Mens Health Blog. Medical Blog

Nowadays, we think we know all there is to know about sex, having babies, contraception, and all that. Yet we seem to know so little about the menopause. Why don’t we talk about it more, compare notes, learn from each other? We do about most other things.

Talking about the menopause is something that most women have just never done. We talk about other aspects of our lives, but not this one. As a result, a conspiracy of shame and silence has drifted down the generations, expressed in such phrases as: ‘It’s her time of life’, ‘She’s going through the Change, poor old thing’, ‘Take no notice of her, she’s just having a hot flush’. Say no more, nudge nudge, wink wink.

Now, however, at last, compared with their predecessors, women reaching the menopause could be the lucky ones, the ones who know about it and are well informed. They can recognise hot flushes and other symptoms for what they are: the body’s response to a fall in the level of the female hormone oestrogen – simply that. They are not something shameful; nor do they mean we are suddenly old. After all, who wants to feel old at 50? It will be another 30 years before you need even to start worrying about that, so don t wish it on yourself now.

Part of the problem is that, until fairly recently, the majority of women didn’t live long enough to experience the menopause. Until reliable birth control became readily available, women who bore children tended to spend the majority of their married lives in a state of pregnancy or breast-feeding until their early forties. A combination of continuing pregnancies and the hazards of childbirth, as well as poor sanitation and inadequate health care, meant that, even at the start of the twentieth century, most women were dead by about fifty. So it is hardly surprising that so little was known about the menopause, let alone talked about.

Those who did survive to the menopause never made much of a fuss about it. They used a bit of self-medication, herbal remedies handed down through the generations, or exciting dietary supplements like ‘two sheep’s ovaries a day sandwiched between unleavened bread’, or ‘one tankard dairy of the urine of a she-goat’, and waited for it to pass.

Today, we often feel the menopause is just another illness to be treated by visits to the doctor and by medication. We hear the term ‘deficiency disease’, that is we are deficient in oestrogen. Yet most women still don’t really know what the menopause is, when it might happen, what to expect, and what can be done to ease their passage through it.

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Comments (0) May 08 2009

- Instead of taking progestogen each month, is it safe to take it, say, every three to six months so that I don’t have so many withdrawal bleeds?

Researchers are now looking into this possibility. The available evidence suggests that, in some women taking oral oestrogen each day and progestogen for ten to fourteen days every second month, the endometrium is protected sufficiently for this to be a safe and convenient option. Further research is needed to determine which women are best suited for this approach, however. Women who have a very light monthly bleed or no bleed at all could turn out to be suitable. Until the research under way has been completed, it seems likely that most doctors will continue to prescribe some progestogen each month.

- I am taking oestrogen and progestogen, with five days at the end of each cycle when I don’t have any hormones. Is this approach widely used?

There doesn’t seem to be any justification for this once-popular approach as menopausal symptoms can return during the hormone ‘break’.

- I’ve had a hysterectomy. Is there any reason why I should take progestogen as part of HRT?

It was suggested at one stage that progestogen might protect the breast from cancer development, and this remains controversial. At the 8th Congress of the International Menopause Society in Stockholm in 1993 there was considerable discussion of whether oestrogen or progestogen, or both, stimulate breast cell growth. It may be that less stimulation occurs in women on low-dose oestrogen and progestogen throughout each cycle. It was suggested that even women without ovaries should be on this combination. Research is assessing this. Meanwhile women without a uterus usually receive oestrogen alone. This does not seem to increase breast cancer risk in the short term (less than five years).

- I am fed up with hot flushes and night sweats and am considering HRT, but I have fibroids. Should this affect my decision? HRT can be prescribed to women with fibroids. However, if fibroids are bulging into the cavity of the uterus heavy bleeding may occur, and this will need to be investigated and may need to be treated before HRT is prescribed.

- My vagina is dry and itchy and sex is often painful. I have started using a vaginal cream that contains oestrogen and wonder if I also need a lubricant?

