Menopause is the New Black

Friday, 19 May 2023

For many, many years, Menopause has been spoken of in a whisper, the mere thought of it squirm inducing. Thankfully, as it affects 100% of the population (... and yes, I do mean 100% - this statement has been fact checked by both sexes), we have moved on. We are currently in the middle of a menopause renaissance, and there has been a sea change on our attitude towards and treatment of a condition that is as inevitable as death and taxes.

There are 3 stages to Menopause. Firstly, Perimenopause describes the final years of a woman’s reproductive years, when ovaries start to slow their production of oestrogen. This can start in the mid to late 40’s, and last for up to 10 years. Perimenopause then leads to Menopause which begins one year after a final menstural period (average age of 51), and is finally followed by postmenopause.

Perimenopause can cause an enormous range of symptoms: brain fog, aching joints, depression, insomnia, mood swings, headaches, hot flushes and vaginal dryness. And from postmenopause, the risk of heart disease and osteoporosis increase dramatically.

These symptoms can be treated by introducing the sex hormones Oestrogen and Progesterone via prescription medicines called Menopausal Hormonal Therapy (MHT). There is now an acceptance that we have had a generation of women who have been under-treated with MHT. This stems from a 2002 study that concluded that the risks of these treatments (increased risk of cardiac events, strokes and clotting and breast cancer) outweighed the benefits. Subsequent studies debunked this study, but many women and doctors were scared off and have stayed away. A recent study in the US showed that the estimated costs of lost hours due to Menopause in the workforce was a staggering 1.8 Billion dollars!

For most healthy women under the age of 60 and within 10 years of menopause onset, the evidence is clear: you should be on MHT.

There are several methods of getting oestrogen into your body. Most commonly in New Zealand, we use patches that we stick onto our skin. Oestrogen patches are fully funded. And because of the way the oestrogen enters the body, it bypasses the liver and there is no increased risk of and blood clots and strokes. The patches are clear and discrete, and are replaced twice a week. Some patients have difficulty absorbing oestrogen via the skin so will need to be on oestrogen tablets. Patches and tablets are called systemic oestrogen, and will help with most symptoms. However about 1 in 3 patients will continue to get vaginal symptoms such as dryness and urinary symptoms. In these cases, you can use topical creams and pessaries to help.

If you take oestrogen and you have a uterus, you will need to take progesterone, too. The great news is that recently micronised progesterone (most similar to the form the body produces naturally, so less adverse reactions) is now available fully funded on prescription. The brand name for this form is called Utrogestran and should be taken at night as it has a mild sedative effect. If you are taking progesterone during peri-menopause you should take it cyclically for part of the month. Post menopausal, it should be taken once a day.

The first few months of MHT can be a bit trial and error as we have no idea how effectively your body can absorb the oestrogen through your skin. Be patient though, and talk regularly with your doctor - you will get there!

Lifestyle wise, it’s your standard recommendations of Sleep, Nutrition, Skincare and Exercise. Pilates is an excellent choice for this time in your life. Check out Upside Pilates for classes specifically designed for you! Menopause is under-studied and under-taught. But there are solutions available for all. There are now doctors that run clinics specifically to treat Menopause. Locally, Dr Deborah Brunt is able to help.

So in closing, here are 3 snackable content points from 45 year old male me:

• Menopausal Hormone Therapy is safe for most women
• Have a plan: have a discussion with your doctor early to plan the process
• You don't need to suffer in silence from these symptoms - we got you!

We are planning a special evening event on Menopause, featuring Menopause expert Dr Deborah Brunt, Exercise advice with Upside Pilates Instructor Amy Hou and Natural Support with Roslyn Pharmacy’s Hilary Procter. Please subscribe to our newsletter or follow our Facebook page to get the official details. As always, we welcome any questions, feedback or thoughts from this article. Email me direct on andy@roslynpharmacy.co.nz .

We are always here to help!

Take Care, Andy