AMS Glossary Fact Sheet for Women114.06 KB

Deep vein thrombosis (DVT)	Deep vein thrombosis (DVT) means a clot has formed in the deep veins in the leg. Small pieces can break off, travel up the veins and lead to a blood clot in the lungs (pulmonary embolus).
Early menopause	Menopause occurring between 40-45 years of age is called early menopause.
Endometrium	The endometrium is the lining of the uterus (womb) which is shed during menstruation (menstrual periods).
Endometrial Cancer	Endometrial cancer is a tumour that forms in the endometrium (or lining of the uterus).
Endocrinologist	A doctor who specialises in the care of people with hormonal problems
Gynaecologist	A doctor who specializes in the care of a women's reproductive system both medically and surgically.
Menopausal Hormone Therapy (MHT) Hormone Replacement Therapy (HRT)/ Hormone Therapy (HT)	MHT also known as hormone replacement therapy (HRT) or hormone therapy (HT) refers to hormones prescribed to help oestrogen deficiency. This is most commonly prescribed for women around the time of menopause to relieve menopausal symptoms and to prevent osteoporosis. Women with other causes of oestrogen deficiency (such as pituitary gland problems) may also be prescribed hormone therapy.
Hysterectomy	A hysterectomy occurs when a woman's uterus or womb is removed. She will no longer be able to bear children and will not have any further periods. However, the ovaries will continue to function and will continue to produce hormones if the woman is premenopausal.
Intrauterine Contraceptive Device (IUD, IUCD, IUS)	A type of long-acting reversible contraceptive (LARC) usually made of flexible plastic that is put in a woman's uterus by her doctor. In addition to contraception, a progestogen releasing IUCD/IUS may also be used for the treatment of heavy periods and as part of MHT.
Oestrogen/Estrogen	Oestrogen is a hormone produced mainly in a woman's ovaries. Oestrogen acts throughout the body and is especially important for the female body changes at puberty and for reproduction. After menopause oestrogen levels are very low.
Off-Label Use	Off-label use is when a drug is used to treat a condition which is different to that which it was first made for, and which is outside the specific purpose for which it was approved by Australia's medicines regulator, the Therapeutic Goods Administration. Off label use requires consent from the patient.
Oophorectomy	Oophorectomy is the term used to describe the surgical removal of one or both ovaries.
Osteopenia	Osteopenia, sometimes called low bone mass, refers to bone that is thinner than normal. Further bone loss may lead to osteoporosis.
Osteoporosis	Osteoporosis is the result of the changes in the bones making them more fragile which can lead to fractures that occur with minimal trauma. Oestrogen in important for bone health and menopause related oestrogen deficiency can lead to osteoporosis.
Ovaries	Ovaries are the pair of female reproductive organs located in the pelvis next to the womb that store and release eggs. The ovaries also make hormones, estrogen, progesterone and testosterone.
Menopause	Menopause is the final menstrual period and is said to have occurred when there have been no menstrual periods for one year. The average age of menopause in Australian women is 51 years (range 45-55 years).
Peri-menopause	Peri-menopause refers to the time from when changes in menstrual cycle (missed periods or changes in amount of bleeding) or menopausal symptoms start to one year after the last menstrual period. It usually starts in a woman’s 40’s and lasts an average of 4-6 years.
Post-Menopause	Post-Menopause starts one year after the last menstrual period.
Premature Menopause	Premature menopause is menopause occurring before age 40 years and includes surgical removal of ovaries (bilateral oophorectomy). Premature ovarian insufficiency (POI) may also be included under this heading although cessation of ovarian function in POI is not always irreversible.
Premature (or primary) ovarian insufficiency (POI)	Loss of ovarian function occurring in women younger than 40 years of age affecting approximately 4% of women. This was previously referred to as premature ovarian failure; however, the preferred term is now premature (or primary) ovarian insufficiency (POI).
Progesterone	Progesterone is the natural hormone found in a woman's body that helps prepare the endometrium (lining of the uterus) for the fertilized egg.
Progestogen	Progestogen is a hormone which can be natural or synthetic, but has a similar effect on a woman's body as progesterone. Progestin is a synthetic hormone which has the actions of progesterone.
Pulmonary embolus	A pulmonary embolus (PE) is when a blood clot formed elsewhere, travels through the system of veins and lodges in the lungs. This can be fatal.
Surgical Menopause	Surgically-induced menopause occurs when the ovaries are removed in an operation. Due to the abrupt cut-off of ovarian hormones, surgical menopause can cause a sudden onset of menopause symptoms.
Testosterone	Testosterone is the male sex hormone found in smaller amounts in women. In women, increased levels of testosterone can lead to acne and can cause unwanted facial or body hair (hirsutism). Low levels of testosterone in women may contribute to loss of libido and sometimes low mood and energy.
Uterus	The uterus (also called the womb) is the female reproductive organ in which a baby develops during pregnancy. A menstrual period occurs when the unfertilised egg from the ovary and the lining of the uterus is shed each month.

 

Note: Medical and scientific information provided and endorsed by the Australasian Menopause Society might not be relevant to a particular person's circumstances and should always be discussed with that person's own healthcare provider.

This Information Sheet may contain copyright or otherwise protected material. Reproduction of this Information Sheet by Australasian Menopause Society Members and other health professionals for clinical practice is permissible. Any other use of this information (hardcopy and electronic versions) must be agreed to and approved by the Australasian Menopause Society.

Content updated February 2022

MAIN POINTS

• Premature ovarian insufficiency (POI) is a loss of function of the ovaries in women who are less than 40 years old.
• Spontaneous POI affects up to 4% of women less than 40 years and in most cases the cause is not identified.
• Irregular/no menstrual periods or menopausal symptoms may be the only sign of POI and blood tests are needed for diagnosis.
• POI can cause infertility and increase the risk of long-term health problems such as heart disease and osteoporosis.
• Hormone replacement therapy is recommended until the usual age of menopause (around 51 years) to reduce the long-term risks.
• Speak with your doctor about treatments and other options to manage any infertility and health consequences.

AMS Menopause before 40 and spontaneous premature ovarian insufficiency128.27 KB

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Premature ovarian insufficiency (POI) is a loss of function of the ovaries in women who are less than 40 years of age. The ovaries do not release eggs regularly and do not produce usual amounts of oestrogen.

Women with spontaneous POI have irregular or no menstrual periods. Women may or may not have menopausal symptoms such as hot flushes. 

Up to 4% of women will spontaneously have POI and enter menopause before the age of 40. Spontaneous early menopause (menopause between 40 and 45 years) affects approximately 12 in every 100 women.

POI can affect your short- and long-term physical and mental health. Speak with your doctor about emotional support and lifestyle and treatment options to manage your health.

Symptoms and consequences of premature ovarian insufficiency

POI has a number of symptoms and long-term health problems, but your doctor can advise you about treatment and other options to manage your symptoms and health (see below).

Signs and symptoms of POI can include:

• loss of menstrual periods – one of the first or only symptom of POI and can be preceded by longer or irregular periods 
• menopausal symptoms such as hot flushes and sleep disturbance, aching joints, vaginal dryness or poor lubrication during sexual arousal
• mood changes, depression and anxiety, feelings of confusion and sadness.

These symptoms can come on suddenly or gradually and can occur while you are still having periods. Long-term health consequences of premature ovarian insufficiency can include a greater risk of:

• infertility
• cardiovascular disease
• osteoporosis
• psychological distress
• memory and learning problems and dementia.

Causes of premature ovarian insufficiency

In up to 90 per cent of women with spontaneous POI, the cause is unknown. In some cases, the condition can be associated with:

• genetic conditions – in women with Turner syndrome and in women who are carriers of Fragile X syndrome. A number of other genetic changes have been identified in research studies but these cannot be screened for at present
• autoimmune conditions – such as autoimmune thyroid disease, type 1 diabetes, pernicious anaemia, myasthaenia gravis and connective tissue disorders
• rare metabolic conditions such as galactosaemia
• chemotherapy and radiation therapy (see AMS fact sheet – Early menopause – chemotherapy and radiation therapy).

