Early Menopause - Women's Health
The Menopause - Menapause
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How do I manage symptoms of menopause?
Eating healthy foods and keeping physically fit are important to feeling your best. But if you are particularly bothered by some menopausal symptoms, you might want to try treatment. Several treatment options, including hormone replacement therapy (HRT), are available depending on your symptoms and other factors. Talk to your doctor about the risks and benefits of treatment so you can choose what’s best for you. There is no one treatment that is good for all women.
• Hot flushes
Some women report that eating or drinking hot or spicy foods, alcohol, or caffeine, feeling stressed, or being in a hot place can bring on hot flushes. Try to avoid any triggers that bring on your hot flushes. Dress in layers, and keep a fan in your home or workplace. If you are bothered by hot flushes or night sweats, ask your doctor about HRT. HRT works best at treating hot flushes and night sweats. If HRT is not an option for you, ask your doctor about trying antidepressant or epilepsy medicine. There is some evidence that these can help relieve hot flushes for some women. Other therapies you may want to try include Vitamin B complex, Vitamin E, Ibuprofen and hormones such as Provera.
• Vaginal dryness.
A water-based, over-the-counter vaginal lubricant (like K-Y® Jelly) can be helpful if sex is painful. A vaginal moisturizer (also over-the-counter) can provide lubrication and help keep needed moisture in vaginal tissues. Really bad vaginal dryness may need HRT. If vaginal dryness is the only reason for considering HRT, an estrogen product like cream for the vagina is the best choice. Vaginal estrogen products (creams, tablet, ring) treat only the vagina.
• Problems sleeping.
One of the best ways to get a good night's sleep is to be physically active. But, don’t exercise close to bedtime. Also avoid large meals, smoking, and working right before bedtime. Caffeine and alcohol should be avoided after noon. Drinking something warm before bedtime, such as herbal tea (no caffeine) or warm milk, might help you to feel sleepy. Keep your bedroom dark, quiet, and cool. Avoid napping during the day, and try to go to bed and get up at the same times every day. If you wake during the night and can't get back to sleep, get up and read until you’re sleepy. Don't just lie there. If hot flushes are the cause of sleep problems, treating the hot flushes will usually improve sleep.
• Mood swings.
Some women report mood swings or "feeling blue" during the menopause transition. Women who had mood swings before their periods or postpartum depression after giving birth may have more mood swings around the time of menopause. These are women who are sensitive to hormone changes. Often the mood swings will go away with time. If a woman is using HRT for hot flushes or another menopause symptom, sometimes her mood swings will get better, too. Also, getting enough sleep and staying physically active will help you to feel your best. Mood swings are not the same as depression.
• Trouble focusing “fuzzy thinking,” forgetfulness.
Some women complain of these symptoms in midlife. But studies suggest that natural menopause has little effect on memory or other “brain” functions. Also, recent studies suggest that women should not use HRT only to protect against memory loss or brain diseases, including dementia, and Alzheimer’s disease. Getting enough sleep and keeping physically active might help improve symptoms. But if memory problems are really bad, talk to your doctor right away.
Can hormone replacement therapy (HRT) help treat my symptoms?
If used properly, hormone replacement therapy (HRT) can be very good at relieving moderate to severe menopausal symptoms and prevents bone loss. But HRT also has some risks, especially if used for a long time. HRT can help with menopause by:
• Reducing hot flushes and night sweats, and related problems such as poor sleep and irritability
• Treating vaginal symptoms, such as dryness and discomfort, and related effects, such as pain during sex
• Slowing bone loss
• Possibly easing mood swings and mild depressive symptoms (HRT is not an antidepressant and is not effective in treating depression.)
For some women, HRT may increase their chance of:
• Blood clots
• Heart attack
• Stroke
• Breast cancer
• Gall bladder disease
When deciding whether or not to use HRT, you and your doctor need to talk about the potential benefits and risks.
HRT is either:
• estrogen taken alone, sometimes called estrogen therapy (ET) or estrogen replacement therapy (ERT);
• progesterone (natural or synthetic);or
• combination estrogen plus progesterone.
How do I take HRT?
There are many different ways to take HRT and many different combinations and dosages, all of which means that there are more options for women.
• Tablets
Oestrogen is taken alone if a woman has had a hysterectomy (removal of the womb). It can also be taken with progestogen for a number of days each month, if she still has her womb.
When a progestogen is included, the treatment up by causing the lining to is called ‘opposed’ because progestogen opposes the effect of oestrogen on the womb lining. Oestrogen on its own can cause the lining of the womb to build up in thickness and so increase the risk of cancer. Progestogens prevent this build- be lost each month in the form of a bleed. This does not mean that fertility has been restored if you have stopped ovulating.
A disadvantage of tablets is that you have to remember to take them correctly. Another disadvantage common to all drugs taken by mouth is that a higher dosage must be taken to compensate for the loss which occurs as the drugs pass through the digestive tract. The high dose may lead to side effects such as nausea. Hormones taken by mouth also pass through the liver and so carry a greater risk of causing liver damage and gallstones.
