(Meno)pause for thought

Medical opinion about HRT has really come full-circle in the last 20 years. Evidence now shows that it’s the most effective treatment for hot flushes, has many other benefits and is safe when prescribed appropriately.

My academic life seems to have a monthly cycle (even if my puny, prematurely-pooped ovaries do not… but that’s another story).

Flavour of the month in women’s health for October is definitely Menopause, a subject which recently hit my radar in a big way (ie. the pooped ovary thing).

Enroute to the Australian Menopause Society (AMS) Congress in Melbourne a couple of weeks back I noticed an article in the Australian about the latest evidence for Hormonal Replacement Therapy (HRT) in which a Danish researcher stated:

“We found a significantly decreased risk of … death, heart failure or myocardial infarction (heart attack) when hormone replacement therapy was started early in postmenopause.”

This information definitely set the tone for the Congress: there are changes afoot for the change-of-life!

You may recall the big stir about HRT some years ago which frightened a lot of women off it. A large scientific study called the Womens Health Initiative (WHI) which was run in the 1990’s found an increased risk of breast cancer, cardiovascular disease, stroke and pulmonary embolism in long-term HRT users. What wasn’t clearly stated in many hysterical press releases at the time was that this data applied to an older, postmenopausal group of women (average age 63) and was therefore not applicable to younger women around the onset of menopause (average age 51).

What became apparent at the AMS Congress was that a woman’s age on commencing HRT is crucial: it should be started early in the menopause (if needed for hot flushes) and be used continuously without long breaks until the decision is made to stop it for good. Evidence was presented that HRT is effective at treating hot flushes and sexual dysfunction in early menopause, and that its early use can have long term protective effects against cardiovascular disease, bone density loss and the development of Alzheimers disease.

Clearly the message is that if you are a women entering menopause with debilitating hot flushes, HRT may not only improve your symptoms but is likely to also have a number of other long-term health benefits.

This information does not apply to older women who have already been through menopause, however. In these women pre-existing cardiovascular damage such as blood vessel plaques is more likely, so starting HRT increases their risk of events like strokes and pulmonary emboli (lung clots). Older women also have an increased risk of breast cancer if they use HRT for more than 5 years.

For the record, I’m not here to try and sell HRT. It should only ever be prescribed as a treatment for menopause symptoms like hot flushes or for osteoporosis, not simply for the other perceived benefits (many of which can be achieved in other ways). First line management of menopausal symptoms requires a holistic appraisal of lifestyle, health and psychosocial factors.

For example, a wonderful presentation at the Congress noted the importance of preventing weight gain earlier in life and at menopause, which is critically important to avoid poor health after menopause when weight loss attempts are too late and likely to fail. The International Menopause society also launched a new campaign on World Menopause Day (18 October) to heighten awareness of weight issues at menopause.

Working your way through the maze of midlife issues can be overwhelming but your keys to success will be information, motivation and support. There are many wonderful sources of menopause information just a click away: try Jean Hailes for Women’s Health and the Australasian Menopause Society for starters.

I’m afraid you’ll have to dredge your own psycho-spiritual reserves for motivation, but seek out the support of family, friends and trusted medical advisors to give yourself the best chance of a smooth transition.

[By Dr Kelly Teagle. Reproduced from an article published in HerCanberra, 30th October, 2012]

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