Risk factors for spontaneous POI include:

• age – although younger women can have POI, the risk increases between 35 and 40 years of age
• family history of early menopause
• never having given birth
• hysterectomy
• HIV infection
• smoking
• low body weight.

Diagnosis of premature ovarian insufficiency

Diagnosis of POI is difficult and can be delayed because women and their doctors might not consider the possibility of menopause in younger women. Excluding other potential causes for the loss of your period will be needed.

Criteria for a diagnosis of POI include:

• more than four months without a menstrual period
• follicle stimulating hormone (FSH) levels in the menopausal range on two occasions at least 4–6 weeks apart.

A diagnosis of POI can be distressing and you will need to plan for your future health. Make sure you are comfortable with your healthcare team because you will need followup support and management options.

Treatment and other options for managing your health

Women with POI should discuss with their doctor the possibility of using hormone therapy.

In women more than 50 years of age, hormone therapy is called menopausal hormone therapy (MHT). In women who are aged less than 50, similar hormone therapy can be called hormone replacement therapy (HRT) because the treatment is replacing hormones that would otherwise be produced in younger women. If you choose to use HRT, international guidelines recommend that you continue HRT until the typical age of menopause (around 51 years) to reduce your risk of long-term health problems. Oestrogen therapy is not suited to everyone and is best avoided if you have breast or endometrial cancer. In these cases, non-hormonal options are available to help manage hot flushes and other symptoms.

HRT options include (see AMS fact sheet – What is MHT and is it safe?):

• oestrogen tablets, patches, gels and topical vaginal treatments – if you have had a hysterectomy
• oestrogen plus progesterone – if you have not had a hysterectomy
• combined oral contraceptive pill as a replacement hormone – if you have no significant risk factors (such as a clotting tendency, past clots or if you are a current smoker).

If contraception is required, hormonal options include the oral contraceptive pill or an intrauterine device plus oestrogen (usually as a patch or gel). If hormones are not recommended for your situation, discuss non-hormonal contraceptive options with your doctor.

Managing fertility issues

There is a very small chance that some women with POI can become pregnant. If you do not want to become pregnant, you should use contraception.

Losing fertility at an early age can cause emotional distress. The support of a partner, family, friends and your healthcare team can help you manage fertility issues.

Women can manage their infertility in a number of ways including:

• choosing not to have children
• adopting or fostering children
• trying in vitro fertilisation (IVF) or medications to stimulate egg production – these have a low chance of success
• using donated eggs
• using donated embryos from another couple.

Managing health risks associated with premature ovarian insufficiency

Adopting healthy lifestyle changes (see AMS fact sheets – Lifestyle and behaviour changes for menopausal symptoms and Weight management and healthy ageing) can reduce the risk of some of the health impacts associated with POI. Long-term health risks include:

• osteoporosis or bone loss
• cardiovascular/heart disease
• learning and memory disturbances
• emotional disturbances.

It is widely known that regular physical activity, a healthy diet and healthy sleep patterns can improve these problems, no matter what the cause. In addition, regular check-ups (including blood tests and bone scans) with your doctor can help you to manage your health.

Osteoporosis

Osteoporosis in women with POI can be caused by:

• low levels of oestrogen
• low levels of calcium in the diet
• smoking
• low levels of physical and weight-bearing activity
• some types of chemotherapy and medications.

In addition to lifestyle changes (quitting smoking, engaging in regular weight-bearing activities, and ensuring adequate dietary intake of calcium and vitamin D) women should have regular bone density scans every one or two years. Use of HRT can help to maintain bone health.

Cardiovascular or heart disease

POI can result in an earlier increase in the risk of heart disease in women.

Taking HRT early and continuing treatment until the age of a natural menopause (51 years) can reduce the risk of heart disease. Regular check-ups for high blood pressure, diabetes and fats in the blood will help you manage your heart health.

Learning and memory problems

There is only limited evidence that low levels of oestrogen affect memory. Taking HRT early and continuing treatment until the age of a natural menopause (51 years) might reduce the risk of any potential learning and memory problems.

Emotional issues

A POI diagnosis means women have the stress of having to cope with potential menopause, infertility and the related long-term consequences. It is only natural to feel some psychological distress and some women might have anxiety and depression. Women can feel confused, sad, old before their time and have mixed feelings about other women’s pregnancies. Psychological counselling can ease this distress. Support from the woman’s partner, family and friends is important.

Support groups

In addition to the support of family, friends and a healthcare team, some women find it useful to talk to other women in the same situation. Available support groups include:

ACCESS Australia (Australia’s National Infertility Network) – www.access.org.au

The Daisy Network Premature Menopause Support Group – www.daisynetwork.org.uk

NZ Early Menopause Support group – www.earlymenopause.org.nz

Where can you find information about other treatment options?

If your symptoms are bothering you, your doctor can help. Your doctor can tell you about the changes in your body and offer options for managing your symptoms. Other fact sheets about treatment options include:

• Early menopause – chemotherapy and radiation therapy

• What is Menopausal Hormone Therapy (MHT) and is it safe?

• 9 myths and misunderstandings about MHT

• Non-hormonal treatment options for menopausal symptoms

• Complementary medicine options for menopausal symptoms

• Lifestyle and behaviour changes for menopausal symptoms

• Weight management and healthy ageing

• POI and Osteoporosis infographic 

The Healthtalk Australia Early Menopause online resource contains women’s stories, information, question prompt list and links to services: https://healthtalkaustralia.org/early-menopause-experiences-and-perspectives-of-women-and-health-professionals/overview-womens-experiences/

If you have any concerns or questions about options to manage your menopausal symptoms, visit your doctor or go to the Find an AMS Doctor service on the AMS website.

NOTE: Medical and scientific information provided and endorsed by the Australasian Menopause Society might not be relevant to an individual’s personal circumstances and should always be discussed with their own healthcare provider. This Information Sheet may contain copyright or otherwise protected material. Reproduction of this Information Sheet by Australasian Menopause Society Members, other health professionals and their patients for clinical practice is permissible. Any other use of this information (hardcopy and electronic versions) must be agreed to and approved by the Australasian Menopause Society.

Content updated October 2020

MAIN POINTS

• Chemotherapy and radiation therapy for cancer and other conditions can cause temporary or permanent loss of your menstrual periods and menopause.
• Before the age of 40, this is known as premature ovarian insufficiency (POI).
• Between the ages of 40 and 45, this is known as early menopause.
• Early menopause and POI can cause infertility and have short- and long-term health consequences such as heart disease, osteoporosis and memory problems.
• Some women who have chemotherapy remain fertile, so it is important to use contraception if you do not want to become pregnant or if your doctor advises you that it is not safe to become pregnant.
• Speak with your doctor about treatments and other options to manage any infertility and long-term health consequences.

Early menopause – chemotherapy and radiation therapy102.27 KB

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Chemotherapy and radiation therapy for cancer and other conditions can cause temporary or permanent loss of your menstrual periods, which can lead to menopause and infertility.

If this occurs before the age of 40, it is known as premature ovarian insufficiency (POI) and between the ages of 40 and 45, it is known as early menopause. POI and early menopause can also happen for other reasons (see AMS fact sheet – Menopause before 40 and premature ovarian insufficiency).

Chemotherapy and radiation therapy can be toxic to the ovaries

Chemotherapy or radiation therapy can cause early menopause because these treatments are toxic to the ovaries, especially when used at high doses to treat cancer. Whole-body radiation therapy and radiation in the pelvic area are more likely to affect your ovaries. At birth, ovaries contain one million immature eggs (primordial follicles). The number of eggs naturally decreases until, at menopause, less than 1000 eggs remain. When chemotherapy or radiation therapy damages the ovaries, women can have fewer remaining immature eggs and/or the immature eggs are unable to mature. Loss of your period after chemotherapy or radiation therapy can either be temporary or permanent. If your period returns, that does not necessarily mean that your fertility returns.

