Rhonda Garad, Monash University and Amanda Vincent, Monash University

We have seen increasingly dramatic headlines over the years on the risks of menopausal hormone therapy (MHT), also known as hormone replacement therapy.

An alarming study in 2002, which found an apparent increased risk of breast cancer in women who took MHT, prompted the first of these headlines.

But newer evidence has been reassuring. It’s also a reminder that when considering your options, any risk associated with taking MHT needs to be balanced with the benefits.

This balance is the main thing your GP will consider when discussing whether MHT is right for you.

21 October 2019:

This radio braodcast with Professor Martha Hickey and Dr Liz Farrell (AMS member and a past AMS President) is available to listen online of as a podcast.

ABC Radio
On Nightlife with Philip Clark

About half the population will go through menopause at some point in their lives - What are the symptoms? How effective is HRT is treating these symptoms? And How does menopause affect women at work? 

Helping us better understand the impacts of menopause are: Professor Martha Hickey, Professor of Obstetrics and Gynaecology at the University of Melbourne, and Dr. Elizabeth Farrell, a gynaecologist and Medical Director of Jean Hailes for Women's Health.

Access here: www.abc.net.au/radio/melbourne/programs/nightlife/menopause-and-hormone-replacement-therapy/11625054

Androgens are hormones produced by the ovaries and adrenal glands, with the principal androgen being testosterone. In women, the ovaries directly release testosterone into the blood stream, but testosterone can also be made from other hormones that come from the ovaries and adrenal glands such as DHEA and androstenedione. In women and men, testosterone acts directly in cells, but it is also converted to estrogen, and has vital biological effects through estrogen action. ^[1.]

Testosterone blood levels in men are about 10-20 fold greater than in women and result in the male features we tend to associate with testosterone, such as deeper voice, more body hair, more muscle and so forth.

Testosterone blood levels in women tend to peak during their 20s. This is followed by a gradual decline with age. By the time a woman reaches menopause, blood testosterone levels are about one quarter of what they were at their peak. ^[2.] However, after the age of 65-70 years, women have testosterone blood levels similar to those seen in young women. ^[3.]

A sudden fall in testosterone blood levels occurs when women have both of their ovaries removed (surgical menopause). Other causes of low testosterone in women include:

• Use of the oral contraceptive pill - switches off testosterone production by the ovaries and produces a liver protein (SHBG) which may reduce the effects of testosterone;
• Oral steroid therapy - suppression of testosterone production by the adrenals;
• Anti-androgen therapy for acne, hirsutism or scalp hair loss - drugs that block the actions of testosterone in body cells; and
• Complete loss of pituitary function (panhypopituitarism).

To exclude other potential causes, we recommend you talk to your healthcare professional.

What are the consequences of low testosterone in women?

The effects of low testosterone in women have been greatly debated over many years. Firstly, and most importantly there is no blood level that can be used as a cut-off to “diagnose” low testosterone in women.

Some studies have indicated that there may be an association between low sexual desire and low testosterone, but this has not been a consistent finding in all studies. ^[4.]

Kathleen Riach, Monash University and Gavin Jack, Monash University

For many, menopause conjures up feelings of embarrassment, hot flushes, mood swings and sleep disturbance. It doesn’t usually conjure up thoughts about the workplace.

Yet menopause at work is fast becoming a target of government and organisational concern.

Free yourself and embrace positive sexual wellbeing 

Download booklet here: Sexual wellbeing after menopause840.7 KB

Sexual wellbeing

Sexual health is a state of physical, emotional, mental and social wellbeing related to sexuality.

Sexuality is an integral part of the human psyche. Sexuality is expressed throughout life in all people both consciously and unconsciously in body movements and body language, speech, appearance and in every imaginable way people interact with each other. The way people demonstrate their innate sexuality varies according to their stage of life. Sexuality is not limited by age, relationship status or sexual preference.

Studies across a number of countries have shown that women place high value on sexual intimacy in their relationships and the majority of women continue to be sexually active into their later years. [1., 2.]

Consequently, a decrease in sexual wellbeing and loss of intimacy can have profoundly negative effects. After menopause 30-50% of women experience sexual difficulties that adversely impact their intimate relationship, psychological wellbeing health, social functioning and overall quality of life. [3., 4.] However, there is a range of treatment options for women to consider.