• Mirena for the progestogen part of HRT
This is an intrauterine system (a type of IUD) which contains a small amount of progestogen that thins the womb lining. It is a contraceptive which is also used for the relief of heavy periods. But it is likely to get a licence for HRT use because it can provide another way of getting the progestogen part of HRT. It works just inside the womb rather than affecting the whole body and may be safer.
• Patches
These are small plasters which are applied to the skin, they are available as single patches which contain oestrogen alone. The hormones pass directly from the patch across the skin into the bloodstream. The patch has to be changed once or twice weekly and a new one applied to clean, dry, hairless skin. If a woman has not had a hysterectomy, she will need progestogen in some form e.g. by using a double patch (containing oestrogen and progestogen) tablets or a Mirena coil.
The main advantage of the patch is that it contains a lower dose of oestrogen which is absorbed into the blood stream from the skin and so is less likely to cause nausea or affect the liver. Side effects can include skin irritation, swelling and blisters. However the matrix patches cause fewer skin reactions than the older reservoir type. An additional problem is that variations in the dosage absorbed from the patch can occur because of individual differences in the skin. The effects of long-term use of patches on the skin are not known.
• Implants
These are small pellets containing oestrogen which are inserted under the skin. They usually contain a six-month supply of hormones and are inserted into the fatty layers of the abdomen, buttocks or thighs under a local anaesthetic. This means that the dosage is fixed for the specific time. If intolerable side effects occur, the implant has to be removed, but locating it may be difficult and removal may be painful. Implants can result in higher oestrogen levels than tablets or patches. With implants, the body may get accustomed to high oestrogen levels and as a result, some women may experience more side effects as the oestrogen in the implant runs out. However, some women find this a very convenient method as once the implant is in place they can forget about it. Women with a womb will need progestogen in some form as well.
• Nasal Spray
‘Aerodiol’ delivers oestrogen through the nasal passages creating a pulse of oestrogen. Unlike other HRT products it does not provide a constant dose of oestrogen throughout the day, but it is effective and easy to use. Women with a womb will also need progestogen.
• Vaginal Ring
Designed for women whose womb has been removed, ‘Menoring’ releases oestrogen into the bloodstream and treats symptoms like hot flushes and vaginal dryness. It is easy to insert and should be changed after three months. A user survey revealed that the vaginal ring is comfortable to wear and does not interfere with sex.
• Creams
Oestrogen cream is put directly into the vagina in a measured dose with an applicator. The applied oestrogen has a local effect on the vaginal lining and is absorbed into the bloodstream. Because the oestrogen passes into the bloodstream, creams should only be used for short periods. If they are used for longer than 3-6 months, women who have not had a hysterectomy would need to take a progestogen. Oestrogen cream will not work immediately — it should be applied for several days before attempting penetrative sex (oestrogen creams are prescribed to reduce vaginal irritation and soreness and should not be used as a lubricant). Unfortunately despite the use of oestrogen cream and/or HRT some women still find vaginal dryness a problem.
• Gels
Oestrogen in gel form can be spread over the skin daily and acts in the same way as the patch. The advantage of a gel over a patch is that skin irritation is avoided. A disadvantage is that the gel must be used daily, whereas the patch only needs to be changed once or twice a week. Some women find the gel messy to use and women with a womb will need to take progestogen as well.
• Bleed-free HRT continuous combined therapy
When progestogen is taken with the oestrogen on a cyclical basis (for 10-14 days of each oestrogen treatment cycle) most women will have a monthly bleed like a period. There are now some preparations that do not cause a bleed because the progestogen and oestrogen are combined in a continuous dose. Current bleed-free HRT formulations include Tibolone, Premique, Kliofem, Kliovance (this also contains a lower dose of oestrogen), Evorel Conti, Elleste-duet Conti, Climesse, Femoston-conti and Nuvelle continuous tablets.
Tibolone differs from the other preparations in that it is not a combination of oestrogen and progesterone but a single drug which combines the properties of both, as well as some of the properties of male sex hormones. Bleed-free preparations are not recommended in the first year after the last period. Women who are still having periods but are experiencing menopausal symptoms are prescribed cyclical HRT which causes a regular bleed. They may choose to change to continuous bleed-free HRT in their early fifties when it is thought that bleeding would have ceased naturally if they had not been taking HRT. Bleed-free HRT would also be appropriate for a younger woman who had no periods for a year and was experiencing menopausal symptoms. Another option is to take oestrogen continuously for three months and then take progestogen for 14 days. This creates a withdrawal bleed every three months.
Continued on Page 4 » Early Menopause FAQ
If you have any queries regarding the topics raised within this article please do not hesistate to contact the Women's Health Clinic via the email form at the bottom of the page or by calling our London clinic on 020 8947 9877.
