Manag­ing Menopause / A med­i­cal insight with Dr Anna Fen­ton and Dr Nikki Carey

Latitude Magazine - - Contents - WORDS Claire Ink­son

When it comes to women’s health, no topic is more shrouded in mystery and con­fu­sion than menopause. Some­thing the team at Ox­ford Women’s Health have been work­ing hard to change.

The de­crease in hor­mones as­so­ci­ated with menopause can play havoc on our bod­ies, both emo­tion­ally and phys­i­cally, but Dr Anna Fen­ton, a renowned gy­nae­co­log­i­cal en­docri­nol­o­gist, and Dr Nikki Carey, a GP with over 25 years’ ex­pe­ri­ence (21 years of which have been spe­cial­is­ing in women’s health­care) are de­ter­mined that women should be armed with ac­cu­rate in­for­ma­tion and know the treat­ment op­tions avail­able so they can man­age menopause in the best pos­si­ble way for them. ‘I am pas­sion­ate about mak­ing sure that women are aware they have choices,’ Dr Fen­ton says.

‘Women want knowl­edge,’ Dr Carey says of menopausal women, ‘knowl­edge is power. If they have knowl­edge, they can man­age it.’

Menopause it­self is de­fined as the time in a woman’s life when a de­cline in the hor­mones oe­stro­gen and pro­ges­terone lead to a grad­ual de­crease in the fre­quency of her men­strual pe­ri­ods, and when those pe­ri­ods have been ab­sent for 12 months con­sec­u­tively, then a woman

is no longer ovu­lat­ing and has en­tered menopause. The av­er­age age for women reach­ing menopause is 51, but the stage prior to this, called ‘per­i­menopause’ usu­ally be­gins around the mid-for­ties, and can last 6–10 years. Per­i­menopause can be­gin as early as a woman’s mid-thir­ties, with around a third of women aware of symp­toms at that age. Per­i­menopause it­self comes with its own chal­lenges. In its early stages, it can present it­self as sleep­less nights and height­ened anx­i­ety, symp­toms which can be eas­ily over­looked or mis­di­ag­nosed in GP vis­its. As the fre­quency of a woman’s men­strual cy­cle de­creases or be­comes more er­ratic, pe­ri­ods can be­come heav­ier and prob­lem­atic. Hot flushes and night sweats can also be­gin around this time, as well as vagi­nal dryness, loss of li­bido, and aches and pains. Longer-term ef­fects can include an in­creased risk of heart dis­ease and os­teo­poro­sis.

Symp­toms can vary from woman to woman, as can the age of menopause com­menc­ing. Some women glide through menopause al­most symp­tom­free, while for oth­ers, with­out treat­ment, menopause can hinder their qual­ity of life significan­tly. How a woman will ex­pe­ri­ence menopause in­di­vid­u­ally is dif­fi­cult to pre­dict. ‘The younger a woman is when she hits menopause, the worse the symp­toms are,’ Dr Fen­ton says. ‘We know that ge­net­ics of menopause are prob­a­bly only rel­e­vant to the age of menopause – it does tend to run in fam­i­lies, but the ex­pe­ri­ence is en­tirely per­sonal to that woman, so we can’t

Some women glide through menopause al­most symp­tom­free, while for oth­ers, with­out treat­ment, menopause can hinder their qual­ity of life significan­tly.

pre­dict it. The things we do know that make menopause worse is that if it hap­pens sud­denly – if a woman has had surgery to the ovaries, and they have been re­moved, or she has had can­cer treat­ment such as chemo­ther­apy where the ovaries have died, that tends to make the symp­toms worse. Ge­net­ics have an ef­fect, and smok­ing has an ef­fect.’

While all this can seem more than a lit­tle daunt­ing, menopause can be man­aged ef­fec­tively with hor­mone pre­scrip­tion and com­ple­men­tary treat­ments, and by seek­ing guid­ance from health pro­fes­sion­als spe­cial­is­ing in hor­mone (known as the endocrine sys­tem) and gy­nae­co­log­i­cal and menopausal is­sues. They have upto-date knowl­edge of what op­tions are avail­able, and can work with you for a treat­ment plan that works best for you as an in­di­vid­ual. Hor­mone Re­place­ment Ther­apy (HRT) is per­haps the most well-known treat­ment for menopause, and is now known as Menopause Hor­mone Ther­apy (MHT).

