Menopause is the absence of menstrual bleeding for 12 months. It usually sets in around 51-52 years of age.
What causes menopause?
There is a decrease in oestrogen and progesterone due to loss of ovarian function, resulting in:
- irregular periods
- abnormal menstrual flow - heavy, clotty bleeding in the absence of any pathology in the uterus
- mood changes
- hot flushes and night sweats
- dryness in the vagina and painful intercourse
- frequent visits to pass urine, or urge incontinence
- a low sex drive
- tiredness, lack of sleep and fatigue
These symptoms may last 2-5 years before menopause sets in.
In some women, they may experience an earlier onset of menopause around the age of 45. Menopause prior to the age of 40 is termed premature ovarian insuffiency.
In addition to the above, a lack of oestrogen may increase the risk of osteoporosis that causes fractures. Cardiovascular risk increases as so does the risk of developing Type 2 diabetes and high cholesterol levels.
How do I know if I am menopausal?
Clinically, the absence of bleeding after 12 months is sufficient for the diagnosis, especially if accompanied by symptoms.
Treating Menopause Symptoms
Unfortunately, there are no 'natural' products or preparations that can reduce hot flushes. Preparations like St John's wort, evening primrose oil, Dong quai, Ginseng and phyto-oestrogens (soy and yam cream) have not shown to reduce hot flashes in good quality studies. Some of these interfere with the metabolism of certain anticoagulants and can be dangerous.
Beneficial, non medical ways of managing symptoms include:
- relaxation techniques
- regular excercise and weight reduction
- stop smoking
Menopausal hormone therapy (MHT) or hormone replacement therapy (HRT):
- oestrogen only preparations - only for women who have had a hysterectomy
- progestogen only - used to provide protection to the uterine lining when used with oestrogen
- cylical oestrogen & progestogen - generally used in perimenopausal women with no periods less than 12 months
- continuous oestrogen & progestogen -can be used if menopause more after 12 months of no periods or if changing from cylical oestrogen/progestogen
- Tibolone (Livial®) - no progestogen cover needed. Not suitable if there is a current / past history of breast cancer
Benefits of HRT
- prevents osteoporosis
- treats hot flushes and night sweats effectively
- lowers risk of developing Alzheimer's disease
- lowers risk of developing colon cancer
Risks of HRT
- small risk of breast cancer (1 case every 1000 women who are on HRT every year).
- Uterine cancer - with oestrogen use only (progestogen is always added as a result)
- Thromboembolism (risk of clots). Oral preparations have an increased risk compared to transdermal.
Sexual function issues in menopausal patients
As a result of menopause, there is a significant reduction in oestrogen, progesterone and a small amount of testosterone. This results in:
- a low libido or sexual desire
- vaginal dryness resulting in painful intercourse
Treatment of low libido with transdermal testosterone
- clinical studies have shown a benefit with short term use (3 years)
- suitable for women with low sexual desire after natural menopause or surgical menopause (if both ovaries have been removed)
- there is no long term risk of breast cancer, but women who have a hormone dependant cancer should avoid it
- Androfeme® (1% testosterone cream) has been approved for use for low libido and can be ordered by mail from Lawley Pharmaceuticals in Western Australia.
- Our doctors will speak to you regarding pre and post treatment blood tests and how to use the Androfeme cream
- It may take 6-8 weeks before a significant improvement in desire is felt. If there is no improvement after 6 months, the treatment should be stopped.
Treatment of vaginal dryness and painful intercourse
- Locally applied vaginal oestrogen is usually effective using preparations like Vagifem® or Ovestin®
- Oral oestrogen in HRT can be used to improve vaginal symptoms but are only used if there are other troubling menopausal symptoms as well
- Products like Replens® or K-Y Jelly are non hormonal alternatives that can be used prior to intercourse
- MonaLisa Touch™ vaginal laser treatment is a non hormonal alternative that causes vaginal rejuvination to treat vaginal dryness and painful intercourse. Suitable for women who cannot use hormones due to breast cancer or who wish to avoid hormonal preparations.