberg. She and many of her female GP contemporaries prescribed it for themselves – even though they don't for patients, out of fear for being sued.

Dr Mansberg says: "Menopause is a 10-year process for a lot of women and they should have the option of HRT.

"The panic is so out of control that women are walking around with no sleep; they can't function and they feel old and have no sexual function."

GPs should not talk women out of taking HRT but should explain the risks and benefits and give them an informed choice. Why should women feel miserable during menopause, if they don't need to?

The excellent Jean Hailes for Women's Health, a not-for-profit organisation providing services for women across Australia, conducted a webcast in October called "Fifty Shades of Midlife - Menopause, Mood & More" which was streamed all over Australia.

The panel consisted of five women – a GP, clinical psychologist, sex educator, naturopath and gynaecologist.

It was a live, interactive event where the health experts gave practical advice for managing menopause. They talked about sexuality and maintaining intimate relationships when you get older, mood, emotional wellbeing and mental health.

They told women "to embrace menopause" and they gave the thumbs up for HRT.

Certainly well worth viewing – especially with your partner.

Matty Silver is a sexual health therapist based in Sydney, www.mattysilver.com.au.

89 comments so far

  • After a few years of menopause symptoms increasing I made the decision to go on HRT after researching and talking to my gynecologist. I have been on it for three months and it has given me back my life and confidence. We live in an ageist society which is particularly hard on women, I fortunately don't look my age (it's the gene pull,) and don't want hot flushes to give that away in particular in the work place. There was nothing worst for me than sitting in a meeting and a hot flush would come over me and I had nowhere to hide that was embarrassing for me and decided it was time to do something about it and I'm glad I did.

    Commenter
    Jill
    Date and time
    December 06, 2012, 10:13AM
    • You will never convince me that HRT is safe, I am in menopause currently and I'm sorry I'll deal with the symptoms rather put myself on the guinea pig treadmill for the medical establishment.

      Commenter
      Rosie
      Date and time
      December 06, 2012, 10:20AM
      • Yes well that's certainly your choice but for many women who still want to (and have to) function normally it certainly has it's benefits and will be considered by many including myself as a useful option when the time comes.

        Commenter
        LucyX
        Date and time
        December 06, 2012, 11:21AM
      • Why are you convinced it's unsafe? I'm really (seriously) glad for you that your symptoms are manageable, but for 10% of women they're severe and long lasting, so if you're not in that group I can well imagine your positive attitude to managing the symptoms.

        I'd rather be six feet under than suffer for any longer with the debilitating symptoms that I'd been trying to deal with for two years (and two years on, are just as bad if I stop the low level of HRT that I'm on). I'll take my chances with the risks (and enjoy the proven benefits) given my family history and quality of life I'm now enjoying.

        Anecdotally, my mother took HRT for many, many years and never developed cancer, and my MIL didn't but developed breast cancer, so any anecdotal reporting has to take the reverse situations into account.

        Commenter
        bornagirl
        Location
        Melbourne
        Date and time
        December 06, 2012, 1:22PM
      • @bornagirl - my mother was automatically put on HRT when she began to have unpleasant menopausal symptoms at the age of 46. Two years later she had her first bout of breast cancer. They now know that the form of HRT she was put on (in the 1970's) was carcinogenic. While it alleviated her symptoms, she consequetly lost both her breasts and now has breast cancer for a 3rd time. Based on her experience I wouldn't want to risk it. You are to some degree a lab rat, as they don't have long term longitudinal studies on the use of HRT.

        Commenter
        Lotus
        Date and time
        December 06, 2012, 2:14PM
      • It's a shame that this and other comments are so willfully ignorant about the human body and drugs, such as HRT. As the author of the article points out, HRT can prevent osteoporosis, heart disease and dementia. Would you 'just deal with it' if you got cancer or type 1 diabetes? You would most likely be dead in a very short period if you did. Osteoporosis, heart disease and dementia, are diseases the body can develop (all on its own) without you necessarily standing near a leaking nuclear power plant! I would rather live a healthy life in my later years than deal with the list of preventable illnesses my mother now has because she didn't take HRT (not to mention the dreadful menopause we all endured with her)!
        As a woman you owe it to yourself to educate yourself - get online and learn about your body's microbiology and safe drugs that the 'medical establishment' has developed - it's not witchcraft, it's real, good science.

        Commenter
        M!
        Location
        Melbourne
        Date and time
        December 06, 2012, 3:46PM
      • That's definitely your choice, but you have to carefully monitor yourself, including your moods and behaviour towards others.To be blunt: I've never seen a psychologically serene menopausal woman and mood swings are just the tip of the iceberg.

        Commenter
        Aka
        Location
        Sydney
        Date and time
        December 06, 2012, 5:14PM
      • I believe Rosie feels it unsafe because she maybe understands how the pharmaceutical industry works. Drugs only have to go through like 5 years of testing before being released which is not nearly enough time to see long term effects. nevertheless, long term effects from drugs usually are seen in the next generation so maybe if its for menopause and you wont be giving birth any genetic defects that may arise from hormone-based rugs would not be an issue.

        It may be safe, it may not be, but I dont think it unfair to question its safety or be skeptical if you know anything about the pharmaceutical industry - sometimes they put drugs on the market that are more dangerous than Class A illegal drugs.

        Commenter
        Mynx
        Date and time
        December 06, 2012, 5:19PM
      • @Mynx: you're talking to someone who's only alive due to significant amounts of prescription drugs over the years, starting in primary school. Back the good old days, people used to die from what for me was a very controllable condition. When you get a lemon, not just one thing goes wrong, and in my mid thirties developed another condition which required the maximum dose of four different drugs to control it. Twenty years after that, and thanks to yet another drug used as an IV tracer for a complex set of scans, the cause of the problem was discovered and removed.

        In my late fifties I'm now healther and fitter than I've been for 25 years - I do 10k fun runs, bike ride up to 30k at a time (seriously ride, not cruise) and go to the gym five days a week. Last stress test was excellent on all counts (not like 15 years ago); eye test reports better eye health (an easy way to show blood vessel health), and apart from some minor grumbles caused by the different conditions have a better than average life expectancy.

        That's ALL down to drugs. I can understand those who've never NEEDED them to be suspicious of them, but I can assure you they wouldn't be knocking back life saving treatment. Once they've discovered drugs really CAN save your life, they'll be a little more relaxed (without being too complacent).

        Commenter
        bornagirl
        Location
        Melbourne
        Date and time
        December 06, 2012, 9:20PM
      • Agreed, Rosie. I'm not rushing out either. What confuses me, is are we talking about actual menopause - the menses have actually ceased, or the slow move toward that stage of life, the PERI-menopause, where the syptoms build, cycles change before declining to nothing?
        I've been peri-menopausal since my mid 40s and am now in my early 50s and long for the day when my one and only real symptom ceases : my 3 week cycle.
        I get the occasional hot flush, but it's the cold flushes I don't like (especially in winter). I can get a bit moody, but I reckon at my age, I'm entitled to a bit of grumpy every now and then. And libido : that's probably the only thing I kind of care about in fairness to my other half. It would probably be the only thing I would like to do anything about. But not with artificial things.
        Anything plant based out there to help?

        Commenter
        Robyn
        Date and time
        December 06, 2012, 11:55PM

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