Menopause

What is menopause?

Menopause or “change of life” happens when all the eggs in the ovaries are depleted. It describes physiological and psychological changes related to a lack of ovarian hormones.

How do I know I’m menopausal?

A woman is considered menopausal when she has not had any periods for over 12 consecutive months. Most women become menopausal between 45 and 55 years of age.

What is surgical or medical menopause?

This describes the condition after both ovaries are surgically removed before the onset of natural menopause, and after certain medications are used to stop ovulation (such as in cancer treatment, or in cases of endometriosis treatment).

What are menopausal symptoms?

Physiological symptoms are:

• Hot and cold flushes
• Night sweats
• Dry skin
• Vaginal dryness
• Urinary urgency
• Loss of libido
• Sleeping difficulties
• Increased risk for cardiovascular disease
• Osteoporosis

Psychological symptoms:

• Mood swings and anxiety
• Irritability
• Forgetfulness
• Trouble concentrating

Does everyone develop menopausal symptoms?

Some women develop menopausal symptoms years before menopause, some afterwards, and some women never develop any symptoms.

What can I do to relieve symptoms?

• Lifestyle modifications: healthy diet, exercise, smoking cessation.
• HRT
• Herbal or alternative remedies

Can I use HRT?

If you have distressing menopausal symptoms and no contraindications for the use of HRT (personal history of hormone dependent cancers, thrombophilia or previous VTE/PE, undiagnosed vaginal bleeding, uncontrolled hypertension or stroke) you can use HRT. There are risks associated with HRT and you need to discuss those risks with your doctor and how they apply to you. If you decide to start taking HRT you need follow up with an assessment of the efficacy and side effects of HRT. We recommend a minimal efficient dose of HRT. Once this is established, you need annual check-ups with your GP to assess for the development of cardiovascular disease or breast cancer.

How long can I be on HRT?

There is no time limit to the treatment. As long as there are no contraindications for continuing HRT you can stay on HRT as long as you need. You can try to stop using HRT every few years to see if symptoms recur.

What risk does HRT carry?

There is evidence that estrogen therapy can be protective against cardiovascular disease if started at the onset of menopause but may be harmful if started over 10 years after onset.
Risk of stroke is correlated with age (rare event before age of 60 years) however HRT increases that risk significantly only after 60 years of age. Furthermore, this risk is related to oral HRT; use of low dose transdermal estradiol does not increase risk of stroke.

Blood clots: oral HRT increased risk, but it does not affect mortality. Transdermal estrodiol may avert some of this risk.

According to recent studies starting HRT within 10 years of onset of menopause reduces risk of all causes of dying.

Cognitive aging: overall findings have not indicated any benefit or risk with use of HRT.
Risk of breast cancer is increased with use of HRT, however this risk is very small and is similar or even lower than that of risk of obesity, decreased physical activity or alcohol consumption.
Risk of ovarian cancer is increased with use of HRT; however this risk is even lower than risk of breast cancer.