Menopause the three stages of that ‘stage of life’ by Dr Robyn Stevens T he word Menopause is actually defined as “the final menstrual period”. In Australia, the average age of natural menopause is 50 years. The Peri- menopause is the time leading up to this. In real life, of course, you cannot know at the time as to which period is going to be your last one! So, menopause cannot definitely be said to have occurred until a woman has gone 12 consecutive months without a period. After the 12 months you are said to be in Post-menopause. Peri-menopause As the ovaries age, hormone levels (mainly oestrogen and progesterone) are fluctuating. One month they may be too low, the next too high! Sometimes they will just gradually decrease. Most of us have heard of the “classic” peri-menopause symptoms which include hot flushes, night sweats, muscle/joint aches, mood swings, irritability, insomnia and vaginal dryness. It is hard for anyone to predict who will get significant symptoms and how long they will last for. Only about 20% of women will get few or no symptoms at this stage. 25% of women will get severe hot flushes that considerably impact their daily life. About 50% of women will get sleep disturbance. About 30% will get significant psychological symptoms. If symptoms are concerning you, it is recommended you see your GP for a full check-up and to discuss management options. Lifestyle, dietary and stress management should be addressed. Becoming an informed patient will empower you to be able to make a decision that considers your individual quality of life benefits and the potential health risks. Menopause Hormone Therapy (MHT) MHT works very effectively to control perimenopause symptoms, especially 12 S E N I O R S O N T H E C OA S T hot flushes. In most women, benefits outweigh risks. HT also significantly lowers the risk of osteoporosis-related fractures. MHT is usually only needed for less than 5 years as in most cases the hot flushes have subsided by then. Unfortunately there are some women for whom MHT is contraindicated/dangerous and should not be taken – for example, women with clotting disorders or high thrombosis risk, and women with pre- existing hormone-sensitive cancers (eg breast or uterus). Recent studies have cleared up some misconceptions about MHT: MHT does NOT cause weight gain There is NO significant increase in breast cancer risk if combined MHT is used for less than 7 years. MHT does NOT increase the risk of heart attack in previously healthy women. Oestrogen – only MHT (used in women who have had hysterectomy) does NOT increase risk of breast cancer (even after 20 years). Body-identical vs Bio-identical A number of women express an interest in using “natural hormones”, often handmade, compounded products in the form of troches, creams and pessaries. These are typically called “Bio-identical HRT”. However, the lack of quality control and testing has led the International Menopause Society to instruct their members not to recommend these. On the other hand, “Body-identical” hormones are compounds that have exactly the same structure as hormones that are produced in the human body. They are of pharmaceutical grade quality and safety has been tested in controlled trials. Up until 2016, no Body-identical progesterone was available in Australia, and all prescribed combined MHT (oestrogen plus progestogen) contained a synthetic progestin. Body-identical “In Australia, the average age of natural menopause is 50 years.” (micronized) progesterone is superior to synthetic progestins in terms of safety profile and side-effects (a number of women are sensitive to synthetic progestins). It has been available in this country since 2016 however it is more expensive. Talk to your doctor about your options. Post-menopause Over 50% of women will get genitourinary (vaginal, vulval, urine) symptoms. These may not present until later (after the hot flushes have finished), or may present in women who had very mild or even no hot flushes at all. Low hormone levels can lead to vaginal and vulval dryness and itching, irritation and soreness. Vaginal lubrication takes longer. Sex can become painful. There may be some pelvic organ prolapse, urinary incontinence or recurrent urinary infections.