Menopause and hormone replacement therapy

MENOPAUSE is not a journey that any woman looks forward to, mainly because of the discomfort felt and not being able to know when the symptoms associated with it will stop.

Take for instance the experience of 64-year-old Verna, who told All Woman that she began experiencing menopause symptoms, which were mainly hot flashes and night sweats, at age 38. She said at the time though the symptoms were present, it was not until she became older that the effects of what was to be a new course in her life really set in.

“At first I didn’t even realise the change of personality or my mood swings. My tolerance level was very low and I got angry very easily. Outside of that, the feeling that you get is out of this world. No doctor can tell you when it’s going to stop and everybody is different. Some doctors tell you that they have female patients up to the age of 80 that are experiencing hot flashes,” she said.

For Verna, the hot flashes and night sweats are the worst part of her experience.

“The night sweats make you uncomfortable when sleeping at nights. It wakes you up when you start sweating in your bed. The heat you get is coming from inside your body; it’s like inside of your body is burning up and it comes out. Sometimes I have to get up and change the bed sheets and by the time I’ve done that and settled down I would have lost an hour and a half, two hours sleep. When you get to work you feel exhausted.”

For her another challenge is having dry skin and wrinkles, which she says is caused by the sweating. On top of that she would experience constant tiredness and palpitations of the heart, which placed her at risk of a heart attack.

“I used to get palpitations of the heart and so I could tell when my hot flashes were coming on, so I would get up from my desk at work and go to the ladies room because I felt it stirring up inside. It drains your energy, makes you feel lethargic. I tried to find out from older women what to expect.”

Verna experienced temporary relief when her doctor introduced her to hormone replacement therapy (HRT).

“At age 47 I was placed on it for five years. It made me feel so good. I felt normal, no hot flashes, and no night sweats. I went to the gym and worked out, but the day when I had to come off that pill I started to fret, because you’re not to take it for too long and it was time for me to come off, which meant I was back to experiencing the ordeal,” she said.

Obstetrician gynaecologist Dr Ryan Halsall said HRT is essentially medication given to women who are going through or have gone through menopause, to relieve the symptoms associated with the transition. He said that these medications contain oestrogen alone or both oestrogen and progestin supplements.

Dr Halsall explained that during menopause, the production of oestrogen by the ovaries falls by about 90 per cent and causes many women to experience hot flashes, dryness of the vagina, sleep disturbances and severe mood swings.

He said the average age of menopause is 51 years; however, there is a wide variation of onset, ranging from 45 years to even after 55 years.

HRT is not routinely given to every woman, rather it is reserved for women with moderate to severe symptoms only, as it does come with risks.

“Now in the early stages of menopause, HRT doesn’t seem to have many bad outcomes, but studies have shown that when used for more than five years, especially in the over-60 age group, there is an increased risk of stroke, blood clots, breast cancer and coronary heart disease,” he pointed out while stating that the risks mentioned do not apply to women who have gone through premature or early menopause (less than 40 years).

The ObGyn said if women think their menopausal symptoms are severe and require treatment, the first step is to visit their family doctor or gynaecologist for a full check-up to see if they are a candidate for HRT. Dr Halsall further explained that this may require blood tests and screening for breast disease, but once all is well, medications will be started for a duration not exceeding four to five years.

However, for those that are not eligible for HRT, Dr Halsall said there are alternative medications that can be given to alleviate symptoms without the increased risks of HRT.