Risk factors for entering early menopause

The likelihood of entering POI or early menopause after chemotherapy or radiation therapy increases:

• with increasing age
• when there are fewer eggs in the ovaries before treatment starts
• with higher doses of chemotherapy or radiation
• with radiation therapy of the whole body or pelvic area
• with some types of chemotherapy
• when doses of chemotherapy and radiation are given together.

Symptoms and health consequences of POI and early menopause

The signs, symptoms and health consequences of POI and early menopause after chemotherapy and radiation therapy include: 

• missing your period or having infrequent periods – an early symptom of POI or early menopause
• menopausal symptoms (either with or without your period) including
  • hot flushes
  • mood changes
  • problems sleeping
  • aching joints
  • dry vagina or poor lubrication during sexual arousal.
• psychological distress and increased risk of anxiety and depression because of:
  • a diagnosis of cancer or severe medical illness
  • treatment with chemotherapy/radiotherapy and the related longterm consequences
  • infertility – women often feel confused, sad, old before their time and have mixed feelings about other women’s pregnancies.
• short and long-term health risks – infertility, osteoporosis and heart disease.

Diagnosis of POI and early menopause

POI and early menopause are difficult to diagnose and the process can take many months. This can be a very stressful time and women should speak with their healthcare team for support and management options. Criteria for a diagnosis of POI or early menopause include:

• more than four months without a period
• follicle stimulating hormone (FSH) levels in the menopausal range on two occasions at least 4–6 weeks apart.

Managing fertility issues

Chemotherapy and radiation therapy might affect your fertility. Thinking about whether you will be able to have children and preserving your fertility can be overwhelming, especially when added to the stress of a diagnosis of cancer or other serious illness. Speak with your healthcare team and get the support you need. If losing fertility is a possibility, your doctor might be able to suggest options to try to preserve your ability to have children. Monthly injections with a gonadotrophin releasing hormone analogue during chemotherapy may help to preserve ovarian function. The most effective option is to have your eggs or embryos frozen before you begin treatment. Some women who have chemotherapy remain fertile, so it is important to use contraception if you do not want to become pregnant or if your doctor advises it is not safe to become pregnant. Some types of contraception are not safe for women with certain cancers or illnesses so talk to your doctor about what is best for you. For those who have developed POI or early menopause, some women choose to live a childfree life, while others adopt or foster children.

Treatment of POI and early menopause

Women with POI/early menopause should discuss with their doctor the possibility of using hormone therapy. In women more than 50 years of age, hormone therapy is called menopausal hormone therapy (MHT). In women who are aged less than 50, the same hormone therapy can be called hormone replacement therapy (HRT) because the treatment is replacing the hormones that the ovaries would be producing if you hadn’t had chemotherapy or radiation therapy.

If you choose to use HRT, your doctor might advise you to continue this treatment until the typical age of menopause (51 years).

HRT options include:

• oestrogen tablets, patches, gels and topical vaginal treatments – if you have had a hysterectomy (see AMS fact sheet – What is MHT and is it safe?)
• oestrogen plus progesterone – if you have not had a hysterectomy
• combined oral contraceptive pill as a replacement hormone – if you have no significant risk factors (such as risk of blood clotting, past blood clots or if you are a current smoker).

Oestrogen therapy is not suited to everyone and is best avoided if you have breast or endometrial cancer. Your doctor can suggest non-hormonal options to help manage hot flushes and other symptoms. If contraception is required, hormonal options include the oral contraceptive pill or an intrauterine device plus oestrogen (usually as a patch or gel). If your doctor does not recommend hormones for your situation, discuss non-hormonal contraceptive options.

Managing health risks associated with POI and early menopause

Adopting healthy lifestyle changes (see AMS fact sheets – Lifestyle and behaviour changes for menopausal symptoms and Weight management and healthy ageing) can reduce the risk of some of the health impacts associated with POI and early menopause. These health impacts include:

• osteoporosis or bone loss
• cardiovascular/heart disease
• learning and memory disturbances
• emotional issues.

It is widely known that regular physical activity, a healthy diet and healthy sleep patterns can improve these problems, no matter what the cause. In addition, regular check-ups (including blood tests and bone scans) with your doctor can help you to manage your health.

Osteoporosis

Osteoporosis in women with POI and early menopause can be caused by:

• low levels of oestrogen
• low levels of calcium in the diet
• smoking
• low levels of physical and weight-bearing activity
• some types of chemotherapy and medications.

In addition to lifestyle changes (quitting smoking, engaging in regular weight-bearing activities, and ensuring adequate dietary intake of calcium and vitamin D) women should have regular bone density scans every one or two years. Use of HRT can also help to maintain bone density.

Cardiovascular or heart disease

POI and early menopause can result in an earlier increase in the risk of heart disease in women.

Taking HRT early and continuing treatment until the age of a natural menopause (50–55 years) can reduce the risk of heart disease. A healthy lifestyle and regular check-ups for high blood pressure, diabetes and fats in the blood will help you manage your heart health.

Learning and memory problems

There is evidence that chemotherapy can cause memory problems, but there is limited evidence that low levels of oestrogen affect memory.

Taking HRT early and continuing treatment until the age of a natural menopause (51 years) might reduce the risk of learning and memory problems.

Emotional issues

In addition to a diagnosis of cancer (or severe medical illness) requiring chemotherapy/radiation therapy, women also have to cope with possible infertility and other long-term health impacts.

It is only natural to feel distressed and some women might have anxiety and depression. Women often feel confused, sad, old before their time and have mixed feelings about other women’s pregnancies. Psychological counselling can ease this distress. Support from the woman’s partner, family and friends is also important.

Support groups

In addition to the support of family, friends and a healthcare team, some women find it useful to talk to other women in the same situation. Available support groups include:

ACCESS Australia (Australia’s National Infertility Network) – www.access.org.au

Cancer Australia – www.cancer.org.au

The Daisy Network Premature Menopause Support Group – www.daisynetwork.org.uk

New Zealand Early Menopause support group - www.earlymenopause.org.nz

Where can you find more information?

If your symptoms are bothering you or you feel you need more support, your doctor can help. Your doctor can tell you about the changes in your body and offer options to manage your symptoms. Other fact sheets about treatment options include:

• Menopause before 40 and premature ovarian insufficiency
• What is Menopausal Hormone Therapy (MHT) and is it safe?
• 9 myths and misunderstandings about Menopausal Hormone Therapy (MHT)
• Non-hormonal treatment options for menopausal symptoms
• Complementary medicine options for menopausal symptoms
• Lifestyle and behaviour changes for menopausal symptoms
• Weight management and healthy ageing
• POI/ Early menopause and osteoporosis https://www.monash.edu/__data/assets/pdf_file/0010/1515187/Early-Menopause_POI-and-Osteoporosis.pdf

The Healthtalk Australia Early Menopause online resource contains women’s stories, information, question prompt list and links to services: https://healthtalkaustralia.org/early-menopause-experiences-and-perspectives-of-women-and-health-professionals/

If you have any concerns or questions about options to manage your menopausal symptoms, visit your doctor or go to the Find an AMS Doctor service on the AMS website.

NOTE: Medical and scientific information provided and endorsed by the Australasian Menopause Society might not be relevant to an individual’s personal circumstances and should always be discussed with their own healthcare provider. This Information Sheet may contain copyright or otherwise protected material. Reproduction of this Information Sheet by Australasian Menopause Society Members, other health professionals and their patients for clinical practice is permissible. Any other use of this information (hardcopy and electronic versions) must be agreed to and approved by the Australasian Menopause Society.

