At King’s we can provide both comprehensive information and treatment options if you are considering treatment for symptoms of the menopause.
WHAT IS THE MENOPAUSE?
The menopause is when you stop having your periods for more than 12 months. It happens when your ovaries stop releasing eggs or your ovaries have been removed and the amount of oestrogen hormone in your body falls. It varies from country to country but most women have their menopause between the ages of 45 and 55 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 oestrogen levels are falling, is called the perimenopause. This can last from a few months to several years. Around half of all women notice physical and/or emotional symptoms. These may include:
- 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 the 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, by using either hormone replacement therapy (HRT) or an alternative treatment.
If you have symptoms of the menopause and are over 45 years of age, you will not usually need any hormone tests to diagnose menopause. Treatment options are offered based on your individual assessment and symptoms.
DO I NEED ANY HORMONE TESTS BEFORE I CAN START TREATMENT?
Treatment options for menopausal symptoms include:
- Lifestyle changes,
- Non-prescribed treatments
- Prescribed treatments.
Psychological treatments Cognitive behavioural therapy (CBT) is a type of psychological treatment. CBT can be used to treat low mood or anxiety related to menopause.
NON-HORMONAL MEDICAL TREATMENTS
Nonhormonal medical treatments, which would need to be prescribed by your doctor, include clonidine or gabapentin for hot flushes.
HORMONE REPLACEMENT THERAPY (HRT)
HRT is the most common form of prescribed treatment for menopausal symptoms. It helps to replace the hormone oestrogen in your body, which decreases around your menopause. You may sometimes also need other hormones (such as progestogen and testosterone) that your body is no longer producing. If you are interested in taking HRT, your healthcare professional should discuss the benefits and risks with you before you start the treatment. This discussion should cover both the short-term (over the next 5 years) and the longer term (beyond the next 5 years) benefits and risks for you. You should also be informed about available alternatives to HRT along with
WHAT ARE THE DIFFERENT TYPES OF HRT?
The type of HRT that you are prescribed depends on your individual situation. If you have a uterus (womb) then a combination of oestrogen and progestogen HRT (combined HRT) would be recommended. Oestrogen alone can cause abnormal thickening of the lining of your uterus, which can lead to bleeding. Adding progestogen will prevent this. Progestogen may be given in the form of tablets, patches or a hormone containing coil.
If combined HRT is started before you have the menopause or within 12 months of your last period then you will be offered a ‘cyclical’ combined HRT, which should give you regular monthly withdrawal bleeds.
If you start combined HRT more than 12 months after your last period, you may be offered ‘continuous’ combined HRT (bleed free HRT). You may experience some vaginal bleeding in the first 3 months, but after this it should stop.
If you have had a hysterectomy, then you will be offered oestrogen only HRT.
Women who notice a low sex drive after the menopause may be offered another hormone called testosterone. This is a hormone linked to sex drive in both men and women.
IS HRT SAFE AND DOES IT WORK?
The effects of HRT have been studied worldwide and research shows that, for most women, HRT works and is safe.
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 desire and reduce vaginal dryness.
- It helps keep your bones strong
WHAT ARE THE RISKS OF HRT?
- HRT with oestrogen alone (used for women who have no uterus) is associated with little or no increased risk of breast cancer.
- HRT with oestrogen and progestogen can increase your risk of breast cancer. This risk is higher the longer you stay on it and reduces when you stop HRT.
- Your individual risk of developing breast cancer depends on underlying risk 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 the age of 60 years. Your healthcare professional should discuss your individual risks based
If you have any other questions about HRT, please call us on 04 519 9999, and ask to speak to one of our Gynaecologists.
HOW IS PREMATURE MENOPAUSE DIAGNOSED?
If your periods become infrequent or stop before the age of 40 years and/or you experience menopausal symptoms, you should see your healthcare professional. You will be offered blood tests to measure your hormone levels to help diagnose premature menopause. The diagnosis is made after two blood tests are performed 4–6 weeks apart.
ARE THERE ANY HEALTH RISKS RELATED TO PREMATURE MENOPAUSE?
You are likely to notice the symptoms of menopause, such as hot flushes and mood changes. There is also an increased risk of developing osteoporosis and cardiac disease in later life. Osteoporosis can lead to broken bones if not treated. Premature menopause will affect your fertility, and your chance of getting
WHAT IS THE TREATMENT FOR PREMATURE MENOPAUSE?
Treatment for premature menopause involves the replacement of hormones in the form of either HRT or the combined oral contraceptive pill. Both are effective in treating hot flushes and keeping your bones strong. While the combined oral contraceptive pill has the advantage of also providing contraception, HRT is a safer option if you have high blood pressure. It is important for you to continue the treatment at least until the average age of natural menopause. By taking HRT, you are simply replacing the hormones your body is lacking, and so there are no added risks. If you are thinking about getting pregnant, you will need a referral to a fertility specialist. Your healthcare professional may also suggest referral to a menopause specialist.