Menopause is a normal part of the ageing process, it is not an illness or a disease and all women will go through it at some point in their lives, and yet it still remains a taboo subject, surrounded by mystery and secrecy. Peri-menopause is the time where our ovaries begin to slow down and periods may become irregular and menopausal symptoms such as hot flushes and poor sleep begin. After you have gone a whole year without a period, you can say you have reached the menopause. This means you can no longer become pregnant naturally.
The average age of the menopause is 51 years, and with life expectancy currently being 83 years, this means that many women may potentially spend a third of their life post menopausal.
HRT stands for hormone replacement therapy and is prescribed to women who are peri-menopausal to replace the hormones that their ovaries are no longer producing to elevate any symptoms they may be experiencing. However HRT also offers long term health benefits if taken for a minimum of 5 years including reducing the risks of osteoporosis, heart disease, dementia, bowel cancer and type 2 diabetes.
Many women ask for a blood test to diagnose if they are menopausal. For the majority of women over the age of 45 years, the latest NICE guidelines state that this is not necessary because they can show false negative or positive results. Therefore, blood tests are a waste of time and resources for the NHS. The blood test measures follicle stimulating hormone (FSH) which stimulates the ovaries to produce oestrogen. Therefore, HRT can safely be prescribed to the majority of women over the age of 45, based on symptoms alone.
Some women are fortunate enough to fly through their peri- menopause without any symptoms, or have symptoms so mild that they do not affect their quality of life. There is also a group of women who do not take HRT because they feel they should just simply manage their symptoms their selves. There is also a small group of women who are unable to take HRT due to other medical conditions. However, menopause care is not just about prescribing medication. It is
important to discuss the physical symptoms and alternative approaches to manage these. Diet, exercise, lifestyle advice as well as coping strategies to use in the home and in the workplace to enable you to have the best possible menopause are also a very large part of a menopause consultation.
Women have oestrogen receptors all over they bodies- in their hearts, their bones, their brains, their joints, their bladder, their vaginas and in their skin. Once they hit the peri-menopause and levels of circulating oestrogen fall, the menopausal symptoms begin. There are in fact 3 main types of oestrogen. Oestrodiol which is produced in our ovaries, oestrogen which is made after the menopause by the liver and oestriol which is produced by the placenta during pregnancy to protect the developing baby. Oestradiol is the dominant oestrogen and is used in body identical HRT in the form of 17 beta oestrodiol. This has been shown to be extremely safe and effective, especially if it is prescribed topically in the form of a gel or a patch and absorbed through the skin, rather than in tablet form where it is processed by the liver. If oestrogen is prescribed topically through the skin, it does not increase the risk of blood clots or strokes.
The primary role of progesterone is to thicken the lining of the womb to prepare for a fertilised egg, and most women produce this in cycles, with a rise in the levels at the beginning of the menstrual cycle to prepare the womb ready to accept a fertilised egg and so the levels drop later in the cycle if this doesn't occur. If a fertilised egg is implanted, progesterone levels continue to rise to protect the foetus.
The protective features of progesterone are required as part of HRT for women who still have a uterus (womb). If oestrogen is prescribed without progesterone, the lining of the womb would continue to thicken and this may very slightly increase your risk of developing problems in the future. Taking progesterone at the same time (known as combined HRT) completely reverses this risk. However, women who do not have a womb can safely be prescribed oestrogen alone.
Modern HRT preparations contains a body identical micronised progesterone made from wild yams and soya beans and is available in the form of a capsule called utrogestan. It is identical in structure to the progesterone our bodies make and there have been no reported increase in the number cases of breast cancer to date for women taking this type of progesterone.
Alternatively, a mirena coil can be used and this releases progesterone locally into the lining of the womb. It is also an effective form of contraception because some menopausal women are still fertile. HRT does not act as a type of contraception.
Testosterone is always regarded as a male hormone, but in fact women produce three times more testosterone than oestrogen before their menopause but much less testosterone than men. Testosterone increases your libido and also helps to improve energy levels as well as increase bone and brain health. While NICE guidelines recommend the prescribing of testosterone to women complaining of a low sex drive who have not responded to oestrogen alone, it is currently unlicensed in the UK. This does not mean it is unsafe, it simply means that the manufacturer has not specified prescribing it to women. Testosterone is usually given as a gel or a cream to rub topically into the skin. There are usually no side effects but it is important to monitor testosterone levels via regular blood tests. There is a testosterone cream available from Australia that is specifically developed for use by women and this is available via a private prescription. This can be prescribed after a consultation with Simply Menopausal if required.