When it comes to health, women are often confident speaking up about things that matter. Periods, puberty, fertility, breast cancer, endometriosis, body image, weight, relationships and mental health are all on the table for a healthy and frank discussion.
However, there is one natural life change that many women still keep to themselves… menopause.
As a 55-year-old woman and a GP of many years, I find this very interesting. Much to my surprise, even some of my friends, men and women, are reluctant to talk about it. And in my clinical consultations with patients, I am often the one who initiates the conversation around expectations or experiences of menopause.
So why the silence?
It is probably not a simple answer. Perhaps in part it is driven by misinformation and confusion about what it can be like to go through menopause.
A sense that this life stage is just something we have to live through on our own. Some will fear the worst, when for most it turns out to be OK. Some women I have spoken to don’t wish to be judged by their age or reproductive stage. Fair enough. No one wants to endure any prejudice around age or have their hormones define them.
But if we live long enough, all women will go through menopause, and perhaps the time has come for both men and women to talk about this life event more openly, embrace it for what it is, and recognise that it is the end of one chapter and the beginning of another. It is a natural part of life.
An added bonus
For many women it can even be a positive time, a life stage during which they are feeling more confident in themselves and their bodies. An added bonus can be the feeling of liberation from the monthly period, sanitary products and contraception. It may even be a chapter worthy of celebration and the gradual emergence of menopause parties over recent years gives women a forum to share this time of their lives.
Given that the average Australian woman lives beyond 80 years old, there is also plenty of life post menopause to be lived and enjoyed.
For most women, our last period or menopause happens between the ages of 45 to 55. Most people understand that oestrogen levels drop, there are no active eggs left in the ovaries and hot flushes can appear.
Beyond that, I find knowledge starts to thin. But increasingly, I am finding that women, and the men in their lives too, want to know more.
Menopause is actually quite complex and the experience is very individual.
Interestingly for reasons that are unclear, around 20% of women simply breeze through it. The other 80% experience a variety of symptoms from mild to severe, which often go on for longer than they’d expected. According to Dr Elizabeth Farrell, gynaecologist and Medical Director of Jean Hailes for Women’s Health, symptoms can continue for an average of 8 years.
Apart from the hot flushes, women may also experience insomnia, aches and pains, mood changes, vaginal symptoms like dryness or pain on sex, altered libido or an increased frequency of bladder symptoms or even urinary tract infections.
These symptoms can dramatically impact on quality of life and be moderately severe for about 20% of women. Sadly, some will not realise that help is even available.
While all of this can sound overwhelming, it’s worth remembering that most women manage menopause fairly well. The most effective form of treatment for bothersome hot flushes is MHT, Menopause Hormone Therapy (or HRT- Hormone Replacement Therapy as it used to be called.)
Indeed MHT, often delivered in patch or tablet form, can be useful for a range of symptoms. Yet many women, and some doctors too are under the false impression that MHT is a dangerous form of treatment and always best avoided at all costs.
Benefits of MHT
The basis of this fear dates back to the 2002 Women’s Health Initiative trial which suggested that MHT significantly increased rates of breast cancer and heart attack. After this trial, a staggering 40% to 50% of women stopped MHT in Australia and many doctors were reluctant to prescribe. It led to a generation of women missing out on hormone treatments that may have improved their quality of life.
Ten years later, further reassessment of this study in 2012 found the interpretation and subsequent reporting of the trial were deeply flawed. While it is true that some women, for example those with a breast cancer history or undiagnosed vaginal bleeding are advised against taking MHT, for many women it is a safe and effective treatment. It is a matter of weighing up the pros and cons with your doctor.
Current menopause guidelines indicate that the benefits of MHT can outweigh the risks in healthy women if started within 10 years of menopause or between the ages of 50 to 60. And the increased risk of breast cancer from taking oestrogen is incredibly tiny. For breast cancer, there is one extra case per thousand women using MHT per year.
Women who drink 2 standard drinks a day or who are overweight are at greater increased risk of breast cancer. I often refer my patients to the websites of The Australasian Menopause Society and Jean Hailes for Women’s Health for up to date and reliable information from experts.
There can be more long term MHT benefits such as reducing cardiovascular risk or improving bone health but the catalyst for initiating therapy is often based around issues with current quality of life.
As Dr Elizabeth Farrell says “Really for the women who suffer from menopausal symptoms that really impact on their quality of life, menopause hormone therapy is a god send. And the number of women who come in and say once they’ve gone on it, they say I’ve got my body back, I’ve got my brain back, I’ve got me back! Now that’s not going to happen to everybody, but for those women in whom it does, it’s amazing for them. Their quality of life has improved greatly. “
While MHT is a highly effective treatment and is now sometimes used for longer than 5 years, it is by no means not the only option. In fact, most post-menopausal women at my GP practice are not on hormone therapies. They can’t take it or simply choose not to.
There are alternatives to MHT that include other medications for flushes, gabapentin (a drug traditionally used for chronic pain) and some women use various natural or complementary therapies. Vaginal symptoms may be improved by using topical vaginal oestrogen pessaries, and a silicone-based lubricant can make sex more comfortable (a water based lubricant is needed if you are using condoms for safer sex).
According to research published in the British Medical Journal in 2017, significant relief from hot flushes can be found with CBT, Cognitive Behavioural Therapy or Hypnotherapy.
Talking with a doctor trained in Women’s Health and exploring your options if need be, can be a game changer. And speaking up about your experiences of menopause with others can help empower you.
I recently spoke with Ms Jean Kittson, comedian, women’s health advocate and author of, “You’re still hot to me. The joys of menopause” for the ABC TV series “Ask the Doctor”. Ms Kittson is open about her own experiences including some embarrassing hot flush moments in the middle of corporate events.
But in writing her book and researching menopause she has arrived at positive conclusion. “I feel great about menopause now. It gives you liberty and a lot of freedom. “Learning more about menopause will “give a lot of women the confidence to embrace this part of their lives and not be fearful of it but go ‘this is going to happen and I’ll be able to manage that.”
Many women leaders of the world are post-menopausal and as she says, the years beyond menopause are a time when many women hit their stride professionally or personally.
“I don’t think menopause is about growing old I think it’s about growing up. I think it’s about actually understanding more about ourselves and our bodies and our place in the world, and where we fit into the cycle of life.”