The Australasian Menopause Society Your Questions Answered

This leaflet answers your questions based on the latest scientific evidence and is intended to assist you when discussing menopause with your doctor Menopause is a time of change in a woman's life and generally occurs between the ages of 45 and 55. The ovaries gradually stop producing eggs and hormones causing periods to become irregular and finally stop. The levels of sex hormones (mainly oestrogen and progesterone) in the body also fail. Menopausal symptoms such as hot flushes and mood swings are common, and the fall in oestrogen levels may lead to an increased risk of osteoporosis and heart disease. Recently, members of the Australasian Menopause Society (AMS), a scientific body committed to menopause education and research, met to discuss the questions most often asked by, women experiencing menopause. These questions relate to skin changes, weight gain, breast cancer, libido, hormone replacement therapy (HRT) and other options. HRT can relieve menopausal symptoms such as hot flushes and night sweats. It may also provide increased protection against osteoporosis and urinary problems. Other benefits include improvements in heart disease, memory loss (including Alzheimer's disease), skin ageing and sexual function. However, HRT may not be suitable for every woman.

Weight Gain

Both women and men tend to experience an increase in abdominal fat as part of getting older. This is thought to be due to changes in energy intake, decreased strength and physical activity, changes in sex hormones or other hormonal factors. Does menopause cause weight gain? From the early 40s most women become aware of a redistribution of fat from the buttocks and thighs to the stomach. Whether this change is caused by menopause alone, ageing alone or a combination of both is unclear. However hormones appear to play a role in the redistribution. Does HRT cause weight gain? HRT does not cause weight gain. Many studies confirm that hormone treatment does not produce weight gain in menopausal women. When commencing HRT some women do experience initial side effects such as feelings of bloatedness, breast tenderness and fullness but these should not be mistaken for weight gain. These side effects tend to settle down within the first few months of therapy. What can you do? To reduce the impact of age on weight and body shape, you should reduce your fat intake, increase your consumption of complex carbohydrates and fibre, and have at least three balanced meals a day. You should also exercise regularly such as brisk walking, dancing, bicycling and swimming. However endurance is the key as exercising for one hour three times a week at a moderate pace is better than 15 minutes flat out every day.

Menopause & Sexuality

Sexuality does not begin and end at any particular stage in life. Nor is it easy to define. For some couples caressing, physical closeness and companionship can be as integral a part of their sexual relationship as intercourse. With age there is a normal decline in both male and female sexuality and problems tend to occur when partners experience differences in libido. What causes loss of libido? Loss of libido, loss of interest in sex or reduced sex drive may occur at the time of the menopause for a variety of reasons including tiredness, stress and relationship problems. Menopausal changes such as vaginal dryness, skin crawling sensations, a change in skin sensitivity, tiredness due to hot flushes, and the sense of just not wanting to be touched are other common factors. In some cases relationship counselling may be of benefit. If the problem is hormonally based oestrogen therapy will alleviate vaginal dryness and other menopausal symptoms. For those with low testosterone levels, testosterone therapy may enhance sexual desire and pleasure. However the effects of long term use of testosterone therapy TIP There are many therapies available to you to alleviate menopausal symptoms and reduce your risk of osteoporosis and heart disease. These treatments target the fall in sex hormone levels, particularly oestrogen, and progesterone, at the time of menopause and are generally referred to as hormone replacement therapy (HRT). TIP Initial side effects with HRT can occur (eg. breast tenderness) however your therapy can be adjusted to meet your individual needs. Preferably, do not cease HRT without first consulting your doctor as rebound symptoms may occur such as hot flushing.

Skin & Other Changes

Skin is an oestrogen dependent part' of the body and is affected in a number of ways by the fall in oestrogen levels following menopause. Changes in hair, teeth and bladder control also occur. However, women who use HRT benefit from improved skin functioning, less abnormal hair growth, better dental health and reduced skin ageing. How can I improve my skin? Skin thickness decreases with time after menopause and as a result cuts and abrasions often take a long time to heal. HRT improves skin thickness and restores the natural moisture balance to dry skin. Wrinkles increase after menopause as a result of skin deterioration and are made worse by smoking and lifetime exposure to sun. Other than not smoking, sun protection is the best action Australian women can take to protect their skin against wrinkling and other sun damage. HRT may also help combat wrinkling of the skin as women who use HRT at the time of menopause experience better skin regeneration and preservation. A crawling skin sensation and dry, itchy eyes also respond well to oestrogen replacement. Will HRT help my vaginal symptoms? The vagina is highly oestrogen dependent. Prior to menopause the vaginal walls are ten cells thick and well lubricated. After menopause, in the absence of oestrogen this lining shrinks to two cells in thickness. changes at the time of menopause can cause thin inflamed vaginal skin, vaginal dryness, painful intercourse, as well as bladder and vaginal infections. Some women also complain of dry vulval skin. These symptoms may be relieved by locally applied oestrogen creams or oestrogen replacement taken as a tablet skin patch or gel A small amount of vaginal discharge is normal in a healthy vagina and may occur with the use of HRT. Can I improve my bladder control? Problems with urinary control are extremely common in women over 50. There are effective treatments available so ask your doctor for more information. Are changes in hair growth normal? After menopause some women experience unwanted hair growth on the jaw-line. In many cases it is a result of hormone changes. Oestrogen replacement can control new hair. growth but electrolysis may be required to remove old hair. Thinning of pubic hair is a normal part of ageing and does not require treatment. What about my teeth? After menopause many women notice that the condition of their teeth deteriorates. It is common to experience reduced saliva, increased gingivitis (bleeding gums) and sometimes changes in taste and smell sensations. There is also an association between increased tooth loss and osteoporosis. Studies have shown that women using oestrogen replacement therapy maintain better dental health. TIP HRT can take several forms including tablets, patches, gels and implants. Ask a qualified medical practitioner with an interest in menopause for a long consultation to fully discuss all management options including diet, exercise, pharmaceutical and other therapies. TIP It is important to address your lifestyle. Smoking is associated with an earlier and more severe menopause as well as many serious diseases later in life. Excessive alcohol (more than 10 drinks. a week) should be avoided.

