Man­ag­ing menopause:

Pro­fes­sor Ker­ryn Phelps re­veals her menopause jour­ney and the lat­est ad­vice on HRT, herbal medicines and other med­i­ca­tions for re­liev­ing symp­toms.

Australian Women’s Weekly NZ - - NEWS -

how to ease the way

Imag­ine the mo­ment I saw the films of my own lung scans placed up on the light box in the spe­cial­ist’s of­fice. Be­cause of my years of ex­pe­ri­ence as a doc­tor, I did not need to be told the re­sult, or read it in a re­port. Spon­ta­neously and un­char­ac­ter­is­ti­cally, tears be­gan to roll down my face. Blood clots. All through my lungs. Within min­utes, an emer­gency trol­ley had ar­rived and I was sur­rounded by a team of in­ten­sivists and physi­cians, an oxy­gen mask ap­pear­ing as a can­nula was inserted into a vein in my arm. I re­mem­ber feel­ing as though I was ob­serv­ing all the drama from a dis­tance. It wasn’t re­ally hap­pen­ing. This must be a mis­take. The de­nial phase passed fairly rapidly as I was wheeled into the in­ten­sive care unit. The thoughts go­ing through my mind bounced be­tween sheer ter­ror and a strange sort of faith in di­vine pro­tec­tion.

I was given two strong pieces of ad­vice in the fol­low­ing days: ex­er­cise ev­ery day, no mat­ter what. And when you get to menopause, you won’t be able to use hor­mone re­place­ment ther­apy (HRT). As you can imag­ine, that led me on a path of look­ing for ev­i­dence for man­ag­ing menopause when the time came. And when it did even­tu­ally come, it was a night­mare. I be­came my very own one-woman med­i­cal ex­per­i­ment.

HRT – the easy fix?

Un­til the early part of this cen­tury, man­ag­ing menopause seemed like it had be­come a very easy prospect. Whether you had symp­toms or not, you took hor­mone re­place­ment ther­apy (HRT). Sim­ple. Not only were we told that HRT would de­lay the age­ing process and pre­vent hot flushes, but it would allegedly pre­vent heart dis­ease, es­pe­cially in smok­ers. It would pre­vent the on­set of de­men­tia. It would save the in­con­ve­nience and em­bar­rass­ment of in­con­ti­nence.

Well, as it turns out, it does fix hot flushes, but at what cost? Was it the fix-all that we had been promised? If ever there was a case of sci­en­tific ev­i­dence be­ing mis­in­ter­preted and rein­ter­preted, and the med­i­cal pro­fes­sion swing­ing from one view to the other and back again, the saga of hor­mone re­place­ment has to be it.

When it did come, it was a night­mare.

Stud­ies set off alarm bells

In the midst of women the world over be­ing told that HRT was a way of im­prov­ing their long-term health, along came a cou­ple of huge tri­als called The Mil­lion Women Study and Women’s Health Ini­tia­tive, the re­sults of which claimed that HRT in­creased the rates of breast cancer and heart dis­ease. The rea­son the Women’s Health Ini­tia­tive was so im­por­tant was that it was the first time a large, good-qual­ity sci­en­tific trial took a close look at the long-term ef­fects of HRT.

The Women’s Health Ini­tia­tive study of more than 161,000 Amer­i­can women was cut short three years early when it iden­ti­fied a strong link be­tween the pro­longed use of com­bined oe­stro­gen and pro­gestin and in­creases in the risk of breast cancer, stroke and heart dis­ease.

In fact, as more long-term stud­ies emerged, it ap­peared that there was not much of a pos­i­tive thing to be said about HRT at all, ex­cept that it does help fix hot flushes and other symp­toms.

Un­der­stand­ably, women aban­doned HRT in droves. Gen­eral prac­ti­tion­ers were left to won­der what on earth to rec­om­mend for women com­ing to see them who had been plunged back into menopausal mis­ery with hot flushes, sleep­less­ness, ir­ri­tabil­ity, night sweats, de­pres­sion and anx­i­ety.

At first, women were an­gry that they had been mis­led, then they felt aban­doned. Many med­i­cal ex­perts were left with egg on their faces be­cause ev­ery­thing they had been claim­ing as fact was now start­ing to look like fake news. There were com­plaints by some doc­tors, claim­ing there were flaws in the stud­ies and that things were not nearly as bad as the me­dia re­ports were say­ing.

Where to now?

Mean­while, what were women to do as they ap­proached menopause or were forced to re­visit the symp­toms they thought they had con­trolled? There was a lot of con­fu­sion.

To­day, there is lit­tle con­sen­sus about the way for­ward for women try­ing to find safe, ef­fec­tive treat­ment op­tions. Many are left to trawl the in­ter­net and seek out a range of opin­ions, think about the risks and ben­e­fits, and then de­cide what is best for them.>>

“Symp­toms may dis­ap­pear af­ter a year or two.”

Fo­cus on life­style

Think of menopause as a re­minder that you are mov­ing into your mid­dle years. You are get­ting older and that means a re­newed fo­cus on life­style in prepa­ra­tion for your older years. The way you ap­proach your post­menopausal years makes all the dif­fer­ence to the qual­ity of your life be­yond that tran­si­tion.

How you cope with the symp­toms of menopause de­pends on how fre­quent and se­vere they are, and dif­fer­ent ap­proaches suit dif­fer­ent peo­ple, so you will need to do some trial and er­ror.

Herbs and sup­ple­ments

A va­ri­ety of herbal medicines can help the symp­toms of menopause. You will need the ad­vice of a health­care pro­fes­sional if you are ex­plor­ing this op­tion. Some ex­am­ples in­clude black co­hosh, red clover, dong quai and vi­ta­min E.

Pre­scrip­tion med­i­ca­tions

Some an­tide­pres­sant med­i­ca­tions are pre­scribed for hot flushes and mood prob­lems.

When other op­tions have been un­suc­cess­ful, HRT op­tions are avail­able. Cur­rent think­ing has shifted more favourably to HRT where it is needed. The gen­eral rule is to use the low­est ef­fec­tive dose for only as long as nec­es­sary. Symp­toms may re­duce or dis­ap­pear af­ter a year or two and are more per­sis­tent in some women. HRT comes in a range of com­bi­na­tions (usu­ally oe­stro­gen and a pro­gestin) and can be taken as pills, ap­plied as patches or in­jected as an im­plant.

If the main prob­lem is vagi­nal dry­ness, oe­stro­gen can be used top­i­cally as a cream. Newer op­tions in­clude com­pounded bioiden­ti­cal HRT (which has the same risks and ben­e­fits as other forms of HRT and may be in­ac­cu­rate or in­con­sis­tent) and mi­cronized pro­ges­terone.

As you can see, the de­ci­sion about the best and safest way to ap­proach menopause is not straight­for­ward.

You will need to spend time con­sid­er­ing what is best for you with ex­pert ad­vice.

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