MHT is de­signed to coun­ter­act menopause symp­toms by pro­vid­ing low doses of the hor­mone oe­stro­gen, or, in the case of women who have not had a hys­terec­tomy, oe­stro­gen com­bined with pro­ges­terone (com­bined MHT) to pre­vent the uter­ine wall from thick­en­ing. MHT can be taken as a tablet daily, a patch, or daily gel, or vagi­nally as a tablet, cream, pes­sary or implant. HRT has had its share of con­tro­versy, much of which stemmed from a study known as the Women’s Health Ini­tia­tive (WHI) that was hastily re­leased in 2002, which cited an in­crease in breast can­cer and stroke in women tak­ing MHT. The study has since been found to have been flawed and open to mis­in­ter­pre­ta­tion. ‘There has been an enor­mous amount of con­tro­versy around MHT over the last 20 years,’ Dr Fen­ton says. ‘It would be nice to put some of that into con­text.’ The fi­nal data from the WHI showed a 20–25 per cent de­crease in breast can­cer di­ag­no­sis, and 45 per cent de­crease in mor­tal­ity, with estro­gen-only MHT. No in­crease was seen among women tak­ing com­bined MHT for up to seven years.

The du­ra­tion a woman is on

MHT, as well as the age at which she com­mences treat­ment, are risk fac­tors. To pro­vide per­spec­tive though, life­style fac­tors can have a sim­i­lar in­crease in risk of breast can­cer: 2–3 units of al­co­hol per day is thought to in­crease risk by 1.5 times, and while post­menopausal obe­sity will in­crease risk by 1.6 times, most of us who would feel ner­vous about MHT would still hap­pily reach for wine and choco­late. The study found there is no in­crease in heart dis­ease with any MHT in women of any age. In fact MHT halves the risk of heart dis­ease for women within 10 years of menopause. Risks of stroke have been found to in­crease in women over 20 years post-menopause in the first year of MHT use, but oth­er­wise risks are min­i­mal. MHT is cer­tainly not thought to be suit­able for ev­ery woman but is an op­tion that women should con­sider ex­plor­ing un­der the guid­ance of a health pro­fes­sional. In many cases, the benefits far out­weigh the risks.

There are com­ple­men­tary ther­a­pies avail­able as well, pro­vid­ing op­tions for women who can­not take MHT, or whose symp­toms are milder in na­ture. These ther­a­pies include hyp­no­sis, re­flex­ol­ogy and acupunctur­e, as well as ex­er­cise such as yoga, and var­i­ous over-the-counter sup­ple­ments. ‘There are clear benefits from hyp­no­sis, there are clear benefits from cog­ni­tive be­hav­iour ther­apy and mind­ful­ness,’ Dr Fen­ton says. ‘In terms of what peo­ple can buy over the counter – Wild Yam doesn’t work. Maca is an ex­tract used

‘The younger a woman is when she hits menopause, the worse the symp­toms are,’ Dr Fen­ton says.

quite widely, par­tic­u­larly in Asia, for menopausal mood is­sues and again, there is rea­son­able ev­i­dence sup­port­ing that. St John’s wort does have an ef­fect, and in­ter­est­ingly it does have a chem­i­cal struc­ture that is vir­tu­ally iden­ti­cal to Prozac, but the flip­side of that is that be­cause it is phar­ma­co­log­i­cally ac­tive, it does in­ter­act with quite a range of pre­scrip­tion medicines, so it’s very im­por­tant that a patient who is tak­ing it dis­cusses it with a doc­tor.’

Dr Carey rec­om­mends that reg­u­lar ex­er­cise, main­tain­ing a healthy body weight and fol­low­ing a healthy diet sim­i­lar to the Mediter­ranean diet will help symp­toms, and over­all health. ‘There is good ev­i­dence,’ says Dr Carey, ‘that when we ex­er­cise to lev­els that the Health De­part­ment in New Zealand rec­om­mends, we ei­ther tol­er­ate the mood swings and hot flushes of menopause bet­ter, or we get less symp­toms.’ Although Dr Carey al­ways works through di­etary and life­style fac­tors with patients first, and be­lieves that life­style fac­tors are vi­tally im­por­tant, life­style changes alone of­ten aren’t enough to al­le­vi­ate menopausal symp­toms, and Dr Carey still cites MHT as the most ef­fec­tive treat­ment, work­ing along­side a healthy life­style. ‘It does an in­cred­i­bly good job,’ she says.

What­ever route women choose to nav­i­gate their jour­ney with menopause more com­fort­ably, with the treat­ment op­tions avail­able, and med­i­cal pro­fes­sion­als like Dr Fen­ton and Dr Carey on hand to help guide women in the di­rec­tion best suited for them, there is no need to fear menopause, and no need for women to suf­fer. The fu­ture for menopausal women looks a lot brighter.

Dr Carey rec­om­mends that reg­u­lar ex­er­cise, main­tain­ing a healthy body weight and fol­low­ing a healthy diet sim­i­lar to the Mediter­ranean diet will help symp­toms, and over­all health.

HEALTH & WELL­BE­ING

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