Managing the menopause

The menopause may produce many symptoms such as disturbed sleep and hot flushes, as well as other health consequences such as osteoporosis. What can we do to combat some of these issues? Gynaecologist and founder of the publication Menopause Matters, Heather Currie, talked with Adam Murphy...

Adam - What options are available for women who are beginning to experience the menopause?

Heather - The first option, which all women need to know about and can continue addressing are diet and lifestyle issues. And as we heard from Juliet, this can have an impact on bone health, but also cutting down smoking, cutting down alcohol, cutting down caffeine, maintain a healthy diet and plenty of exercise can also help those early menopausal symptoms that we heard Imogen talk about. In practice though, many women may be really struggling with symptoms and may not be in the right mindset to change their diet and lifestyle. And often we do need to help them get symptoms under control, but then continue to advise and encourage about the diet and lifestyle changes. The most effective treatment is hormone replacement therapy, and it really does what it says on the tin. It replaces the hormone. We've heard that the consequences of menopause, both the early symptoms, the intermediate symptoms, which are related to vagina and bladder problems, and also long-term symptoms such as changes in bone health are all due to lack of oestrogen.

Heather - And therefore what HRT aims to do is give the oestrogen back. There are many ways that oestrogen can be taken. It can be taken in a daily tablet, a twice weekly patch, a weekly patch, a daily gel that you apply to your thighs or to your arms, and a spray, which is the newest option, which you can apply to your arm. So the main part is oestrogen. And as we've heard there's oestrogen effects throughout the body, and when it gets into the circulation, it goes around the body and helps those effects that we've heard about. Unless someone has had their womb removed, i.e. had a hysterectomy, then the other hormone that's involved is progestogen. So this is needed to prevent oestrogen stimulating the lining of the womb, which if went on for long enough could increase the risk of thickening of the lining and in fact, endometrial cancer. But we have ways of combining the progestogen which can be really simple, such as within the daily tablet or within a patch, or can be taken as a separate option along with your separate oestrogen. So there's lots of options to think about. And it's really important that women take time to get the information and find out what's going to be best for them.

Adam - And when we're talking about any kind of treatment, any kind of therapy, there are side effects. As Catherine mentioned, there's a higher risk of breast cancer if the hormones stay in the system longer. Does that kind of thing apply here to HRT as well?

Heather - There is an association with a small increased risk of breast cancer in certain types of HRT. So if a woman is able to take the oestrogen-only - as I said, that's only relevant if she's had a hysterectomy, had the womb removed - then there seems to be little or no risk of an increased risk of breast cancer. However, if the oestrogen is combined with progestogen, then certain types of HRT taken for more than five years after the age of 50 may be associated with the stimulation of breast cancer cells that are already present, not actually causing the breast cells to turn into cancer. So perception of risk is really important and really complicated. So if one woman is having minimal menopausal symptoms and knows of someone close to her who had breast cancer, then she's going to be more concerned about the breast cancer risk than the benefits from HRT. Whereas another woman who doesn't have any sort of close history of breast cancer and is having significant symptoms then for her, there's going to be far more benefits by taking HRT, but overall for the majority of women under the age of 60 or within 10 years of the menopause who are having menopausal symptoms and may have risk factors for bone health, or may just have the risk factors for bone health, the benefits of HRT far outweigh the risks.