October is Menopause awareness month.
If you’ve already reached menopause or going through it, you’re well and truly acquainted with the numerous symptoms that can beset you; unless you’re one of those lucky women who breeze through it. Go you!
So how do you know when you’ve reached menopause?
Our reproductive hormones change in our mid-30s, and most women in their 40s have entered the stage before menopause, called perimenopause, when most symptoms begin to occur. You’ve officially reached menopause when you have not had a period for 12 months.
So why do we need a month-long menopause awareness campaign?
If you’re yet to reach the pinnacle of female reproduction and the subsequent slippery slide down the other side, I’ve got news for you and why menopause awareness month is necessary.
Let’s start with a simple truth.
Menopause can be a lonely place, affecting every aspect of your life.
- It can hurt relationships as you struggle with moods ranging from depression to rage.
- Coping at work can become near impossible, and opening up to your employee, hoping they’ll understand and not be perceived as weak, seems futile as anxiety and other raging symptoms lead to what appears to be questionable performance and subsequent job loss.
- Your self-esteem can take a hit, and self-compassion goes out the window as you berate yourself after another emotional rollercoaster for your perceived inadequacies when in truth, it’s your reproductive hormones diminishing.
We, the women of the world.
With so much disruption to daily life, surely we deserve the medical world to be fully on board and support us at this significant time of life so that we can come out the other side thriving.
We, the women of the world, need greater awareness among medical professionals, better access to information and more scientific studies on the effects of hormone replacement therapy during perimenopause, menopause and post-menopause.
Seriously. We should expect nothing less.
Our doctor should know what we need once we enter perimenopause and help us become fully aware of the many symptoms we may experience once we reach menopause to help us navigate the travails and offer medical and holistic solutions.
But, of course, you might ask, surely, my doctor can help, and I’ll not be fobbed off? Well, to be honest, you might be dismissed. And, as I’ve been told, menopause is not an illness. Yeah, right. Thanks for the advice, Doc.
In the UK, MPs are calling for free menopause hormonal replacement medication and health checks beginning at 45.
Yay!! This cannot come soon enough. But will it happen? And what about the rest of the world? What about here in Australia? We have a long way to go, and starting a conversation with your doctor is a good place to start. However, if you’re feeling the need to get even rather than simmer with rage, you could lobby your local member of parliament.
It’s been a cold war since 2002.
In 2002 a major study on the effects of hormone replacement for perimenopausal and menopausal women came to a grinding halt after only 5.6 years, which meant most medical professionals promptly pulled their patients off HRTs.
But why? What happened? From the get-go, the trial was flawed, and when the results started coming in, they appeared to be alarming. Except the results were inconclusive, the reporting was misrepresented, and the media scaremongering began.
Unfortunately, the long cold war waged on hormone replacement therapy in 2002 left its mark, and here we are in 2022, still struggling to get help. Some medical doctors remain hesitant to prescribe HRT to women going through menopause.
Thankfully, even if at a glacial pace, there is change on the horizon, and well-versed medical professionals agree that hormone replacement therapy is beneficial for easing the symptoms of menopause and supporting women’s health issues as they age.
I reached menopause at 50ish and suffered my fair share of menopausal symptoms in the years that followed, some of which I’ve written about. You’ll find two articles which you may find interesting; the first discusses the frightening prospect of hair loss in women, and the other is about how menopause changes your skin.
When I was looking for medical support in 2010, few doctors were willing to prescribe hormone replacement therapy.
Too many risks, they said; the science was against it, they muttered.
Except, as we now know, the science and the reporting of that science were flawed and a generation of women who could have enjoyed the benefits of hormone replacement therapy went begging, myself included.
And it’s true; we were left begging. If you wanted an HRT any time after 2002, you needed to beg and plead with your doctor; worse, they handed over the script for an HRT without further advice or medical opinion!!
I remember not-so-fondly the young doctor who tentatively pushed the script towards me without any discussion.