Content updated October 2020

MAIN POINTS

• Urinary incontinence is common in women
• Women can have stress or urge incontinence or a mixture of both
• Learning how to contract pelvic floor muscles correctly can help treat stress incontinence. Some women may need surgery
• Bladder training and vaginal oestrogen can assist with urge incontinence

AMS Urinary Incontinence in Women87.09 KB

What is incontinence?

Urinary incontinence is the involuntary loss of urine.

It is a common problem for women, getting worse with advancing age. 1 in 2 women over the age of 70 has some form of urinary incontinence. Not everyone who has had a baby has incontinence, and women who have not had children may still suffer from incontinence.

Urinary incontinence can be also associated with vaginal prolapse, chronic lower back pain, or bowel issues, including faecal incontinence. Children may also suffer from incontinence but this often has a different cause. What are the different types of incontinence? There are two main types of urinary incontinence:

• Stress incontinence
• Urge incontinence

Stress Urinary Incontinence (SUI) is more common, affecting 1 in every 5 women. Women who have not had a baby have a 1 in 10 chance of developing SUI, while for those who have had a baby, the chance rises to approximately 1 in 3.

Urge Urinary Incontinence (UUI) is less common in younger women, affecting approximately 1 in 30 women, but becomes more common with advancing age.

The difference between managing these two types of incontinence are discussed below.

In some instances, both types of incontinence can occur in one person, though the cause for each type is different. This is known as mixed incontinence. Mixed incontinence affects approximately 1 in 10 women.

What is considered normal bladder function?

• Passing urine 4-6 times per day
• Passing urine no more than once per night
• Passing 1-2 cups of urine (250-500mls) each time
• Passing urine in a steady stream until the bladder is empty
• Being able to delay passing urine until convenient, and
• Having no leakage of urine between visits to the toilet

In a woman with normal bladder function, the muscles of the pelvic floor contract when she is doing any physical activities. These activities may include sneezing, coughing, sports or any other physical effort which can cause the pressure in the abdomen to rise.

When the pressure in the abdomen rises, the muscles of the pelvic floor contract, compressing the urethra (the tube which connects the bladder to the outside) and triggering contraction of the sphincter (the muscle that wraps around the urethra to keep it closed). This prevents any leakage of urine.

What causes stress urinary incontinence?

Stress incontinence is the involuntary loss of urine often related to physical exertion. This is caused by either:

• loss of the support of the urethra by the muscles and ligaments of the pelvic floor, or
• loss of the strength of the sphincter

When the pressure in the abdomen rises, insufficient contraction of the pelvic floor means the compression of the urethra will also be insufficient. This in turn leads to insufficient contraction of the sphincter, resulting in the loss of urine and “stress incontinence”.

What causes urge urinary incontinence?

Urge urinary incontinence is the involuntary loss of urine associated with urgency (having to rush to the toilet), or being unable to delay passing urine until a convenient time.

The uncontrollable need to pass urine occurs due to overactivity of the muscle of the bladder wall. It is associated with increased urinary frequency, urgency and needing to wake up multiple times during the night in order to pass urine. Typically, the feeling of urgency can be associated with daily activities, such as when you put the key in the front door, or when water is running. This is also known as overactive bladder syndrome. Some people with overactive bladder syndrome can feel urgency, but not actually leak any urine.

Mixed urinary incontinence is the involuntary loss of urine associated with both urgency and any physical exertion, or when sneezing or coughing.

Management of Stress Incontinence

Strengthening the pelvic floor muscles and learning how to contract them correctly is an important step in managing SUI. About one in two women are unable to contract their pelvic floor correctly. Nurse Continence Advisors or physiotherapists specialised in pelvic floor management can assist you with a personalised training program of pelvic floor muscle contractions. They will also teach you "the knack”. “The knack” is contracting your pelvic floor before coughing, sneezing, or doing anything that raises the pressure in your abdomen. The training can also help you learn how to isolate the muscles of your pelvic floor around the anal area, to help control any anal incontinence and the passage of wind.

Other approaches to treating stress incontinence

Using stool bulking agents or softeners will help avoid constipation and having to strain when opening your bowels. When emptying the bowels and bladder, it may also help to use a low stool to elevate the knees slightly higher than hips, relaxing the pelvic floor and the abdomen. Additionally, avoiding heavy lifting can help avoid raised intra-abdominal pressure leading to SUI.

Some women may be able to use a continence pessary, which is inserted into the vagina and supports the bladder neck, helping to reduce leakage.

Another non-surgical option is duloxetine, an antidepressant medication known as a serotonin and noradrenaline reuptake inhibitor (SNRI). It may help some women but its use is not approved for this purpose in Australia or New Zealand.

Your doctor may recommend surgery if other treatments have not helped. You may be referred to a specialist urogynaecologist to discuss the benefits and risks of surgery for SUI. The types of surgery available for SUI include urethral bulking agents, midurethral slings, colposuspension, or an autologous fascial sling.

None of the types of surgery currently available have a 100% cure rate, however for 80-90% of women, their surgery will provide significant improvement at 12 months post-surgery.

For incontinence caused by neurological disorders, such as multiple sclerosis or spinal cord injury, management should be tailored to the individual woman's needs.

It’s very important to have an accurate diagnosis of SUI before considering surgical treatment because it can make overactive bladder symptoms worse. The diagnosis of SUI can be established with a special test called urodynamic studies. This test is essential before surgery is undertaken.

Management of Urge Incontinence

This usually starts with simple measures, such as using vaginal oestrogen and seeing a physiotherapist to help with pelvic floor rehabilitation. Learning how to retrain your bladder to hold larger amounts of urine can help reduce the urge to pass urine.

Retraining the bladder includes learning how to contract pelvic floor muscles repeatedly and practising how to hold the contraction for a specific period of time. Wiggling your toes can also help reduce urge incontinence as this sends a signal to the bladder to relax.

If you are overweight, even 5% weight loss can improve urinary urgency significantly. Removing bladder irritants can also help reduce the urge symptoms. Common bladder irritants include alcohol, caffeine (especially tea & coffee) and fizzy drinks. If you are postmenopausal, vaginal oestrogen may be prescribed to use as a vaginal cream or tablet. Oestrogen can plump up the lining of the vagina, which thins out once you go through menopause, and may provide some improvement in incontinence. However, the effect wears off once you stop using the treatment. The amount of oestrogen that gets absorbed into the body is very small and considered safe. Women who have had breast cancer should consult with their doctor to discuss whether or not they can use vaginal oestrogen.

Adding in anticholinergic medications can help in addition to bladder training and weight loss. These medications aim to decrease the contractions of the detrusor (bladder wall muscle). Another available medication is called mirabegron. Some of these medications can be quite expensive as not all of them are available on the Pharmaceutical Benefits Scheme (PBS).

If a trial of two or more medications has not helped, you may need to see a specialist who will talk to you about other treatment options, including injections of Botulinum toxin (Botox) into the bladder wall. Percutaneous tibial nerve stimulation (PTNS), or sacral nerve stimulator implants can also help by interfering the urge signals from the bladder through the process known as neurological modulation.

Where to seek further help/ information:

Your GP can start management, and if necessary, refer you onto a Gynaecology or Urogynaecology clinic.

Helpful online resources include: 

• Australian Physiotherapy Association website: http://physiotherapy.asn.au  then click “Find a Physio” and choose a Women's Health & Continence physio in your area
• www.UGSA.com.au  then click “Patient Information”
• www.yourpelvicfloor.org 

If you have any concerns or questions about options to manage your menopausal symptoms, visit your doctor or go to the Find an AMS Doctor service on the AMS website.

NOTE: Medical and scientific information provided and endorsed by the Australasian Menopause Society might not be relevant to an individual’s personal circumstances and should always be discussed with their own healthcare provider. This Information Sheet may contain copyright or otherwise protected material. Reproduction of this Information Sheet by Australasian Menopause Society Members, other health professionals and their patients for clinical practice is permissible. Any other use of this information (hardcopy and electronic versions) must be agreed to and approved by the Australasian Menopause Society.

