Menopause is not a disease, rather a life stage. It occurs when a woman no longer produces eggs, and signifies the end of natural reproductive capacity. The ovaries stop producing eggs, and as a result, several hormone levels change. It is the change in the hormone levels which may cause symptoms. “Menopause” technically refers to the last period, but the surrounding time (preceding the last period and the time after) which is termed the “perimenopause”, can last for years. Women experience menopause in different ways. Not all women experience symptoms of menopause, and some will only experience minor noticeable changes. A few will experience troublesome features such as hot flushes, sweats, muscle and joint pain, fatigue, loss of energy and concentration, anxiety and depression, vaginal dryness, insomnia and seek treatment in order to improve quality of life. Clinic 66, our Chatswood clinic, on Sydney’s north shore clinic provides menopause counselling, and treatment options.
Our doctors will explore your ideas, concerns and expectations and then work out a management plan to suit you as an individual. Some women are concerned about the risks associated with Hormone Replacement Therapy ( HRT) and we will explain these to you. Some women should not use HRT, due to risks outweighing the benefits, for instance, women who have had breast cancer. However, there are some benefits to HRT, such as a reduced risk of bowel cancer, and helping with bone mass retention. Topical oestrogens eg vaginal pessaries or vaginal creams are delivered locally ( with no or minimal systemic absorption) and are considered less risky, over HRT taken orally or via a patch.
It is possible to use HRT topically, as with vaginal oestrogen replacement. Local oestrogen replacement, using pessaries or creams, can help combat vaginal dryness, making intercourse more comfortable and pleasurable, or in those women who are not sexually active, it can will make a speculum examination, more tolerable, such as when a pap smear is due.
Some women will prefer to use complementary therapies, such as herbal supplements like Dong Quai, Red clover, Black cohosh. Phyto oestrogens, such as those found in soya products are said to be helpful. Whilst there is not a lot of evidence to suggest that a complementary approach is definitiely effective, it may be that an individual notice an improvement in symptoms. Complementary therapies are not available on the Pharmaceutical Benefit Scheme ( PBS) . There are minimal regulatory controls over complementary therapies, and there is minimal or no quality control over strengths and constituents of supplements and bespoke therapies. Bioequivalents can be made up in compounding pharmacies, in Australia, but Gynaecare policy is that we do not recommend these.
When attending the clinic for a menopause consultation, our doctors will also undertake a review of your cardiovascular system and bone health. You may be referred for a bone density scan, to assess your bone health. Bone mass may deteriorate after menopause, but there are treatments which can slow down bone loss, as well has helpful lifestyle interventions. It is likely that we will recommend a bone density scan prior to commencing HRT, or to monitor bone density as part of ongoing review.