Menopause: Feeling hot, hot, hot!
Menopause and Mayhem
In most western countries, women are now living long enough to spend half their adult life after the menopause. In this era of information overload, it is surprising how little reliable information women get to deal with this life event. Due to the lack of clear information, you often arrive at the menopause, unprepared and unaware. This is not a very pleasant experience. There is a lot of myth and misunderstanding about the menopause. As a first step, it helps us to understand what exactly is going on during the menopause. If you men are thinking of skipping this article and going to the sports section, think again, as your very survival may depend on reading this.
Change : sputtering hormones
Although the word menopause literally means ‘stopping of the monthly cycles’, it is when the ovaries stop working that the female body starts to experience the ‘change’. The average age this can start can range from mid forties to mid fifties. In the few who had to have their ovaries removed at a young age, the menopause starts almost instantly. The series of changes that take place affects the whole body. The ovarian production of the key hormones Oestrogen and Progesterone become more and more erratic, causing disruption to the monthly cycles and irregular bleeding. This can be long drawn out and can last up to a year. Some may get no periods for several weeks, followed by flooding that can be unpleasant and exhausting.
Symptoms & Signs
The body temperature can suddenly become very high, causing a ‘hot flush’ at the most inopportune moment, followed by sweating. This is often embarrassing in social situations and can be frightening if you’re not sure what is going on. Some women experience dizziness, light headedness, waves of nausea and even migraines.
The gradual loss of oestrogen causes dryness in the vagina as well as thinning and loss of elasticity leading to pain and even bleeding during intercourse. There may be problems with the bladder, such as infections, frequency and stress incontinence causing minor ‘accidents’. Understandably there will low interest in sex. There could be breast tenderness and reduction in cup size; changes to the skin and hair such as dryness and thinning; unpleasant facial hair; aching muscles and joints; fatigue and lack of sleep. Psychologically there will be low moods, irritability, unpredictable tearfulness, anxiety and even depression.
This is certainly a lot to put up with for someone who may also be dealing with other stresses in life. It would help if the friends and especially family are more understanding and less critical at this crucial period of life. Knowing what to expect by speaking to a Doctor or a Nurse will help. Having a good discussion on what treatments are available for the relevant symptoms would help us have contingency plans making the menopause less scary.
Hormone Replacement Therapy
While dealing with the menopause is hard enough for womanhood, it is made worse by the confusion and controversy over the various available treatments. Thankfully we now have considerable evidence from millions of women who have been on it for the past two decades on the benefits and relative risks of Hormone Replacement Therapy (HRT). Obviously when used for the right person for the appropriate duration.
For most undergoing natural menopause in the 45-55 age range, HRT can provide substantial relief from the hot flushes and tiredness. It will also help prevent bone loss and offers some protection against ovarian, endometrial and colonic cancer. The best option is to take it for a short term, preferably up to 5 years depending on individual circumstances. You have to keep in mind that this rule doesn’t apply to those who have lost their ovaries at a young age, where HRT is needed for much longer durations until the natural menopausal age. HRT helps give energy, improves libido, skin tone and vaginal health. The slight increase in risk of breast cancer happens after 5 years and escalates after 10. As do risk of ovarian and endometrial cancer if taken longer into the sixth or seventh decade of life, so caution is needed.
HRT is available as tablets, patches and gel treatments. Women with an intact uterus need to take a combined preparation much like the pill. Do remember that if you’re taking it at mid forties it does not guarantee contraception. Many mistakenly believe that they stop being fertile as soon as periods stop. Don’t get caught out! It is recommended to use protection for one to two years after the cessation of periods. Also watch out for the patch slipping off at night and attaching itself to your man, it may help him get in touch with his feminine side a bit too much.
As an alternative to HRT there is a drug called Clonidine ( also used for Migraines some time) for hot flushes – but it is not as good as the real deal. It does come in handy when you have any medical history that contraindicates taking HRT. But it does have some side effects that can be unpleasant.
If the predominant symptoms are tiredness, hot flushes and mood swings it has been found that mild antidepressant drugs such as Fluoxetine and Citalopram help the menopausal symptoms. They need to be taken over a period of 6-12 months.
If your major concern is thinning of the bone (Osteoporosis) take calcium and vitamin D supplements. Exercise, weight management and a good diet help tremendously. There is a new line of bone strengthening drugs called bis-phosphonates that are quite effective. Consult your Physician /Gynaecologist for help.
For vaginal dryness and repeated urinary problems use a local gel lubricant and if worse request an Oestrogen cream or pessary from your Physician.
It is always better to discuss your individual risks and benefits with your Doctor who has your medical records at hand. It is easy to get overwhelmed by recommendations or scare stories from friends and family. As with most medicines, one size doesn’t fit all.
There are many popular 'natural' remedies that are sold for peri-menopausal symptoms. Some are dietary modifications such as using soy ( soy milk, soy cheese, soy yogurt) and Flaxseed ( a sprinkling of about 25 gms on breakfast cereal should do) which are worth a try.
There are others sold as benefiting menopause such as Gingko Biloba ( see the full article on the benefits and dangers of Gingko here) and Black Cohosh ( Frankly there are too many reported risks and side effects to this so I wouldn't recommend it at all).
The evidence to support them are at best anecdotal. As these fall under the category of supplements they do not have to go through the same regulatory framework as prescribed drugs.
So while the word 'natural' sounds attractive and promising, the true fact is there is no consensus over dosage, the source where they come from and whether they exist in the form they are supposed to be. There are anecdotal benefits to many of these remedies but as menoipausal symptoms fluctuate it is hard to say whether they work or not. Other word of caution is that thye can also interact with existing prescribed drugs and can make other diseases worse, so always contact your Physician before choosing to take any of these.
© 2010 Mohan Kumar