Content updated May 2020

MAIN POINTS

• Vaginal laser is a new treatment being offered for some menopausal symptoms
• There is insufficient high quality evidence for its safety and benefits
• Vaginal oestrogen is safe and effective and can be used by most women
• Vaginal laser for menopausal symptoms is not approved by regulatory authorities in Australia and the USA  

Vaginal Laser Therapy63.05 KB

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What is vaginal laser treatment and what is it used for?

Vaginal laser treatments are now being offered to women to treat symptoms commonly found after menopause. Low oestrogen after menopause can cause vaginal dryness and inflammation, pain during intercourse and urinary symptoms. The CO2 (carbon di-oxide) laser has been used for many years in other areas of medicine, especially for the treatment of some skin conditions, pre-cancerous cervical abnormalities and genital warts. After using some local anaesthetic cream, a probe is inserted into the vagina. Beams of light penetrate the tissue causing heat-related injury. This causes collagen production as it heals. A series of several treatments spaced some weeks apart is usually recommended and “top-up” treatments may be advised.

What are the risks and benefits of vaginal laser therapy?

Currently in Australia and the USA, the CO2 laser has not been approved for use in treating menopausal symptoms because there has not been enough high-quality research evidence supporting its benefit and safety. In the USA, the Food and Drug Administration (FDA) has issued a warning about the use of laser therapy for “vaginal rejuvenation”. In addition to CO2 laser, there are other types of lasers and radio frequency devices being used in a similar way and without good evidence. Some studies have shown that vaginal laser helps to thicken the fragile vaginal lining and increase lubrication, with improvement in vaginal dryness, pain, and urinary symptoms. However, there are potential complications such as scarring, infection, pain and altered sexual sensation. This is a relatively new treatment and so far, there are no good studies of long-term follow-up. In addition, there are concerns that women are being sold an expensive treatment where there is a safer and much cheaper option available.

What other treatments are available?

Vaginal oestrogen treatments are safe and effective in most women other than those with breast cancer. They remain the “gold standard” for treatment of vaginal dryness. For some women with breast cancer who are unable to use vaginal oestrogen, non-hormonal vaginal moisturizers are available although they may not be as effective.

Where can I go for help?

Your doctor can discuss your concerns and examine you. It is very important to check for other conditions that may be causing your symptoms.

Information for your doctor to read includes AMS Information Sheet:

• Vulvovaginal symptoms after menopause

Further reading includes:

1. US Food and Drug Administration 2018. FDA warns against use of energy-based devices to perform vaginal ‘rejuvenation’ or vaginal cosmetic procedures: FDA safety communication. http://www.fda.gov/MedicalDevices/Safety/ AlertsandNotices/ucm615013.htm. Updated July 30, 2018. Accessed 29 November, 2018

2. Buttini M, Maher C. The first published randomised controlled trial of laser treatment for vaginal atrophy raises serious questions. MJA 2018;209(9):376-377.

3. Buttini M, Maher C. To the Editor. Menopause 2018;25(8):951.

If you have any concerns or questions about options to manage your menopausal symptoms, visit your doctor or go to the Find an AMS Doctor service on the AMS website.

NOTE: Medical and scientific information provided and endorsed by the Australasian Menopause Society might not be relevant to an individual’s personal circumstances and should always be discussed with their own healthcare provider. This Information Sheet may contain copyright or otherwise protected material. Reproduction of this Information Sheet by Australasian Menopause Society Members, other health professionals and their patients for clinical practice is permissible. Any other use of this information (hardcopy and electronic versions) must be agreed to and approved by the Australasian Menopause Society.

Content updated March 2019

MAIN POINTS

• Falls and fractures can happen at any age, but the risk increases as women age.
• Falls in older people are more likely to cause more severe injuries.
• Low bone density, low muscle strength and poor balance are more likely as women age and increase the risk of falls.
• Improving your bone health can also help decrease the risk of falls and decrease the severity of any injuries or other consequences if you do fall.
• Appropriate physical activity can help decrease several fall risk factors.
• Speak with your doctor, assess your overall health and make changes to decrease your risk of a fall.

Decreasing the risk of falls and fractures before, during and after menopause67.29 KB

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You can reduce your risk of having a fall. The years before, during and after menopause are great times to speak with your doctor, assess your overall health and make changes to decrease your risk of a fall.

By the numbers – falls and fractures in women after the age of 40

Between the ages of 40 and 60 years, women begin to experience a decrease in the ability to balance and a decrease in bone density. Both of these changes contribute to the likelihood of both a fall and more severe outcomes after a fall. Here are some statistics showing the increase in the risk of falls as women age:

• After the age of 50, one in two women will break a bone at some stage during the rest of her life because of a fall.
• One in five women will fall each year before she reaches the age of 60.
• One in three women will fall each year after the age of 65.
• One in two women will fall each year after the age of 80.

In older people, 30 per cent of falls result in more severe injuries such as head trauma, hip fracture, other fractures and dislocations. Of the hip fractures in older people, more than 90 per cent are caused by a fall – 25 per cent of people with hip fractures die within 12 months and 25 per cent never regain full mobility. After a fall, older people can also lose confidence and become less physically and socially active.

Factors increasing the risk of falls and fractures

A proper review of your risk of falls and bone fractures can be performed by healthcare professionals. Self-assessment tools are also available to help you to uncover any risk factors. Your risk of having a fall increases if you have:

• low bone density / osteoporosis – women 60 years or older with osteoporosis have twice the risk of falling
• decreased strength in your lower body
• decreased balance, reaction time and postural stability
• a history of previous falls
• other medical conditions including (but not limited to) – hearing and vision problems, heart disease, incontinence or dementia.

Decreasing your risk of falls and fractures

Your doctor can suggest steps you can take to decrease your risk of falls. These include:

• increasing muscle strength through physical activity
• maintaining or improving your bone density (see section below)
• improving your mobility through physical activity
• improving balance through physical activity
• having your vision and hearing checked
• making sure your footwear is appropriate
• reviewing your environment for tripping hazards
• speaking with your doctor if you have a fear of falling or feel physically or socially restricted.

Maintaining or improving your bone health decreases the risk of falls and fractures and may decrease the severity of injuries or other consequences if you do fall.

You can improve your bone health with:

• physical activity to improve bone density, muscle strength, mobility and balance – weight-bearing activities or strength training can improve your muscle strength, bone density and mobility, while activities such as Tai Chi, yoga or Pilates can improve balance
• adequate calcium intake – a minimum of 1200g per day, preferably from dietary sources
• Vitamin D – helps calcium absorption and maintains bones. Low vitamin D blood levels are common in Australia and you may need supplements if your blood levels are low
• anti-osteoporosis medications, including menopausal hormone therapy (MHT), can reduce the risk of a first fracture and especially further fractures by up to 70%.

Where can I find more information?

Lifestyle and behaviour changes for menopausal symptoms (See AMS fact sheet Lifestyle and behaviour changes for menopausal symptoms)

Osteoporosis (www.osteoporosis.org.au)

Calcium Supplements (See AMS information sheet Calcium supplements)

Self-assessment tool: Are you at risk of osteoporotic fracture?

Self-assessment tool: Know your bones

If you have any concerns or questions about options to manage your menopausal symptoms, visit your doctor or go to the Find an AMS Doctor service on the AMS website.

NOTE: Medical and scientific information provided and endorsed by the Australasian Menopause Society might not be relevant to an individual’s personal circumstances and should always be discussed with their own healthcare provider. This Information Sheet may contain copyright or otherwise protected material. Reproduction of this Information Sheet by Australasian Menopause Society Members, other health professionals and their patients for clinical practice is permissible. Any other use of this information (hardcopy and electronic versions) must be agreed to and approved by the Australasian Menopause Society.

