Until Davina McCall’s Channel 4 documentary, Sex, Myths and the Menopause, many women were unclear about what to expect when approaching this time in their lives. However, new treatments are changing the conversation.
In the UK, the average age of the menopause is 51 and yet many of the symptoms — anxiety, mood swings, brain fog, hot flushes, palpitations, night sweats, headaches, vaginal dryness and discomfort, hair loss and insomnia — can start years before a woman’s periods stop and may continue for years afterwards.
Lisa North, a 43-year-old chef from Kent, visited her GP in July because she was experiencing some of the symptoms listed above. “I was told to keep taking pills,” she says. “There was no advice and no treatment. Everything I know now about my symptoms has come from doing research online, the media and talking to friends.”
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Aside from hot flushes, which are experienced by up to 80% of women, no other symptom is unique to the perimenopause (the menopausal transition before menopause). Symptoms vary from woman to woman and can change over time. In terms of diagnosis, it’s the combination of symptoms and a blood test that will confirm it.
Mr Michael Savvas, a senior consultant gynaecologist and specialist in the management of the menopause at the London PMS & Menopause Centre, explains: “The difficulty with perimenopause is that a woman could appear to be not menopausal because she’s still having regular periods. But sadly, some of the symptoms, particularly depression and anxiety, can be at the most severe at this time, so the natural thing for GPs to consider is antidepressants.”
Women who have a history of hormone-related depression, such as postnatal depression, suffer the most in the one or two years before their periods stop and what they really need is oestrogens instead of, or as well as, antidepressant therapy.
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Savvas has been working in menopause treatment for more than 30 years and has long advocated the use of Hormone Replacement Therapy (HRT) to alleviate symptoms. Too many perimenopausal women who are still having periods suffer with symptoms caused by declining oestrogen levels needlessly, he says.
And while uptake of HRT is on the rise, there are a generation of women and GPs whose reservations about it stem from the findings of a 2002 clinical trial that linked it to breast cancer. We’ve since learnt that that study was badly designed, with inappropriate conclusions, but it remains in public consciousness.
There are many kinds of HRT, and careful assessment of a woman’s needs and medical background will determine the most appropriate type for her. Oestrogen can be given orally as tablets or by using oestrogen gels, patches or implants. Women taking oestrogen also need to take a second hormone, progestogens, for seven-14 days every month to ensure regular monthly bleeds and prevent overthickening of the endometrium or lining of the womb. This is to help reduce the risk of endometrial cancer of the womb.
“Sometimes symptoms such as tiredness, low moods and loss of libido may persist. In such cases the addition of testosterone can be very helpful,” adds Savvas.
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Not only can oestrogen replacement help alleviate menopause symptoms, some studies have indicated that it may also reduce the risk of developing osteoporosis, heart disease and possible dementia. While research is ongoing, the good news is, so is the conversation about women’s health.