The European Society of Human Reproduction and Embryology (ESHRE) guideline offers best practice advice on the care of women with premature ovarian insufficiency (POI), both primary and secondary.

The patient population comprises women younger than 40 years (which includes Turner Syndrome patients) and women older than 40 years, but with disease onset before 40. 

Information for  women with  Premature Ovarian Insufficiency

The consumer companion for the clinical guideline providing recommendations for POI is for you if: 

• You have been diagnosed with premature ovarian insufficiency (POI). 

The booklet aims to

• increase awareness of premature ovarian insufficiency
• encourage women with POI to attend their healthcare provider.
• provide women with POI with tools to discuss their options with their healthcare provider.

Information for  women with Iatrogenic  Premature Ovarian Insufficiency

The consumer companion for the clinical guideline providing recommendations for iatorgenic POI is for you if:  

• You have been diagnosed with premature ovarian insufficiency (POI) as a result of treatment for cancer or benign disease -
• You are about to undergo treatment that could result in POI

The iatrogenic booklet aims to:

• increase awareness of premature ovarian insufficiency
• encourage women with POI to attend their healthcare provider.
• provide women with POI with tools to discuss their options with their healthcare provider.

 These booklets are intended for patients, but may also be useful for their family members and caregivers 

Although some women may abruptly stop having periods leading up to the menopause, many will notice changes in patterns and irregular bleeding. 

Whilst this can be a natural phase in your life, it may important to see your healthcare professional to rule out other health conditions if other worrying symptoms occur.

Many women experience Abnormal Uterine Bleeding (AUB) during perimenopause. AUB  is defined as bleeding that differs in frequency, regularity, duration or amount to your regular menstrual bleeding. [1] Changes to the menstrual cycle often carry no significant consequences [2]; however, they could have a range of causes. Although it may simply be a symptom of perimenopause, it is still sensible to raise the issue with your healthcare professional. A thorough history and physical examination will indicate the cause of uterine bleeding and help discern the need for further investigation and treatment. [3] Other investigations for abnormal uterine bleeding include a PAP Smear, Endometrial or Uterine Sampling (Endometrial Biopsy), a Vaginal Ultrasound (Echography) and routine laboratory testing.

Changes before the Change1.06 MB

This booklet is designed to support women diagnosed and treated for breast cancer who may experience menopausal symptoms. Menopausal symptoms can be a side effect of some breast cancer treatments. Management of menopausal symptoms after treatment for breast cancer needs a different approach to that used by women who enter menopause naturally.

This booklet provides information about menopause and its symptoms. It describes some of the physical and emotional changes experienced by women with breast cancer and offers some practical suggestions for managing these changes.

This booklet is not a replacement for advice given by a health professional and it does not cover all options available. Only a health professional can help individualise your care.

Managing menopausal symptoms after breast cancer - a guide for women 

In recognition of World Menopause Day on October 18, 3AW Talking Health with Dr Sally Cockburn ran a special edition of the program.

Sally sat down with Jean Haile's Gynaecologist, Dr Elizabeth Farrell AM and Jean Haile's Endocrinologist, Dr Sonia Davison to give listeners a better understanding of menopause and how it involves more than just hot flushes. 

Talking Health: Menopause - October 16, 2016

https://audioboom.com/boos/5171069-talking-health-menopause-october-16-2016

Dr Farrell is a past President of AMS

Dr Davison is AMS "Changes" Editor

Heart Health Matters

Menopause is the stage in your life when your periods stop permanently, signaling the end of your reproductive years. It happens when there are no more eggs in your ovaries. Because eggs stimulate your body to produce oestrogen, the levels of estrogen in the blood drop, resulting in menopausal changes in the body when they are exhausted.

As a result of the hormonal changes surrounding menopause, many women experience both physical and emotional symptoms:

• Hot flushes / flashes
• Night sweats
• Insomnia and disrupted sleep
• Racing heart / palpitations
• Weight gain (especially around the waist and abdomen)
• Headaches
• Changes to the skin, hair and nails
• Aches and pains in joints and muscles
• Lower sex drive
• Vaginal dryness, pain during sexual intercourse and increased risk of vaginal infections
• Inability to control urination and increased risk of urinary infections
• Difficulty concentrating and memory lapses
• Fatigue / low energy levels
• Mood swings and irritability
• Depression