Content updated March 2019

MAIN POINTS

• Weight gain during and after menopause has more to do with your lifestyle and the changes of ageing than with hormonal changes of menopause.
• The hormonal changes of menopause can cause fat to settle in your abdomen rather than your hips, thighs and buttocks.
• Menopausal Hormone Treatment (MHT) does not cause weight gain and can reduce the abdominal fat caused by menopause.
• Menopause is a great time to visit your doctor, assess your overall health and make changes to improve your lifestyle and health.
• Eating a healthy diet, engaging in physical activity, stopping smoking and drinking less alcohol will help you to maintain a healthy weight beyond menopause. 

Maintaining your weight and health during and after menopause98.50 KB

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Both men and women can gain weight as they age, but for women, it can be difficult to separate the effects of ageing from the effects of menopause.
Menopause is a great time to speak with your doctor, assess your overall health and make changes to improve your lifestyle.

Lifestyle choices and ageing are the main cause of weight gain after menopause

Between the ages of 45 and 55, women gain on average half a kilo a year. Contrary to popular belief, weight gain around menopause is mainly associated with your lifestyle and ageing. Hormonal changes of menopause do result in a change in body composition with increased fat and decreased muscle (thus no net change in weight) and can cause fat to settle in your abdomen rather than your hips, thighs and buttocks. It is a myth that Menopausal Hormone Therapy (MHT) causes weight gain, although some women might experience some fluid retention. On the contrary, MHT can decrease the accumulation of abdominal fat after menopause. The good news is that making healthy lifestyle choices can help you to achieve and/or maintain a healthy weight and improve your future health. Healthy choices help at any age, but are even more important around the time of menopause. Healthy choices you can make at menopause include:

• monitoring menopausal symptoms and other body changes and getting early advice from your doctor
• ensuring adequate intake of calcium (preferably through your diet) and vitamin D
• eating a healthy diet
• maintaining a healthy weight
• engaging in physical activity
• stopping smoking
• drinking no more than two standard alcoholic drinks per day.

Benefits of maintaining a healthy weight beyond menopause

Excess abdominal fat is associated with heart(cardiovascular) disease and diabetes, so decreasing abdominal fat by maintaining a healthy weight can decrease your risk of these diseases. For both women and men, maintaining a healthy weight and engaging in physical activity can also reduce the risk of other diseases such as cancer and dementia. Obesity is a risk factor for more severe menopausal symptoms, so losing weight if you are overweight might also help to improve your symptoms. Lifestyle choices will also improve your bone health and reduce the risk of osteoporosis. Post–menopausal women should consume 1300 mg of calcium each day (equivalent to 3–4 serves of low-fat dairy), preferably spread throughout the day. For older women, adequate vitamin D requires 15 to 30 minutes of sunshine, two to three times per week, but speak with your doctor about whether you might need vitamin D supplements. Participating in weight bearing and resistance exercise is also important (see below). Low body weight (body mass index<18) is a risk factor for osteoporosis.

Healthy eating to reach and maintain a healthy weight

Whatever your weight, to reduce the risk of chronic disease you should eat a wide variety of nutritious foods. This strategy will also help you to improve your health through maintaining a healthy weight. If you are overweight or you are gaining weight, speak with your doctor about a healthy diet plan and other lifestyle changes. We now know that diet and exercise plans should be tailored for each person and should take into consideration your physical condition and personal circumstances. The debate about which dietary strategy (eg. low fat, low carbohydrate, high protein, intermittent fasting) is best to lose body fat is ongoing and requires more research. Your doctor is best placed to understand both your situation and the latest research and can discuss which approach might be best for you.

Physical activity to promote your future health

During and after menopause, adequate physical activity can reduce the risk of chronic diseases of ageing and has other potential benefits such as:

• reducing cholesterol, blood pressure and improving heart health
• improving physical abilities and reducing risk of falls– strength, coordination, balance and endurance
• increasing muscle mass and bone strength reducing the risk of osteoporosis.

Your doctor can recommend a program of physical activity suited to your current physical condition.

The Australian physical activity and sedentary behaviour guidelines for adults 18–64 years recommend physical activity for all adults at all ages, including women during and beyond menopause.

The recommendation is for people to do either:

• 150 minutes (2.5 hours) of moderate intensity physical activity weekly

or

• 75 minutes (1.25 hours) of vigorous intensity physical activity weekly.
• To obtain greater benefits and help weight loss, avoid unhealthy weight gain and to reduce the risk of cancer, the recommendation is for women to do:
• 300 minutes (5 hours) of moderate intensity physical activity weekly

or

• 150 minutes (2.5 hours) of vigorous intensity physical activity weekly.

Activities of moderate intensity take effort, but you will still be able to talk. Examples include:

• brisk walking
• recreational swimming
• dancing
• household tasks like cleaning windows or raking leaves
• pushing a stroller.

Activities of vigorous intensity need more effort, and breathing becomes harder and faster. Examples include:

• jogging
• aerobics
• fast cycling
• organised sports
• tasks involving lifting, carrying or digging.

Muscle-strengthening exercises are also recommended at least twice per week.

If you are more than 65 years old, your physical activity program must take into account your health status and previous experience of a particular activity. Speak with your doctor for advice.

Where can I find further information?

• Myths about MHT (see AMS fact sheet – 9 myths and misunderstandings about menopausal hormone therapy)
• Osteoporosis (see www.osteoporosis.org.au)
• Healthy eating (see www.eatforhealth.gov.au)
• Physical activity (see Australian physical activity and sedentary behaviour guidelines for adults 18–64 years at http://www.health.gov.au/internet/main/publishing.nsf/content/health-pubhlth-strateg-phys-act-guidelines#apaadult)
• Information for your doctor to read includes AMS Information Sheets:
  Osteoporosis
  Weight management and healthy ageing 

If you have any concerns or questions about options to manage your menopausal symptoms, visit your doctor or go to the Find an AMS Doctor service on the AMS website.

NOTE: Medical and scientific information provided and endorsed by the Australasian Menopause Society might not be relevant to an individual’s personal circumstances and should always be discussed with their own healthcare provider. This Information Sheet may contain copyright or otherwise protected material. Reproduction of this Information Sheet by Australasian Menopause Society Members, other health professionals and their patients for clinical practice is permissible. Any other use of this information (hardcopy and electronic versions) must be agreed to and approved by the Australasian Menopause Society.

Content updated February 2019

MAIN POINTS

• The Australasian Menopause Society does not recommend the use of compounded bioidentical hormone therapy in any form.
• Many pharmaceutical-grade, approved menopause hormone therapies (MHTs) prescribed by your doctor are ‘body-identical’ – i.e. they contain hormones identical to those produced in the human body.
• Compounded bioidentical hormones (BHTs) are not more ‘natural’ – even when made from plants, they must be chemically synthesised in a laboratory.
• Compounded BHTs are not tested for quality, safety and negative side effects and they have been associated with cases of endometrial cancer.
• There is no evidence that compounded BHTs are effective and safe to use.

AMS Compounded Bioidentical HT89.17 KB

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Many women are attracted to the idea of using ‘natural’ forms of hormones that are identical to those produced by the body before menopause. For this reason, an industry has sprung up selling compounded bioidentical hormone therapies (BHT) with the claim that these are a better source of hormones.

Compounded BHT preparations are handmade by some pharmacists and are marketed as ‘safe’, natural and superior to conventional, pharmaceutical-grade menopause hormone therapy(MHT). Some marketing even claims the compounded BHTs have ‘anti-ageing’ effects. The marketing often describes MHT as ‘synthetic’ when, in fact, many MHTs contain the same hormones as those produced by the body.

As you will read below, these claims are either not true or are inaccurate.

The Australasian Menopause Society does not recommend the use of compounded bioidentical hormone therapy in any form including creams, lozenges and pessaries. If you are having menopausal symptoms, see your doctor to discuss your concerns and treatment options.

