My morning motivational message reminded me of the menopause so I decided I would dive into the topic and discuss it today.
Menopause is a hot topic at the moment, and it is great that the medical community is finally getting savvy about this as all women (51% of the population in England and Wales) go through this if they are lucky enough to make it to middle age. The average age of menopause in the UK is 51 years, however the symptoms of perimenopause often start at around 45 years of age. The medical definition of menopause is when you have not had a period for a whole year. The ovaries no longer release eggs and as a result the level of hormones start to fall.
Which hormones?
The main hormones that are affected by menopause are oestrogen (spelt "estrogen" if you are American), progesterone and testosterone. There are oestrogen receptors on every cell in the body and so when these levels start to drop everything can be affected. This means the list of symptoms experienced in menopause can be very varied between individuals and for some can be quite dramatic. Menopause is a natural process, not an illness, but those going through it can certainly feel as though something very bad is going on!
For every symptom there is a product. There are such a wide array of products and medicines available to help manage the symptoms, it can often feel very overwhelming! The most effective treatments are those designed to replace the hormones, known as HRT.
What is HRT?
HRT stands for hormone replacement therapy. Back in the 1940's scientists realised they could extract oestrogen from the urine of pregnant horses. They called this product "Premarin" which was short for "pregnant-mare-urine". This was used as an early version of HRT for many years, and while it provided a lot of the symptom relief people were hoping for, it was also found to cause a big increase in endometrial cancer. Women were strongly encouraged to try and manage their menopause symptoms with more natural methods such as healthy food and cold, wet flannels, with limited success.
However some women did continue to take it and research progressed and eventually it was discovered that taking the oestrogen with progesterone reduced the risk of this type of cancer. This was the beginning of our search towards safer HRT.
There was a big study called the Womens Health Initiative which started in the 1990's. Over many years this study showed that HRT caused increased risks of some types of cancer and blood clots, but lower risk of hip fractures, diabetes and dementia for women under 65. With this, and many other studies, plus the development of alternative preparations (that don't come from horses urine) we are in a much more knowledgeable position when it comes to HRT and have a lot more options.
Who should I talk to?
I know from speaking to my friends that when they started experiencing symptoms they went to their mums for advice first. It is only natural to seek guidance from the woman most people feel closest to, who you know will have gone through the same thing. Mothers are genetically very similar as well so it is likely that their experience is going to be similar to yours. However the options for HRT has increased dramatically over the years, and the risks associated with it have lessened as well. The advice they were given just does not apply today and so I would encourage anyone considering HRT to speak to someone at their GP practice in addition to your well meaning mother.
So what are the benefits?
Well, HRT aims to replace the hormones that are missing. The falling oestrogen levels cause unpleasant side effects, but they are also bad for our health. Replacing them with HRT can protect your future health from the bone-weakening disease known as osteoporosis, heart disease, type 2 diabetes, bowel cancer and dementia. All that plus improvements in sleep (by reducing the night sweats), mental health and more. For most women the benefits of taking HRT outweigh the risks.
Is it risky?
This largely depends on the individual, and the type of treatment. For example, blood clots can be a risk if using a tablet, but not with a patch or gel. HRT can increase the risk of breast cancer, but not by much, it is a similar risk to drinking a glass or two of wine each night.
Past illness and family history can make people more prone to certain side effects and complications so consult with your GP practice and they can take into account your individual medical history and advise on the best product for you, and let you know what your individual risks are.
As I mentioned earlier - for most women the benefits are greater than the risks and women who take HRT often lead longer, healthier lives.
What products are there?
There are lots to choose from, with tablets, patches, gels, pessary's and even the "coil" a device that is inserted into the uterus that releases progesterone for up to 5 years. If you try one type and it doesn't agree with you, or doesn't really provide the relief you need despite increasing up to the biggest dose, then there will likely be other options you can try.
What other lifestyle changes can I make?
Clearly HRT is only one part of the management of perimenopausal and menopausal women. Lifestyle recommendation regarding diet, exercise, smoking and alcohol consumption are all encouraged. Taking HRT to reduce your risk of heart disease is unlikely to be very beneficial if you are smoking 20 a day and eating a diet of ultra - processed foods. Osteoporosis and fractures will still be a risk if consuming alcohol regularly, so consider taking a break from drinking to re-evaluate if you need it in your life (see my blog post about this here).
Another important lifestyle change that I can not stress highly enough is exercise. Regular physical activity will help reduce your risk of a number of different health problems and lessen many of the symptoms of menopause. Thanks so much for reading all the way until the end, but your health is important to me, so go and get moving.
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