You will find that your oestrogen-containing cream improves lubrication and reduces itchiness within a week or two. Until then, you may want to use a lubricant when having sex.

- Are hysterectomy rates going up?

After peaking in the late 1970s, rates of hysterectomy appear to have stabilised in Australia, with about 25 per cent of women having the procedure by the age of sixty-five. A NSW study found women aged from thirty-five to forty-nine years were most likely to have it, particularly in their late forties. Most of the operations were for benign disease such as endometriosis or fibroids.

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Comments (0) Apr 21 2009

About a quarter of women starting on HRT experience a small weight gain (up to 3 kg) during the first cycle and for a few months after. A smaller proportion put on considerable weight, part of which seems to be due to fluid retention. Some other women gain weight because of increased muscle mass — because they have discovered exercise in midlife. In older women who already have trouble moving freely, further weight can present problems because it makes regular activity more difficult.

Heather was sixty-eight when her doctor suggested she go onto HRT because of a personal and family history of heart disease. (She had already had coronary bypass surgery and her mother had died of a heart attack.) Heather’s weight shot up after starting on a twice-weekly oestrogen patch and daily progestogen tablets. The doctor reduced the dose of the patch but her weight increase continued, amounting to 13 kg over a ten-month period. In consultation with her doctor she embarked on a program of exercise and dieting aimed at getting her weight down and benefiting her heart. At the time of writing she was trying to decide whether HRT was worth the trouble. ‘I’m looking at the information and making up my mind whether to continue with HRT,’ Heather said.

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Comments (0) Apr 20 2009

women CONSIDER HRT for many different reasons, the most common being to relieve symptoms associated with the menopause. In addition, women at risk of fractures due to osteoporosis, or likely to develop heart and blood vessel disease, may have HRT recommended to them by their medical practitioners. The same advice is increasingly given to women with existing osteoporosis, or those with a diagnosed heart or blood vessel condition, the rationale being that HRT may prevent these problems getting any worse.

HRT and menopausal symptom control

Hot flushes and sweating often prompt menopausal women to seek medical assistance. Other common reasons for consultations include psychological symptoms like loss of concentration and ‘feeling blue’, general tiredness, irritability, vaginal dryness and pain with intercourse, loss of libido, urinary frequency and persistent urinary discomfort.

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Comments (0) Apr 20 2009

Research shows that when the ovaries stop releasing eggs at the menopause, and the lining of the uterus no longer changes in preparation for a possible pregnancy, most women continue to make measurable and useful amounts of active sex hormones. The major source of oestrogen is chemical conversions that take place in fat tissue, hence the amount of body fat has a good bit to do with oestrogen levels in postmenopausal women. The brain and the adrenal glands (two small organs near the kidneys) also continue to produce hormones that control the reproductive system at this stage of your life. Like body weight, your genetic make-up is an important factor in the output of these hormones.

Overall, we produce relatively smaller amounts of oestro-gens, progesterone and androgens (a class of hormones that includes testosterone) after menopause than before it, and the balance of the various hormones changes. Testosterone, for example, becomes a more dominant hormone, even though less is produced after menopause than beforehand. The altered hormone balance explains some of the rapid and not-so-rapid changes to the body associated with menopause.

These hormones act on chemical structures called hormone receptors in many parts of the body. Their influence extends to the ovaries, fallopian tubes, uterus, cervix, vagina, vulva, skin, heart, blood vessels, liver, joints, bone, breasts, brain and urethra (the passage from the bladder to the outside). Various forms of oestrogen affect tissues such as the vaginal lining and the blood vessels in quite different ways. For each of us, changes in our hormone balance will be different, and consequently the effects will vary from woman to woman. Thus the increased prominence of testosterone after menopause may cause an increase in facial hair, altered libido (interest in sex), and a change in the distribution of body fat that is quite apparent to some women but goes almost unnoticed by others.

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Comments (0) Apr 20 2009