Yasmin Williams - HEALTH-WISEMENOPAUSE IS the cessation of the menstrual cycle. At this time, a woman no longer releases follicles ('eggs') from her ovary and therefore cannot get pregnant. Menstrual cycles do not cease abruptly. Perimenopausally, there are hormonal fluctuations, which often give rise to symptoms.
Deficiency in the levels of the hormone oestrogen may cause:-
Hot flushes or flashes and excessive sweating
Emotional changes anxiety /irritability/depression
Possible decline in mental function -the association with Alzheimer's is well documented
Worsening of migraine headaches
Urinary problems - incontinence (difficulty holding urine)
Burning/frequency
Recurrent vaginal infections and vaginal discomfort due to dryness which may result in dyspareunia (painful sex)
Loss of bone mass with frequent fractures
As a clinician, my approach
to menopause management would be:-
1. Assessment of any symptoms
2. Review of the woman's wishes and needs
3. A look at the woman's family history and risk factors for breast/uterine cancer, cardiovascular disease & osteoporosis (bone loss)
4. Complete physical including pelvic exam, pap test, breast exam
5. Blood tests to check liver
function, cholesterol and triglyceride
levels
6. Bone density test to help determine risk of osteoporosis
Hormone replacement therapy (HRT) for the treatment of menopausal symptoms, is used to describe several treatment regimes and modalities in which a woman takes oestrogen and progesterone or oestrogen only.
Hormonal replacement therapy now has two main goals:-
1. to stop uncomfortable physical /emotional changes
2. to prevent progressive loss of bone mass/bone strength.
Not very long ago, there was a # 3 goal to reduce the risk of heart attack/stroke.
The recent findings of the Women's Health Initiative Study were that HRT does not reduce the risk of heart attack and may in fact increase the risk of stroke. It also established that HRT was associated with an increased risk of invasive breast cancer in those women in the study who were taking both oestrogen and progesterone but not in those women who had had removal of their wombs/uterus and were taking oestrogen alone.
Phytoestrogens (weaker chemicals which mimic action of oestrogen) are found in a variety of foods, including seeds, legumes, vegetables and other plant sources and may relieve hot flashes/vaginal dryness/mood swings.
Some persons believe that there may be a lower risk for diseases associated with oestrogen when these phytoestrogens are used instead of the conventional hormone replacement regimes. More research is needed in this area.
As one approaches menopause and oestrogen becomes deficient, it is important to remember the increasing need to have a good intake of dietary calcium to prevent/slow loss of bone mass and to prevent fractures. Good food sources of calcium are dairy products, including yoghurt, calcium fortified beverages, sardines, salmon and green leafy vegetables. Dietary calcium intake should be supplemented with calcium tablets/vitamin D as necessary.
Exercise works to prevent osteoporosis or bone loss and may even reverse the condition. Weight bearing exercises are best for combating osteoporosis. It therefore makes good sense to start exercising early in life so that one develops strong bones before oestrogen levels begin to fall. Remember walking briskly for 30 - 60 minutes daily will not only help to strengthen bones but strengthen the capacity of the heart or in other words 'produce cardiovascular fitness '.
Finally, stress-reducing activities can go a long way in keeping you healthy and happy during and after menopause. Once again we see the importance of a lifestyle which includes adequate diet and exercise as well as healthy stress relieving activities.
Dr. Yasmin Williams is a Family Doctor and Public Health Specialist.
