MENOPAUSE

The menopause is sometimes known as the ‘change’ and is marked by the ending of menstruation. In the UK, the average age of menopause is 51 yrs. A woman is said to have become menopausal once she has not had a period for one year. When menopause occurs under 40 years of age, it is known as premature menopause. It is estimated that premature menopause affects 1% of women under the age of 40 and 0.1% of women under the age of 30.

As the ovaries now produce less estrogen, many women experience both physical and emotional symptoms, such as hot flushes, night sweats and irritability. These symptoms may start about 3-4 years before menopause and continue for a further 2-3 years. For women who find the symptoms interfering with quality of life, hormone replacement therapy (HRT) may provide significant relief.

HORMONE REPLACEMENT THERAPY (HRT)

HRT comprises of low dose estrogen and progestogen to alleviate symptoms of menopause. The progestogen component in the HRT is to protect the lining of the womb (endometrium) from developing cancer. Thus in women with hysterectomy where there is no need for endometrial protection, an estrogen only preparation is perfectly adequate.

In addition,  HRT has a protective effect on bone density, cardiovascular health and colon cancer. After sub analysing the WHI and Million Womens’ studies, and also with newer but smaller studies, the benefits of HRT are thought to be greater than risks in women below 60. In most women, HRT has a protective effect on cognitive function and on risk of strokes.

Most women are suitable for HRT; but it may not be suitable for women with a personal or family history of breast, ovarian or endometrial cancer, or a personal history of blood clots or high blood pressure.

Hormone therapy is available as oral tablets and dermal patches. Local estrogen as tablets or cream may give considerable benefit from symptoms of vaginal dryness and discomfort.