Menopause and perimenopause
This year, I am seeing an increasing number of women presenting to the clinic wondering if their symptoms may be related to the perimenopause or menopause. It may be due to the present Senate Inquiry into Menopause and Perimenopause, or the growing amount of information available online.
Twenty years ago, the preliminary findings of a large study about hormone replacement therapy (HRT), the Women’s Health Initiative, were released to the media, and the study was abandoned on the basis that it suggested an increased risk of breast cancer for women taking HRT. Many women stopped taking HRT and many doctors, including me, became reluctant to prescribe HRT. The policy that followed was that HRT could be taken at the lowest possible dose, for the shortest time it was required, to reduce perimenopausal symptoms like hot flushes and night sweats.
Recently, the interpretation of the findings of the study has been revised. The study was initiated to look at cardiovascular risk, and the control and treatment groups of women were not determined based on breast cancer risk. The small increase in the number of women in the HRT arm of the study who were diagnosed with breast cancer, was not valid as the trial participants were divided into control and treatment groups based on Cardiovascular risk, not breast cancer risk. The increased number was minimal (8 in 10,000 women) and follow-up twenty years later did not show any increased deaths from breast cancer.
It is also important to know that there has been a significant change in the hormones that are prescribed now, compared with 25 years ago. The newer regimes offer great benefits at minimal risk for most women. Most women prescribed HRT (or MHT – menopausal hormone therapy) are offered a topical estrogen (Patch or gel or vaginal pessary or cream). If the woman has an intact uterus, she is also prescribed progesterone or a synthetic progestogen. Oral progesterone and the Mirena IUD are the most common forms now. Some women also benefit from testosterone and can be prescribed this under certain conditions. Most of these hormones are body-identical.
The Senate Inquiry is hearing from women and medical practitioners about their experience of menopause diagnosis and treatment. Common concerns are the lack of awareness about menopause and the time it can take women to have their symptoms recognised as being due to hormone changes during the peri-menopause and menopause, particularly if they are in a younger age group. Unfortunately, many of the body-identical hormone treatments are not presently available on the PBS. Hopefully, the Senate Inquiry will make a difference.
If you think that you may be experiencing hormonal changes, please feel free to discuss your concerns. You may like to fill in a questionnaire and bring it with you to an appointment.
For further information, I recommend the Australasian Menopause Society, and a British site, Newson Health. Dr Louise Newson is a British GP and Menopause expert who advocates and educates about menopausal assessments and treatments. On her site, she has a free short course called Confidence in the Menopause, and an app called Balance which has resources as well as ways women can monitor their symptoms.
I have been delighted with the improvement in well-being that I am seeing in women who have recently started on MHT. I am happy to discuss with you whether a trial of MHT might be appropriate for you.