Menopause

Western women can expect to live about 40% of their lives after menopause. But instead of being able to enjoy the freedom from periods, PMT and contraception worries, many women find that the 'change of life' menopause is more than a mere nuisance; it can severely disrupt their lives.

Symptoms can include

  • Hot flushes and night sweats
  • Menstrual irregularity and/or heaviness
  • Loss of muscle tone and elasticity
  • Vaginal dryness
  • Facial hair
  • Mood swings
  • Weight gain
  • An increased risk of cardiovascular disease.
  • Bone loss leading to osteoporosis

Understandably, women don't want to put up with these symptoms, and nor should they. Once women are aware of the reason for their bodily changes, they can take steps to avoid or reduce any unpleasant symptoms. During a woman's reproductive life, a cycle of hormone production takes place and while more than 20 hormones are involved, the main hormones are oestrogen, progesterone and testosterone.

However, a woman's reproductive life is programmed to eventually come to an end and during the period leading up to menopause, fluctuating blood levels of hormones can create the symptoms mentioned above.

By definition, menopause is said to have taken place when there are no periods for 12 consecutive months in a woman 45 or older. The majority of women throughout the world have their last period between 48 and 55, with the average age being 51. The good news is that women can now 'take charge of the change' more effectively than ever before.

There are basically two ways of dealing with the symptoms of menopause: hormonereplacement therapy (HRT) and 'natural' (or alternative) treatments.

Hormone Replacement Therapy (HRT)
HRT is a chemical formulation of oestrogen, progesterone and occasionally testosterone. It is only available by prescription from a doctor. HRT comes in various forms: tablets, patches and the newest form - a gel which is rubbed on the skin once a day. Implants or pellets of oestrogen are popular with women who have had a hysterectomy; these women can see the doctor once a year, have an injection and not have to worry for another year.

According to Dr Susan Davis from the Jean Hailes Foundation in Melbourne, HRT is the only treatment which will help women with severe menopausal symptoms, such as frequent hot flushes causing embarrassment, waking up at night drenched with sweat, or depression.

Another benefit of HRT is its usefulness in maintaining and developing normal bone strength and therefore preventing osteoporosis which is linked to a fall in oestrogen levels. Both men and women with a low oestrogen level are prone to osteoporosis.

Another undisputed fact is that women are more prone to heart disease after menopause. It is thought that the oestrogen in the body prior to menopause prevents hardening of the arteries. The medical profession is divided, however, as to whether pharmaceutical HRT can prevent heart disease in women. Some studies have shown that women on HRT have on average 50% fewer heart attacks and strokes.

In contrast, though, Professor John Eden from the Royal Hospital for Women in Sydney says that so far, only one reliable scientific study has been done and this showed no effect at all on the prevention of heart disease. On balance, it appears HRT can lower the risk of heart disease, but whether it is wise to initiate oestrogen therapy in women who have heart disease is not clear. This is something women should discuss with their doctor.

While HRT has been available for more than 30 years, women are still concerned about possible short and long-term side effects. Nausea, breast tenderness and unwanted bleeding are nuisance side effects of HRT. If women do experience these or any other symptoms while using HRT, they should advise their doctor. HRT is available in various formulations and the first prescription they try might not suit them. There is increasing evidence that a very low dose of oestrogen can still provide the benefits without the side effects.

Does HRT increase a woman's chance of getting cancer? Some studies show that women on HRT suffer 20-40% fewer deaths from some types of cancer. However, others have shown an increased risk of breast cancer with HRT. On balance, the latest evidence indicates that there may be a very slight increased risk of breast cancer in some women taking HRT compared to women not taking it. On the other side of the coin, women taking HRT are much less likely to die as a result of any cancer which is diagnosed. Another positive new development with HRT suggests that long-term use can reduce the incidence of dementia.

'Bio-identical' HRT
A form of HRT which many women are asking about is 'bio-identical HRT'. This form of HRT refers to plant-based (as opposed to synthetic) preparations which on a molecule level are similar in structure to the hormones women make themselves. Manufactured from soybean extract, these preparations are 'tailor-made' to the individual woman. Just like pharmaceutical HRT you can't buy it over the counter; 'bio-identical' HRT must be prescribed by a doctor.

Richard Stenlake is a compounding chemist and one of the few pharmacists skilled in dispensing bio-identical HRT. Compounding allows a chemist to formulate medicine to meet patient's specific needs. In the case of HRT, Stenlake uses a form of oestradiol where the dose can be modified for the specific patient. This is not available in the conventional forms of HRT, as it is not commercially viable for drug companies to make several strengths of one drug - the three oestrogens, or specifically oestradiol.

Richard Stenlake creates individual formulations to suit each woman's particular hormonal deficiencies. They are a combination of oestrogens, progesterone and testosterone which are compounded in identical formulations as the hormones in women's bodies. Most of his formulations are prescribed in troches (lozenge) form. He says this means they go straight into the bloodstream, bypassing the stomach and aiding absorption. He occasionally uses gels. Some in the orthodox medical community are sceptical about this form of HRT. Dr Susan Davis from the Jean Hailes Foundation says that the only difference between 'natural' HRT and 'synthetic' HRT is that the latter have undergone some additional steps in a laboratory to modify their chemical structure in the body. Richard Stenlake says the orthodox medical community may be sceptical due to a lack of clinical trial information about bio-identical HRT. Since pharmaceutical companies cannot patent naturally-occurring substances such as soy, they are reluctant to fund any research into their effects.

For further information about bio-identical HRT, contact:
Richard Stenlake, Compounding Chemist
169 Oxford St
Bondi Junction NSW
Ph: 02 9387 3205

Natural Or Alternative Therapies
The word 'natural' is powerful. Most people think that if something is 'natural' it can only be good for you - or at the very least, not harmful. However, there are some issues about the use of 'natural' treatments for menopause which should be addressed. For example, unlike synthetically produced HRT which has to undergo rigorous clinical trials, natural forms of HRT don't. Having said that, many experts believe natural therapies do have a role to play in managing menopausal symptoms, although they aren't yet proven.

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