Menopause

As women age, so do their ovaries. Function gradually declines, and eventually stops — along with periods. This results in hormone deficiencies which cause a range of symptoms, as well as increasing future health risks.

Before.

During reproductive years, the ovaries produce eggs and a steady supply of 3 hormones - estrogen, progesterone and testosterone.

During the menstrual cycle there are predictable variations in these hormones that result in ovulation (egg release) and periods.

As well as being essential for fertility, normal levels of these hormones are also important for heart, brain, skin and bone health.

During.

Usually when women are in their 40’s (although it can happen much earlier) hormone production from the ovaries starts to fall and levels may fluctuate erratically.

Women begin to experience symptoms including changes in mood, sleep, memory or libido. Many also suffer from hot flushes, joint pain, fatigue, palpitations, vaginal dryness or migraines. This can put a strain on work, family life, and relationships.

During this time (known as the peri-menopause) women still have periods, but they may become heavier, lighter or irregular. Egg release becomes less frequent, although it is still possible to become pregnant during this time.

Eventually (up to 10 years after the start of peri-menopause) the ovaries will stop working. They no longer produce eggs and hormones stay low. Periods stop, and when they’ve stopped for 12 months it’s called the menopause.

For most women menopause occurs around age 51, but it may occur later or much earlier - one in 100 women are under 40.

After.

Once the menopause is reached, a women enters the post-menopausal phase. Hormone levels remain low and these hormone deficiencies have significant health risks.

If left untreated, many women continue to experience menopausal symptoms, but also have an increased risk of heart disease, osteoporosis, osteoarthritis, diabetes, depression, bowel cancer and dementia.

Symptoms.

Could you be suffering from symptoms of the peri-menopause or menopause? Ask yourself the following questions:

If you’re in your 40’s (or older), and answered yes to any of these, it’s very possible that you are experiencing low or fluctuating hormone levels. Younger women can also experience symptoms - approximately 1 in 100 women go through the menopause under 40.

Most women (8 in 10) will experience symptoms related to their falling hormone levels. Symptoms typically last around 4 years after the last period, but in 10% of women will continue for up to 12 years.

Hormone replacement.

The most effective way to treat symptoms of the menopause, and protect future health, is to replace (i.e. “top up”) the hormones that women become deficient in.

This is called hormone replacement therapy; “HRT” (or Menopause Replacement Therapy; “MRT”) and it works the same way as giving thyroid hormone to someone with low thyroid function.

HRT.

HRT is safe for most women, and can be taken indefinitely.

The hormones used are “body-identical” which means they are exactly the same as the hormones your ovaries produce. They are naturally derived from a vegetable (the yam).

HRT replaces estrogen and (if needed) progesterone. Many women also benefit from replacing testosterone.

Estrogen

Well known as an important female hormone, estrogen (also spelt oestrogen) acts all over the body reducing many menopause symptoms. It also keeps bones strong and improves heart and brain health. It can be taken through the skin (as a gel, spray or patch) or as a tablet.

Progesterone ­

Progesterone protects the uterus (womb) lining by stopping it from growing too thick. It’s not usually needed after a hysterectomy. Body identical progesterone is taken as a tablet, but if contraception is needed (HRT is not a contraceptive) a mirena coil is often used instead.

Testosterone

Usually thought of as a male hormone, women produce testosterone too. In fact, pre-menopausal women produce 3 times more testosterone than estrogen.

Testosterone is available as a cream, and may be added to HRT after a few months if women still experience symptoms such as fatigue, brain fog and lack of libido.

Benefits.

Using HRT to top up low hormones is an effective way to reduce menopause symptoms, but it’s also important for protecting future health.

Taking HRT lowers the risk of heart disease, osteoporosis, osteoarthritis, diabetes, depression, bowel cancer and dementia. For this reason, it’s important for most women to continue HRT after the menopause, even if they no longer have symptoms.

Risks.

Have you heard that HRT causes breast cancer or blood clots?

Unfortunately, in the past, HRT has been incorrectly labelled as dangerous. This is a result of misinterpreted data and overstated risks (mostly related to old types of HRT).

As a result, many women have been worried about taking it and suffered with symptoms and increased risks to their health.

For almost all women, the benefits of HRT far outweigh any risks.

Breast cancer

Breast cancer is common, so it’s understandable that women are concerned about increased risk. It affects 1 in 8 women, regardless of whether they take HRT.

The increased risk is associated with HRT that contains a synthetic oral progesterone, and is very small - similar to taking the contraceptive pill, or drinking one large glass of wine per night. This risk is reduced further by using body identical (micronised) progesterone, or a locally acting mirena coil.

Studies have shown that there’s no increased risk of breast cancer in women taking micronised progesterone for the first 5 years. Importantly, HRT does not increase the risk of dying from breast cancer.

Being above a healthy weight and not exercising increases your risk of breast cancer far more than the potential risk from HRT. Many women who take HRT find it easier to lose weight and are more motivated to exercise. HRT also reduces the risk of cardiovascular disease - the most common cause of death in women (including in women who’ve had breast cancer).

Women taking estrogen only HRT actually have a reduced risk of breast cancer.

Blood clots

Using HRT that delivers estrogen through the skin (in a gel, spray and patch) does not increase the risk of blood clots and is the preferred way to give it. Giving estrogen as a tablet is associated with a small increased risk of blood clots, similar to the contraceptive pill.

Bio-identical HRT

Some women are given “bio-identical” or “custom compounded” hormone replacement products which usually come in the form of (often expensive) lozenges, pessaries and creams.

Although symptoms may improve for some women, the benefits of these products have not been proven in scientific studies.

Unlike “body-identical” HRT described above, these products are unregulated. This means they are not manufactured under the same strict conditions or required to undergo rigorous testing to confirm purity and effectiveness.

There are safety concerns associated with potential contamination, as well as underdosing of progesterone which can increase the risk of endometrial (womb) cancer.

For this reason, these products are not recommended or endorsed by menopause societies or specialist doctors. “Body-identical” HRT is a safe and effective alternative.

What else?

For women unable to take HRT, or those who choose not to, there are other options which can help to reduce symptoms of the menopause and protect future health.