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