Menopause – a Mystery

by Dr. Goonjan Bhola
Menopause is when you stop having periods. It happens when your ovaries have been removed or your ovaries stop releasing eggs and the amount of estrogen hormone in your body falls. Most women have their menopause between the ages of 45 to 55 years, with average age around 51 years.
 Menopause can occur earlier in some women. If it occurs before the age of 40 years, it is known as premature menopause or premature ovarian insufficiency. The time before your last period, when your estrogen levels are falling, is called perimenopause. This can last from a few months to few years.
Around half of the women notice physical and/or emotional symptoms during this time.
The most common symptoms are-
  • Hot flushes
  • Night sweats
  • Vaginal dryness
  • Low mood and/or feeling anxious
  • Joint and muscle pain
  • Loss of interest in having sex
Every woman experiences menopause differently. Some experience one or two symptoms, which may be mild, while others have more severe and distressing symptoms. Some women choose to go through the menopause without treatment, while others prefer some form of treatment to manage their symptoms well, by using either hormone replacement therapy [HRT] or an alternative treatment.
Options for the treatment of Menopausal symptoms:
  1. Lifestyle Changes – Regular aerobic exercises, such as running, swimming may help, as well as low intensity exercises, such as yoga. Reducing your intake of caffeine and alcohol may also help to reduce hot flushes and night sweats.
  2. Non Prescribed treatments – Herbal medicines-plants or plants extract, such as St John’s wort, black cohosh and iso flavones [soya products], can help reduce hot flushes and night sweats for some women. However, their safety is unknown and they can react with other medicines that you may be taking for conditions such as breast cancer, epilepsy, heart disease or asthma.
  3. Alternative therapies– acupuncture and homeopathy may be helpful to some women.
  4. Complementary therapy-aromatherapy -although effects of these therapies specifically on menopausal symptoms are not distinctly known.
  5. Non-Hormonal Medical treatment– Clonidine or Gabapentin for hot flushes.
  6. Physiological Treatment – Cognitive behavioural therapy [CBT] is a type of psychological treatment. CBT maybe offered for low mood or anxiety related to menopause.
  7. Hormone Replacement Theory – HRT is the most common form of prescribed treatment for menopausal symptoms. It helps to replace the hormone estrogen in your body, which decreases around your menopause. But it should be discussed with your doctor. Types of HRT depends on individual situation. If you have uterus then a combination of estrogen & progestrone HRT (COMBINED HRT) would be recommended. Estrogen alone can lead to abnormal thickening of uterine lining which can lead to bleeding. Adding progestone prevents this. Progestogen can be given in form of tablets, patches or a hormone – containing coil. In case of previous hysterectomy then only estrogen is enough in HRT treatment. Women with low sex drive after menopause are offered another hormone called testosterone, a hormone related to sex drive in both women & men. HRT is available as oral tablets, skin patches, injections, body gels, spray, vaginal rings, creams or pessary.
Frequently Asked Questions on HRT
  1. IS HRT SAFE & DOES IT WORK? For most women, HRT works and is safe.
  2. WHAT ARE THE BENEFITS OF HRT? It is an effective treatment for hot flushes and low mood, associated with the menopause. It can improve sexual drive and reduce vaginal dryness. It helps keep bones strong by preventing osteoporosis.
  3.  WHAT ARE THE RISKS OF HRT? HRT with estrogen alone (used for women who have no uterus) is associated with little or no increased risk of breast cancer. HRT with estrogen & progestrone can increase your risk of breast cancer. This risk is higher if you stay on it for long and reduces when you stop it. Your individual risk of developing breast cancer depends on underlying risks factors, such as your body weight and your drinking and smoking habits. HRT taken as a tablet increases your risk of developing a blood clot, which is not the case if HRT is taken as a patch or gel. HRT in tablet form slightly increases your risk of stroke, although the overall risk of stroke is very low if you are under 60 years of age.
  4. CAN I HAVE HRT IF I HAVE DIABETES OR HIGH BLOOD PRESSURE? HRT should not affect your blood sugar control, so one can take after consulting the doctor.
  5.  WOULD TAKING HRT PREVENT DEMENTIA? It is not known whether HRT affects the development of dementia.
  6.  DO I STILL NEED TO USE CONTRACEPTION WHEN TAKING HRT? HRT does not provide contraception. You need to continue using contraception for 1 year after your last period if this happens after the age of 50 years. If your last period happens before 50 years then continue using contraception for 2 years.
  7.  WHEN SHOULD I SEEK ADVICE AFTER STARTING HRT? Review appointment with health professional after 3 months of starting or changing HRT and then yearly. 
  8.  HOW LONG CAN I TAKE HRT FOR? The benefits and risks of taking HRT will depend on individual situation. There are no standard benchmarks.
  9.  HOW DO I STOP HRT? You can stop HRT suddenly or reduce gradually before stopping it. The chances of symptoms coming back is the same either way.
  10. WHICH TREATMENT IS THE BEST FOR HOT FLUSHES & NIGHT SWEATS? Patient should be offered HRT after discussing its benefits and risks with the doctor.
  11. WHICH TREATMENT IS BEST FOR MY LOW MOOD? HRT is an effective treatment for low mood. CBT is also helpful in treating low mood and anxiety related to the menopause. Low mood as a result of the menopause is different from depression. So antidepressants are not helpful unless diagnosed with depression.
  12.  WHICH TREATMENT IS BEST FOR LACK OF INTEREST IN SEX? HRT containing estrogen and/or progestogen may be helpful as a treatment for low sexual desire during menopause. Another hormone called testosterone, is also linked to sex drive in both men & women.
  13.  WHICH TREATMENT IS BEST FOR VAGINAL DRYNESS? Many women use vaginal moisturisers and lubricants for vaginal dryness. Estrogen given vaginally in form of tablet, ring, creams are also used in treating vaginal dryness. These can also reduce bladder infections and help urinary symptoms.
Dr. Gunjan Bhola is an expert in High risk obstetrics, endoscopy and gynaecologist oncology. She provides treatments for conditions related to prenatal care, prolapse of pelvic organs, painful menstrual period management, high risk pregnancy, abnormal delivery, vaginal infections, female reproductive organ cancer management, and hysterectomy. She is associate director, Cloud 9 hospital, Faridabad. You can find her on Twitter @bholachibber

April 3, 2022

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