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May 8, 2009
The first report on the use of hormones to reduce symptoms of the menopause said, in 1935:
‘In most patients, symptoms are rather mild, so no treatment is necessary except an instructional and reassuring talk from the medical adviser as to the normality of the symptoms, their temporary nature, the importance of avoiding stress and anxiety, and perhaps the administration of a simple nerve sedative.’
The writer of this report was right in that these symptoms are all normal, and many of them are temporary. However, that doesn’t mean we have to live with them if they are reducing our quality of life. Pain during childbirth or tooth extraction is normal, but most people nowadays would choose to use various methods to reduce it.
If you are one of the lucky ones, and you are not bothered by hot flushes, night sweats, distressing states of mind, vaginal and bladder problems, and if you are at little or no risk of developing osteoporosis, then you will probably feel that HRT would be an unnecessary medical intervention for you.
Few elderly people regard old age as a blessing, yet we all want to get there. To do it, all women have to go through the menopause, with its many and varied symptoms, few of which we would wish upon ourselves if we could redesign female biology from scratch. Women born in this century were the first who could confidently expect to live to three-score-years-and-ten, and most of us will five another 10 or more years beyond that. We want them to be rich, fulfilling years. There is nothing any of us can do to stop the ageing process, but at least many of the problems of the menopause can now be relieved by replacing the oestrogen we all inevitably lose.
April 21, 2009
There is no doubt that care of elderly women is a significant part of health care spending. But what is often neglected in these financial analyses is the enormous amounts of money these same women save the health care system by looking after sick and dying husbands or other family members at home, often for many years.
Such comments also imply that long-term HRT will necessarily result in a fitter, healthier group of older women. We don’t yet have the evidence to say this with certainty. It may be that widespread use of HRT will result in women living longer and with fewer fractures and heart attacks. However, nothing is more certain than that we must all die, and if the cause of death is not heart disease or complications from fractures, it could well be a disease that might cost the community even more, such as dementia or cancer.
Herbs often used for hot flushes include Cimicifuga racemosa, which is said to have a direct action in reducing FSH levels (which relate to oestrogen levels, plus ginseng, motherwort and lime blossom (taken in tincture form first thing in the morning and last thing at night). Ginseng is the common name of several species of Panax herbs, and it has been prized in the East for thousands of years. Modern research has confirmed that it reduces sweating and helps the body adapt to heat stress, enhancing energy and stamina in trying conditions. Ginseng comes in a wide variety of formulations, and we recommend a cautious approach to its use as excessive amounts can lead to high blood pressure and palpitations. If no improvement is seen with any herbal substance within four weeks, it is wise not to persist.
Vitamin E and evening primrose oil tablets have strong advocates among some women with severe flushes. Natural dietary sources of vitamin E are oils made from corn, soybeans, coconut, peanuts and olives, plus alfalfa, barley, peanuts, rolled oats, chocolate, cabbage, spinach and asparagus. Vitamin E in supplement form should be used with caution and monitored regularly because it can interfere with normal blood clotting and raise blood pressure. As with all vitamins, it is preferable not to overdo the amount of vitamin E coming from supplements, and expert advice should be sought on dosage levels.
Regular physical activity is sometimes advocated for hot flush relief. The findings of the Melbourne Women’s Midlife Health Study supported an association between exercise levels and feelings of good health when activities took participants outside the home. There was no apparent association, however, between exercise levels and the intensity and number of hot flushes experienced.
Premenopausal women have only one-fifth the risk of heart disease that men of the same age have. After menopause the gap closes, and a woman’s risk of heart disease increases markedly, so that in the sixty to sixty-five age group heart disease risk in women is only one-third that of men. This change in risk is usually explained in terms of the decline in oestrogen levels after menopause.
Differences in stroke rates between women and men are not so pronounced. Women have approximately two-thirds the chance of stroke of men up to the age of sixty-five. The rates are similar for the over-seventies. Above eighty-five, when women well and truly overhaul men, numerically speaking, the absolute number of strokes in women is higher.
One of Australia’s leading heart research centres, the Baker Medical Research Institute in Melbourne, discussed the image and reality of heart and blood vessel disease in its 1992 Annual Report. ‘When we think of cardiovascular disease, it tends to be in terms of heart attacks and cholesterol and blood pressure. When we think of how to prevent cardiovascular disease, it’s things like diet and exercise and giving up cigarettes. And historically, we’ve thought about men and heart attacks; 85 per cent of heart transplants, for example, have had male recipients.
In some women, a procedure called a diagnostic hysteroscopy is in order when there is abnormal bleeding around the time of menopause, spontaneous bleeding after the menopause, or abnormal bleeding while on HRT. The purpose is to try to find the cause of the abnormal bleeding. The procedure involves the insertion of a small telescope through the cervix, which enables the doctor to view the endometrial tissue and assess its distribution and thickness and the presence of any abnormalities. At or after hysteroscopy the doctor can take a sample of the endometrium by means of biopsy or curettage. If you still have your uterus and are being prescribed, or choose to take, oestrogen without added progestogen (this is known as unopposed oestrogen), you should have an endometrial biopsy or a curette every six to twelve months. The same applies to women on HRT who have had previous abnormal changes to the endometrium.