“Oh, you want an HRT to help with insomnia? Errrr… Okay”.
This barely audible mumble hardly gave me the confidence to take the damn medication.
So many questions? So, few answers.
What was I taking? Horse urine? What should I expect? How will hormone replacement therapy help me? Should I take it, Doc? What do you think? Will I get cancer? What about heart disease and stroke? Will it help with my chronic insomnia?
Nope. Nothing. Ushered out into the great unknown, into the comforting arms of Dr Google.
So, naturally, the script was filled, but not one pill was taken. Sounding familiar?
And your doctor’s irritated when you mention Dr Google? Really?
Twenty years on. What now?
So, here we are 20 years later, and ever so slowly, the medical profession is coming around.
So, if you’re curious about hormone replacement therapy to battle the symptoms of menopause and your doctor is steering you away from HRTs, then find a new doctor or at least get a second opinion.
What can hormonal replacement do for you?
Hormone replacement is usually a combination therapy with oestrogen in either a transdermal patch or gel and progesterone, preferably micronised and is taken orally once a day.
HRT can help reduce hot flushes, vaginal irritation, sexual dysfunction, and urinary symptoms caused by menopause and will also help support bone and skin health.
It’s been said there are at least 34 reported menopause symptoms.
The most common symptoms of menopause include:
- hot flushes and night sweats
- mood changes
- sore breasts
- aches and pains
- dry vagina
- reduced sex drive
- itchy skin
- weight gain
Taking HRT within ten years of menopause can help with immediate symptoms such
as hot flushes, sexual dysfunction, and mood changes, and the long-term benefits can help your bone, skin, and heart health.
If you’d like to read more on thriving in menopause, I recommend the book by Dr Ginni Mansberg, The M Word. How to thrive in Menopause.
How long can you take it?
Most doctors well versed in hormonal replacement say you can remain on HRT indefinitely as long as you don’t have any medical conditions that preclude you.
Of course, you must discuss all this with a trusted medical doctor, as what’s right for one woman may not be suitable for another.
Your doctor will also recommend an annual health check-up, including a mammogram, to screen for breast cancer. Whether you’re taking HRT or not, you should get a yearly health check once you reach menopause.
Should you stop at 60?
Initially, my doctor told me she would not prescribe after 60; that was when I was 58. When I returned at 62, expressing concerns about my bone health after a bone scan, she did not hesitate.
So, I guess it’s a matter of weighing up the overwhelming positives versus the minor possibility of a negative outcome.
If you’re over 60 and have any issue with your heart health, then your doctor will probably not prescribe HRT, regardless of your bone health status. But again, this is something you must discuss with your doctor and weigh up your options.
What does oestrogen do for your skin?
Let’s get to what it can do for the health of your skin. Despite all my efforts to keep lines, wrinkles, blotchy pigmentation and sun damage at bay, I was disappointed to discover that once I reached 60, I would see a dramatic decline in collagen.
Collagen is the protein responsible for keeping the skin resilient and wrinkle-free.
So, where had my collagen gone? Well, oestrogen is essential in keeping your collagen robust, your elastin flexible, and your skin moisturised thanks to the role oestrogen plays within the hyaluronic acid matrix in the dermal layer of the skin.
Of course, you can slow down the visible signs of ageing with great skincare and other active ageing devices, and I wouldn’t suggest going on hormone replacement just for the sake of the collagen in your skin. Still, resilient, hydrated, healthy skin is a nice bonus among the other benefits. Right?
What about breast cancer?
Oestrogen is not the sole cause of breast cancer but can be the spark.
The lifetime risk of developing breast cancer is one in eight, which changes with age. Your risk at 40 will be different from when you’re 70.
HRT alone will not give you breast cancer.
It’s important to note that there may be other elements, such as lifestyle choices like alcohol and cigarette smoke or a genetic predisposition.