Breast Cancer

The risk of an Australian woman developing breast cancer during her lifetime is 1 in 14. However, as more breast cancers are being detected by mammograms at an early stage, the result is that fewer women are dying from the disease. Importantly less than 10% of all cases of breast cancer are in women with a strong family history of the disease. Only if your mother or sister developed breast cancer under the age of 45 years are you at increased risk of developing the disease yourself. All women over the age of 50 should participate in the national breast screening program and have a free mammogram every two years. Women with a strong family history of breast cancer should have yearly mammography from 40 years of age. Does HRT cause breast cancer? Women who take HRT have a slightly increased risk of being diagnosed with breast cancer. They also have a lower risk of dying from breast cancer than women who do not use HRT. A possible explanation for these findings is that women using HRT see their doctor more regularly and have more breast screening which results in a slightly increased breast cancer diagnosis rate. A recent review of 51 studies involving women taking HRT found no increase in death from breast cancer amongst HRT users. The review also found: For every 1,000 women taking HRT for 5 years there may be 2 extra cases of breast cancer diagnosed For every 100 women using HRT for 13 years there may be 1 extra case of breast cancer diagnosed The risks and benefits of HRT use are individual to your health needs. Discuss them with your doctor.

Alternative Therapies

Many women seek natural or dietary solutions to help them through menopause. A healthy lifestyle involving a balanced diet and regular exercise is important. Many factors need to be considered when thinking about the benefits and risks of alternative therapies. Alternative therapies can take many forms including herbal or plant supplements, skin creams and foods. Little is known about the risks associated with alternative therapies sold in Australia, and you should not assume that supplements and extracts described as 'natural' are safe or effective. People may unwittingly consume high concentrations of compounds, particularly when combining a variety of different supplements, for which we do not know the effect on the human body. What standards must alternative therapies meet? Lack of adequate regulation is a major concern. Alternative therapies which are 'Listed" by the Australian Government only need to meet the requirement that they contain no known toxins. Unlike prescription medicines which can also be derived from natural sources, alternative therapy suppliers do not have to prove the product to be safe or effective, or adhere to the same high quality and purity standards, to be able to sell their products. Where is the proof? Despite enthusiastic product claims there is almost no solid scientific evidence to support the claims made for any alternative therapy in relation to health benefits for menopausal women ~ including osteoporosis and symptom relief. SOY AND PHYTOESTROGENS Phytoestrogens ('phyto' means plant) are a type of plant oestrogen, also known as isoflavones, which are commonly found in plants such as soy beans. It is widely claimed that phytoestrogens provide menopausal women with health benefits, however there is no scientific evidence to support these claims. The argument in favour of phytoestrogens is based upon the observation that in countries where beans such as soy are the main source of protein (Asia, India and South America), women appear to experience fewer menopausal symptoms, However the link remains unproven. Soy food products are good for our health and are known to help reduce cholesterol, but recent research has shown that it is not the phytoestrogen component of the soy protein which provides this benefit. PROGESTERONE CREAMS AND WILD YAM CREAMS Progesterone is a hormone produced by the body. Progestogen is one form of progesterone which can be produced either within the body or synthetically. There is no satisfactory scientific evidence that so-called Progesterone Creams or Wild Yam Creams provide menopausal women with any therapeutic benefit. Doctors are very concerned about reports that some women are using progesterone creams instead of prescribed progestogens as part of hormone replacement therapy. These women are at increased risk of cancer of the womb (endometrial cancer). Will research continue? The medical profession is eager to foster the development of safe and effective new agents to increase the treatment options available to women at the time of menopause. Various centres around Australia are conducting scientific studies on these compounds. FEBRUARY 1999 PANEL Dr Sheila O'Neill (Chair) AMS President, Brisbane Dr Rod Baber Sydney Dr Susan Davis Melbourne A/Prof John Eden Sydney Copies of this pamphlet are available from your HRT Pharmaceutical Representative