“Menopause” in a page

Dr Katie Allen sitting with her dog on her lap in hot pink pants

“Menopause” in a page’(if you print it with narrow margins!)

Definitions around menopause

Menopause is one day of your life, 12 months after your period
Perimenopause is the time leading up to this
Post-menopause is the rest of your life, after the day of menopause
The phrase ‘going through menopause’ is what most people use, including doctors, to describe the time when menopausal symptoms affect a woman. This can encompass up to a decade on either side of menopause and for some women the rest of their lives.

The symptoms of perimenopause and beyond

The most common symptoms doctors see are hot flushes, or simply feeling warmer than expected, insomnia, and mood changes. Many women describe this as rising to anger faster or being irritated by things you can normally allow to slide. Or perhaps just being more emotionally reactive than usual. Brain fog or forgetting nouns and loss of concentration is extremely annoying for women and can have a debilitating effect on their ability to work at a consistently high level. Loss of libido and increasing aches and pains are also problematic. Abdominal weight gain is another issue that confronts women.
Longer lists can be found on the internet using the resources below.

Considerations before HRT

As always maintain or improve lifestyle factors. This will not only reduce the level of hormones required but will set you up for the rest of your lives. Diet may need to be tidied up beyond what maintained a healthy weight prior to menopausal symptoms, and work-life balance with women having time for themselves is equally important.
A family history of breast cancer needs to be addressed but is not a direct contraindication. A personal history of breast cancer does not always exclude HRT but is something that definitely needs to be discussed on an individual basis with specialists involved.
A family history of heart disease, osteoporosis, dementia, and autoimmune diseases are reasons to consider HRT, even without symptoms, though it is never essential.

History of menopause

Women who live long enough, have been going through menopause since humans arrived on Earth. So why is there a sudden fuss? Mostly it is a lifestyle change. We now live in a world full of toxins, many of which disrupt our endocrine systems so this can worsen menopausal symptoms. We are also expecting ourselves to work at a frenetic pace day in and day out at an age when our ancestors had stopped working and took on nurturing and educational roles in the community. And as we have children later in life women are often caught between aging parents and teenage or younger children that need attention, whilst the equality of males and females has often not quite kept up the pace in this area of care. Then we have hundreds of years of males overseeing medicine and not understanding the impact of menopause on women. We also lost many of the ‘witches ’ or wise women who did know how to treat menopause over the same period. Hence, menopause as a lifestyle disruptor is only starting to come out of the closet now.

History of HRT   for menopause

Despite the potted history above, HRT was the standard of care for a while, in women who had dreadful symptoms. Until the WHI study in the late 1990s. Whilst we did gain data that is still relevant today, most of the information, when reanalysed and viewed through current standards, is no longer applicable. We now use different compounds and would start HRT in perimenopause or close to menopause. This almost negates the breast cancer risks and CV risks reported, leaving only positive benefits if we use body/bioidentical products.

Definitions of bioidentical and body-identical hormones

Both body-identical and bioidentical describe compounds that have the same structure outside as inside the body. The simplest difference is in the preparation. Bioidentical hormones started to gain popularity when there was no alternative commercial product. These are preparations made by compounding chemists. This means the quality is not controlled by a government body, it is at the discretion of the individual chemist. The term body identical came into existence to try and distance commercial products from chemist-made products. For more detailed information click here.
The main concept to be aware of is that oestrogen must be applied topically to remain either body or bioidentical. Oestrogen does exist as tablets and will help alleviate symptoms but comes with greater risk profiles and fewer long-term health benefits.

PBS

Unfortunately, the PBS is a slow lumbering system that tries to save money for the public whilst subsidising beneficial medicines at the same time. It has been run by men for many decades previously. We can access oestrogen as a patch or sachet of gel on the PBS, however, we cannot access body-identical progesterone on the PBS. Cheaper synthetic progesterones do protect the lining of the uterus but have no protective effect on the brain, unlike body-identical progesterone. As uterine protection was the historical reason for prescribing progesterone, it may be some time before we see the gold standard of body-identical progesterone added to the PBS.

How long to take HRT  for menopause?

The International Menopause Society recently stated HRT can be taken as a lifelong medication. The Australian Menopause Society is currently (2024) reviewing their guidelines, and hopefully will issue the same statement.
Currently, HRT treatment times are an individual choice and can be used short or longer term, as a woman decides. Some choose HRT only whilst they are having fluctuating hormones, others feel better on HRT and choose to continue into later life.

 

Resources Around Menopause

Australian Menopause Society – has good fact sheets and does look at things like endocrine disruptors.

Dr Lousie Newson – UK doctor who advocates very much for HRT. She has podcasts, social media accounts, books, and an app. So take your pick. Good information in lots of forms.

Dr Libby Weaver is a nutritional biochemist – A great book called Rushing Woman Syndrome. Also available as an audiobook. This is more about our habits and lifestyle factors. Put it on in the car and make everyone listen.

Dr Ginni Mansberg is an Australian GP and has written The M word. It’s an easy guide to menopause if you prefer a book or an audiobook!

Dr Mary Claire – thepauselife.com – has great Instagram messaging if that’s your thing. She has backed this by a really good website full of resources. She is a US gynaecologist.

Dr Felice Gersch is another US gynaecologist who does lots of teaching and courses. She can explain complex things in an easy way which is always a bonus. She covers PCOS through to healthy aging without hormones which is why she is recommended for those wanting more in-depth knowledge.

There are heaps of other great resources out there, these are just the ones that come to mind just now and come in a wide variety of forms, not just fact sheets!