If you’re hesitating because, despite the minimal risk HRT poses, you are concerned about breast cancer? Let’s be clear. Alcohol consumption puts you at a considerably higher risk of breast cancer.
Even a moderate alcohol intake can trigger cancer, and the risk increases with each additional drink you consume.
And a word from the World Health Organisation on alcohol consumption and breast cancer.
Simply reducing alcohol consumption can significantly reduce the risks, says WHO/Europe. Copenhagen, 20 October 2021
Breast cancer is the most frequently diagnosed cancer type in the WHO European Region, with 1579 women diagnosed daily.
Alcohol consumption is one of the major modifiable risk factors for the disease, causing 7 of every 100 new breast cancer cases in the region.
During Breast Cancer Awareness Month, WHO encourages everyone to understand that the risk of breast cancer can be significantly reduced by simply reducing alcohol consumption.
If you’re hesitating because, despite the minimal risk of HRT poses, you are concerned about breast cancer? Let’s be clear. Alcohol consumption puts you at a considerably higher risk of breast cancer.
If you haven’t done so already, it might be time to have a big think about your relationship with alcohol.
Mood swings and depression?
I’ve always said menopause is liberating, and in many ways, it is. Not getting a period every month is bloody brilliant, pardon the pun, and no longer being at the mercy of a horror mood swing or the lunge into depression every 14 days is also blooming marvellous.
During the years of perimenopause, as well as hot flushes and night sweats, mood swings and depression can be debilitating and often under-diagnosed or diagnosed as depression, which it is, but without looking at the whole hormonal picture and whether HRT would be a better option leaves us with an incomplete diagnosis, making the subsequent treatment with anti-depressants alone, somewhat inadequate.
Muscle and Bone Loss.
The loss of oestrogen accelerates the decline in bone density and muscle mass.
A loss of bone density is a very real problem. It’s known as osteoporosis, and finding ways to reduce your risk will be one of the most important things you can strive for to minimise the risk of bone fractures and general fragility.
What about your muscles? Surely you jest? They were the first thing to go!
Along with bone loss, a loss of muscle mass will accelerate after menopause, so while oestrogen will help, you’ll have to work hard, building muscle with a good supply of healthy protein in your diet, and as the saying goes… use it or lose it.
Weight-bearing exercise will significantly improve your bone density and overall muscle mass.
If you don’t want to go to a gym, there’s a lot of help on Youtube. Just don’t overdo it if working out is new to you. Perhaps buddying up with a friend is a nice idea and keeps you motivated.
Sexual dysfunction, urinary incontinence and vaginal irritation.
Libido? What libido? You’re kidding, right? If a loss of libido and sexual function is a problem, you can either accept this as part of the ageing process or fight back with HRT or targeted oestrogen vaginal creams.
Regaining your libido, soothing vaginal irritation and enjoying a healthy sex life are worth fighting for, and no woman should suffer through urinary incontinence without medical advice and support.
More information on urinary problems can be found here.
Discuss your specific needs and desires or lack thereof with your doctor. I know this may all feel a little uncomfortable, but once you start talking about it, you’ll feel better knowing there are solutions. And, if your doctor is not listening, find a doctor who will.
My final thoughts?
Seriously, can I say it any louder? If you’re suffering symptoms of menopause, consider visiting your doctor and discussing hormone replacement therapy.
In 2022, there’s no need to be left off the oestrogen bus, and maybe it’s time to get on that bus and enjoy the ride into menopause.
Of course, a disclaimer. I’m not a doctor, but I am a post-menopausal woman, and I’ve spent a lot of time thinking about and researching menopause. HRT may not be suitable for you if you have a history of breast cancer or other medical conditions such as coronary heart disease, previous blood clots, uncontrolled high blood pressure or liver disease.
Even so, talk to a well-versed medical doctor who knows what’s what. Then, you can decide whether hormone replacement therapy is suitable for you or if other solutions will help relieve your symptoms.
If you found this article informative or helpful, please share it with the other women in your life.
See you next time,