Compounded bioidentical hormones are not more ‘natural’ than MHT

Even if compounded BHTs are produced from plant sources, the hormones must be chemically synthesised in a laboratory, just like conventional MHT. The oestradiol found in many conventional MHTs is the same hormone produced by ovaries before menopause, so many MHTs could also be described as ‘natural’ or ‘bioidentical’. ‘Bioidentical or ‘body-identical’ hormone therapies are terms which can be applied to pharmaceutical-registered MHT products where the hormones have the same chemical structure as those produced in the human body.

Many conventional MHTs contain hormones identical to those produced in the body

When using MHT, you can be assured the safety and effectiveness of the products has been widely tested and you can avoid the uncertainty and potential dangers of compounded BHTs. In most cases, MHT is also cheaper. If you wish to use products containing pharmaceutical-grade body-identical hormones, the following approved and regulated products are available in Australia and New Zealand:

• oestradiol – as tablets, transdermal patches or gel and as a vaginal treatment
• progesterone – as capsules in Australia (‘Prometrium’) and NZ (‘Utrogestan’).

Compounded bioidentical hormones are not safer than MHT

The reputation and use of MHT went into decline after the highly publicised Women’s Health Initiative (WHI) studies in 2002and 2004 led to confusion among women and doctors. This contributed to the rise of the compounded BHT industry.

We now have a much better understanding of the risks and benefits of MHT, as more information has been collected and the WHI studies have been reassessed.

Today, there are many treatment options using regulated MHTs with known and tested quantities of hormones. These are available in many different combinations and forms such as tablets, transdermal patches, gels or vaginal treatments. Doctors can now tailor MHT for each woman’s personal health situation to give the best possible results with the lowest possible risk.

In contrast:

• compounded BHT preparations have not been tested for quality, safety or negative side effects
• there is no way to know if compounded BHTs are contaminated with other additives
• compounded BHTs are not regulated and standardised like pharmaceutical-grade MHT.

Compounded bioidentical hormones have been associated with endometrial cancer

If you still have your uterus, your doctor can prescribe conventional MHT containing progestogens to protect your uterus and reduce the risk of endometrial cancer.

Of concern, compounded BHTs have been associated with cases of endometrial cancer, after the compounded progestogen component did not protect women from endometrial cancer.

Compounded bioidentical hormones do not work better than MHT

There is no evidence that compounded BHTs are more effective than conventional MHT. It is difficult to know the levels of hormones compounded BHTs will produce in your body for a number of reasons:

• Compounded BHTs are handmade for women often based on expensive, saliva testing for hormone levels – these tests are not standardised and are not quality controlled.
• Compounded BHTs are not regulated and standardised like pharmaceutical-grade MHTs.
• It is impossible to know the exact quantities of hormones in a handmade preparation of compounded BHT and it is impossible to know what else has been added or whether it is contaminated.

Even if compounded BHT preparations result in an adequate level of hormones in your body to decrease your menopausal symptoms, you will still have the side effects of those hormone levels and, at the same time, you will have no way of knowing if the compounded BHT is safe (see above).

Compounded bioidentical hormones are sold outside Pharmacy Board Guidelines

Compounded BHTs are sold outside Pharmacy Board Guidelines, which state that medications can be compounded only for research purposes or if a commercial product is not available or not suitable.

As pharmaceutical-grade MHTs are available and can deliver ‘body-identical’ hormones, this means compounded BHTs are not required and their preparation and sale is outside the guidelines.

Where can you find information about other treatment options?

If your symptoms are bothering you, your doctor can help. Your doctor can tell you about the changes in your body and offer options for managing your symptoms. Other fact sheets about treatment options include:

• What is MHT and is it safe?
• Non-hormonal treatment options
• Complementary medicine options for menopausal symptoms
• Lifestyle and behaviour changes for menopausal symptoms.

If you have any concerns or questions about options to manage your menopausal symptoms, visit your doctor or go to the Find an AMS Doctor service on the AMS website.

NOTE: Medical and scientific information provided and endorsed by the Australasian Menopause Society might not be relevant to an individual’s personal circumstances and should always be discussed with their own healthcare provider. This Information Sheet may contain copyright or otherwise protected material. Reproduction of this Information Sheet by Australasian Menopause Society Members, other health professionals and their patients for clinical practice is permissible. Any other use of this information (hardcopy and electronic versions) must be agreed to and approved by the Australasian Menopause Society.

Content updated September 2018

MAIN POINTS

• Many of the myths about MHT come from the Women’s Health Initiative (WHI) studies of 2002 and 2004. New information about MHT means doctors better understand the risks and benefits of MHT.
• MHT is the best way to control menopausal symptoms and gives some women health benefits.
• Combined MHT (oestrogen plus progestogen) or oestrogen alone cause no significant increase in breast cancer or heart disease risk in women aged 50 to 59 or in women who start treatment within 10 years of menopause. 

9 myths and misunderstandings about Menopausal Hormone Therapy (MHT)90.28 KB

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Menopausal Hormonal Therapy (MHT) is the best treatment to improve hot flushes and quality of life for menopausal women. In the early 2000s, the Women’s Health Initiative (WHI) studies of postmenopausal women caused confusion among women, the media and doctors. New information about MHT and the WHI studies means doctors better understand the risks and benefits of MHT.

1. Misunderstanding – MHT will make you put on weight

Women who use MHT do not gain any more weight than women who do not use MHT. Ageing, social, lifestyle and medical factors are the main causes of midlife weight gain. The hormonal changes of menopause do cause fat to move from the hips to the abdomen.

2. Myth – Breast cancer is the most common cause of death in postmenopausal women

Fear of breast cancer is a major reason why women do not use MHT. Many postmenopausal women believe they are more likely to die from breast cancer than heart disease or stroke. The opposite is true. For example, in Australia in 2014, 12 in every 100 women died from coronary heart disease, nine in 100 from stroke and four in 100 from breast cancer.

3. Misunderstanding – One-quarter of women who take MHT get breast cancer

This misunderstanding came about because some journalists incorrectly reported the early WHI study results. New information combined with better understanding suggests that:

• Five years taking combined MHT (oestrogen plus progestogen) did not increase breast cancer risk in women aged 50 to 59 or in women who started treatment within 10 years of menopause. After 13 years, women had a small increase in breast cancer risk (nine extra cases of breast cancer per 10,000 women)
• Seven years taking oestrogen only MHT did not increase breast cancer risk in women aged 50 to 59 or in women who started treatment within 10 years of menopause. After 13 years, there was still no increased risk of breast cancer.

4. Misunderstanding – MHT increases the risk of heart disease

An analysis of all studies (40,410 women) showed MHT did not increase the number of deaths from heart and blood vessel disease or heart attacks. MHT also did not increase the number of cases of angina in healthy women or in women with pre-existing heart and blood vessel disease.

5. Myth – A blood test is necessary to diagnose menopause

Blood tests for hormone levels and other tests are not needed to diagnose menopause. A woman is considered postmenopausal when she is over the age of forty-five and has had at least 12 months without a period. Blood tests can be helpful for women who are younger than forty years of age or who have had a hysterectomy and have menopausal symptoms.

6. Myth – Complementary medicines and therapies are as effective as MHT and safer

MHT remains the most effective way to control menopausal symptoms. Some complementary medicines and therapies are promoted as natural and safe without evidence that they work. Some products (such as soy) should be avoided if you are unable to take prescribed MHT for safety reasons. Often there is no way to know if complementary therapies are safe or uncontaminated, especially if they are bought online. Speak with your doctor about complementary medicines or therapies. They might not be suitable for your situation.

7. Myth – Compounded bioidentical hormone therapy is safer than conventional MHT

Doctors advise against the use of compounded bioidentical hormone therapy. “Bioidentical hormones” are chemically the same as those produced by the body. Some MHTs prescribed by your doctor are “bioidentical”. There is no evidence that compounded bioidentical hormone therapy is better than prescribed MHT.

