Menopause Endings and New Beginnings
Menopause is a word originally derived from the Greek language ‘meno’ meaning month and ‘pause’ implies ‘to cease’ hence it means the last period a woman has.
Median age of menpause in Australian born women, is 51years.
This discussion about menopause, at SBS Hindi is through the lens of our subcontinent women, and the average age in India, of attaining menopause is earlier in the timeline, around 46 years of age.
Perimenopuase is the time leading up to the change, and can be variable in duration, typically 4-8years. This reflects the time the ovaries are winding down in their function and the low oestrogen state that ensues.
Premature menopause (<40years) occurs in 1% of women, can be for no obvious reason or be surgical, chemo therapy or radiotherapy based.
A woman is termed post menopausal when she has not had any periods for 12 months.
This talk covers most of the following key messages
Every woman is unique and management of menopause involves tailoring her symptoms, impact on her her quality of life to what options are available and exploring good strategies together, to get through this time.
Typical symptoms reported include – Hot flushes, night sweats, skin dryness, insomnia, moodiness, anxiety and depressive tendencies, urinary frequency, vaginal dryness, discomfort or pain with sexual intercourse, reduced libido, joint pains,tiredness & fatigue etc
General lifestyle advice – phytoestrogen rich foods (daal is a prime example) in a nutritous balance with adequate exercise, self care and a timely review by your General Practioner, ‘speciaist in life’ is a good start
Please don’t focus on diagnostic blood tests (Oestrogen levels are likely to be low, the pituitary based hormones including FSH can be variable). The menagement in an otherwise healthy woman, is essentially clinical. However, it is a good time to assess overall well being and Breast screen Australia offer free 2 yearly mammograms, targeting the 50-74yr age group.
The philosphy around prescription of menopause hormone therapy has done full circle – Initial use as a prevention tool from a cardiovascular angle, (Cardiovascular disease, primarily coronary artery disease (CAD), is the leading cause of death among women), followed by much negative press, in 2002 when a study called Womens Health Initiative was published in JAMA, causing many women to abandon their hormone replacement therapies. Clinicians were swayed likewise and almost half of women then on HRT stopped taking it.
The current thinking is – Can safely use Menopause Hormone therapy (MHT) for SYMPTOM RELIEF in healthy women (within 10 years of the menopause), for the duration of the symptoms and the overall additional risks in terms of breast cancer risk and venousthromboembolism are low. A risk benefit based discussion is the way to go. The lowest effective dose is desirable. Improved bone density and reduction in osteporosis is reflected in reduced fractures after falls, another positive from the ageing perspective.
Personal and Family history may alter the risks and is a key part of the decision making and suitability. For example trans dermal patches/creams as well as local vaginal pesseries etc might be better options for some women.
Many other options like antidepressants, natural thearapies exist and should be reviewed in the context of safety and effectivity based on trials and research if available.
Good patient Information is available from Australasian Menopause society and the Jean Hailes for womens Health.
If you are part of the group of women, who will have some symptoms through the menopause journey (the vast majority), and it is creating distress or affecting your quality of life, please organise a review with your GP/Gynaecologist/menopause based organisations or special interest clinicians to review the many good options and support available to you.