Compounded bioidentical hormone therapy offers no advantages and many disadvantages because there are:

• no regulations for their use
• no standards for quality of manufacturing
• no testing of the products for negative effects, quality or safety.
• serious side effects such as endometrial cancer
• possible higher costs

8. Misunderstanding – All progestogens have the same risks

Therapy combining progestogens and oestrogen is used to reduce the risk of cancer of the uterus in women who still have a uterus. Progestogen is a term that covers both progesterone (naturally occurring in humans) and progestins (synthetic progesterones). Different types of progestogens have different risks. Your doctor can discuss the different MHT options available and work with you to reduce your risk.

9. Misunderstanding – Non-hormonal medications are as effective as MHT for hot flushes

Evidence suggests non-hormonal treatments are not as effective as MHT, although more studies are needed. You should ask your doctor about non-hormonal treatment options if you are not able to use MHT for medical reasons or you do not want to use MHT.

Where can you find information about MHT and other treatment options?

If your symptoms are bothering you, your doctor can help. Other AMS fact sheets about treatment options include:

 

• What is Menopausal Hormone Therapy (MHT) and is it safe?
• Non-hormonal treatment options for menopausal symptoms
• Complementary medicine options for menopausal symptoms
• Lifestyle and behaviour changes for menopausal symptoms.

Information for your doctor to read includes AMS Information Sheets:

• Risks and benefits of MHT/HRT
• Non-hormonal treatments for menopausal symptoms
• Lifestyle and behavioural modifications for menopausal symptoms
• Complementary and herbal therapies for hot flushes

If you have any concerns or questions about options to manage your menopausal symptoms, visit your doctor or go to the Find an AMS Doctor service on the AMS website.

NOTE: Medical and scientific information provided and endorsed by the Australasian Menopause Society might not be relevant to an individual’s personal circumstances and should always be discussed with their own healthcare provider. This Information Sheet may contain copyright or otherwise protected material. Reproduction of this Information Sheet by Australasian Menopause Society Members, other health professionals and their patients for clinical practice is permissible. Any other use of this information (hardcopy and electronic versions) must be agreed to and approved by the Australasian Menopause Society.

Content updated October 2018

MAIN POINTS

• Many women wonder if lifestyle and behaviour changes can help with menopausal symptoms.
• Studies have shown mixed results for lifestyle changes, so speak with your doctor if you have any questions.
• Maintaining healthy weight might be helpful as there is evidence that weight gain can increase the severity of menopausal symptoms
• Some evidence suggests yoga can help menopausal symptoms. Other activities such as exercising, breathing and relaxation practices or controlling environmental temperature might not necessarily help your symptoms, but they can help with your overall sense of wellbeing.
• Cognitive behaviour therapy (CBT) can improve wellbeing and decrease the impact of menopausal symptoms.
• Hypnosis might give you some benefit, but there is no evidence that acupuncture, magnetic therapy, reflexology or chiropractic  interventions help menopausal symptoms.

AMS Lifestyle and behaviour changes for menopausal symptoms92.27 KB

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Many women are interested in the potential of lifestyle and behaviour changes to manage their menopausal symptoms. Unfortunately, the clinical evidence for the effectiveness of lifestyle changes is mixed and limited.

If your symptoms are bothering you, your doctor can explain how specific lifestyle changes might suit your situation. Everyone should consult their doctor before embarking  on lifestyle and behaviour changes  and this is especially important  if you have menopausal symptoms.

Lifestyle changes

Maintain healthy weight

Women often ask their doctors about menopause and weight gain. It is a myth that menopause causes weight gain and in fact the opposite is true- evidence suggests  that weight gain can make your menopausal symptoms worse.

Ask your doctor for exercise and dietary advice to suit your situation.  General principles  of a healthy diet include consuming:

• 6300 to 6700 kJ (1500 to 1600 calories) per day to maintain weight
• 5450 to 5900 kJ (1300 to 1400 calories) per day to lose weight
• three main meals and two protein-containing snacks per day
• smaller portions
• more oily fish such as salmon, trout, sardines, mackerel
• less meat
• less fat and sugar.

Exercise regularly

Exercise may not directly help your hot flushes and night sweats, but it can help to maintain healthy weight and this can decrease the severity of your symptoms.

Exercise has many mental and physical benefits and builds more muscle mass.  This extra muscle burns more energy even when you are resting. Exercise can also help reduce the risk of osteoporosis, a possibility for some menopausal women.

You will get the best benefit if you incorporate three types of movement into your day:

• aerobic activity for heart health - climbing stairs, walking the dog and gardening all help to build more movement into your day
• flexibility training such as stretching, yoga or pilates improve both flexibility and balance
• strength training helps to build bone and muscle and can include simple body weight  exercises you can do at home. Get advice from your doctor before lifting heavy weights.

Everyone should visit their doctor before starting a new exercise program. For more ideas about exercise, see the AMS information sheet Lifestyle advice for healthy ageing.

Control your environment to improve cooling

Common sense changes to your environment  can help to make you more comfortable, even if such changes do not directly decrease your symptoms.

Changes  you can make include:

•  adjusting clothing
  • dress in layers
  • wear sleeveless blouses or tops
  • wear clothing made of natural fibres that breathe
  • avoid jumpers and scarves
• using a hand fan or electric fan as required
• keeping cooler at night
  • lower the room temperature
  • put a cold pack under the pillow
  • turn the pillow over to the cool side when feeling warm
  • use dual control electric blankets
  • use a bed fan that blows air between the sheets
• drinking cool liquids such as iced water.

Avoid hot flush triggers

If you have noticed that some triggers can increase the frequency or severity of your hot flushes and night sweats, avoiding these triggers might help.

Triggers include:

• spicy foods
• smoking - a risk factor for hot flushes
• alcohol -can trigger hot flushes and you might find your flushes improve if you avoid alcohol

Mind- and body-based therapies and practices

Cognitive behaviour  therapy

Group and individual cognitive behaviour therapy (CB1) can help you to change unhelpful ways of thinking, feeling and behaving. Studies suggest  CBT can help you cope  with the impact  of menopausal symptoms while also increasing your wellbeing.

Yoga, breathing  practices and relaxation

While all of these practices  can help with wellbeing,  only yoga has been shown in some studies to improve menopausal symptoms and sleep.

Other therapies

Hypnosis

Studies have shown varied results, but a recent trial suggested that hypnosis might help with hot flushes and sleep.

Acupuncture

A large Australian trial recently showed that acupuncture has no benefit for menopausal symptoms.

Magnetic therapy,  reflexology, chiropractic interventions

Studies have not shown that any of these therapies help women with menopausal symptoms.

What are the other treatment  options?

If your symptoms are bothering you, your doctor can help. Your doctor can tell you about the changes  in your body  and offer options for managing your symptoms. Other treatment  options include:

• Menopausal Hormone Therapy (See AMS fact sheet - What is MHT and is it safe?)
• Complementary therapies (See AMS fact sheet­ Complementary medicine options for menopausal symptoms)
• Non-hormonal prescribed medications (See AMS fact sheet ­Non-hormonal  treatment options for menopausal symptoms).
• Cognitive behavioural therapy for menopausal symptoms (see https://www.womens-health-concern.org).

Information for your doctor to read includes AMS Information Sheets:

• Combined menopausal hormone therapy
• Oestrogen only menopausal hormone therapy
• Non hormonal treatments for menopausal symptoms
• Complementary and herbal therapies for hot flushes

If you have any concerns or questions about options to manage your menopausal symptoms, visit your doctor or go to the Find an AMS Doctor service on the AMS website.

NOTE: Medical and scientific information provided and endorsed by the Australasian Menopause Society might not be relevant to an individual’s personal circumstances and should always be discussed with their own healthcare provider. This Information Sheet may contain copyright or otherwise protected material. Reproduction of this Information Sheet by Australasian Menopause Society Members, other health professionals and their patients for clinical practice is permissible. Any other use of this information (hardcopy and electronic versions) must be agreed to and approved by the Australasian Menopause Society.

Content updated October 2018