What is Menopause?

Menopause is when women reach an age where they don’t experience a menstrual period for 12 months. The average age of Menopause is around 51 years. It usually begins between the ages of 45 and 55. Every women’s menopause experience is unique. Symptoms are generally more severe when Menopause occurs suddenly or over a shorter period of time.

Prior to Menopause, periods become irregular, and women start to experience the symptoms of Menopause; this is known as perimenopause. The road to Menopause is rocky.

Menopause can last anywhere from a few months to several years. Conditions that impact the health of a women’s ovary, like cancer and hysterectomy or lifestyle factors such as smoking, tend to increase the severity and duration of symptoms during Menopause.

Because the symptoms and experience of each woman are different, you may consider filling in this symptom score sheet.



Hormonal and Cholesterol Changes during Menopause

Hormonal changes occur over a period leading up to and during Menopause. Circulating follicle-stimulating hormone (FSH) and luteinising hormone (LH) levels increase in the blood.

Follicle-stimulating hormone (FSH) is an integral part of the reproductive system. It’s responsible for the growth of ovarian follicles. Follicles produce estrogen and progesterone in the ovaries and help maintain the menstrual cycles in women.

The FSH works with the LH increase in the blood and oestradiol (estrogen type) and progesterone decrease.

Circulating FSH and LH stimulate the body to produce Oestradiol and Progesterone. However, during Menopause, Oestradiol and Progesterone are no longer released as before due to physiological changes. Hence, FSH and LH keep getting manufactured, trying to tell the body to make more Oestradiol and Progesterone!!!

This is why during Menopause, hormone tests check the levels of FSH, LH, Estrogens (Estrone, Oestradiol and Estriol) and Testosterone.

Other hormones that influence Menopause are Testosterone and Dehydroepiandrosterone (DHEA). Total testosterone is usually not altered during Menopause, whereas DHEA declines with age.

Unfortunately, also during Menopause, bad cholesterol (LDL) goes up, and the good cholesterol (HDL) goes down.


Symptoms of Menopause

Since circulating hormones levels change during perimenopause and Menopause, this leads to symptoms occurring all over the body. Often, remembering all the symptoms can be overwhelming. To help your discussion with your doctor, we have created a symptom score sheet to consult with your GP.


Some of these symptoms include:

Vascular (Blood Vessels) – Hot flushes and Night Sweats

Genital (Reproductive System) – Vaginal Dryness, Burning Irritation, lack of lubrication, pain during and after sexual intercourse

Urinary System – Incontinence, pain during urination and frequent urinary tract infections (UTIs)

Skeletal System (Bone and Muscles) – Bone loss, osteoporosis, joint and muscle pain.

Skin and Soft Tissue: Decreased collagen content/elasticity, redistribution of fat.

Breast – Breast pain and Breast waste

Psychological – Mood disturbances, Depression, Fatigue, irritability and insomnia

Sexual – Loss of Libido, pain during sexual intercourse

Cardiovascular (Heart) – Narrowing of the blood vessels (Atherosclerosis), Heart Disease

Central Nervous System (Brain) – Dementia, Memory Loss, Parkinson’s disease, Macular Degeneration.


Management of Menopause

Hormone replacement therapy is the most effective treatment for troublesome vasomotor symptoms associated with Menopause at any age. Hormone therapy reduces the frequency of hot flushes and the severity of it. Improvements are typically noticed after two weeks after starting hormone replacement therapy. Quality of life, sexual function and other menopause-related symptoms such as joint and muscle pains, mood changes and sleep disturbances may improve with hormone replacement. Hormone replacement is also important in the prevention of bone loss in postmenopausal women.

Hormone replacement therapy significantly lowers the risk of hip, spinal cord bones and other osteoporosis-related fractures in postmenopausal women. However, the benefit of reducing fracture risk appears to be lost within a few years of stopping hormone replacement therapy.

However, Hormone Replacement Therapy should never absolutely be used in women who suffer from breast or endometrial cancer, heart attack, stroke, transient ischaemic attack, active liver disease or undiagnosed vaginal bleeding.

Benefits are more likely to outweigh risks for women with bothersome symptoms before the age of 60 years or within ten years after Menopause.

However, the dose and the choice of hormone replacement therapy needs to be discussed with your general practitioner.

When hormone replacement therapy cannot be used, other options include a particular group of anti-depressants known as SSRIs and other medications that work on the central nervous system.


What is Hormone Replacement Therapy?

Hormone Replacement Therapy (HRT), or menopausal hormone therapy (MHT), is medication containing the hormones that a woman’s body stops producing after Menopause. HRT is used to treat menopausal symptoms.

The hormones used in traditional HRT are made from the urine of pregnant horses and other synthetic hormones.

HRT comes in the form of oral tablets and capsules, patches, creams and troches.


Risks Vs Benefits and Misinterpretations

A study published in 2002 known as the women’s health initiative study created worldwide concern about the safety of using Hormone Replacement Therapy. However, the design of the study led to many misinterpretations. This is why it is highly recommended to discuss with your doctor the risk of using Hormone Replacement Therapy. For example, many women today avoid using Hormone Replacement therapy, thinking it increases the risk of breast cancer; however, the risk of breast cancer is less than 1 case in 1000 which is the same risk of getting cancer from a sedentary lifestyle, obesity and alcohol consumption. It is worth also noting the chance of getting osteoporosis and bone fractures for not taking hormone replacement therapy at Menopause is 30 in 100!


What is Bio-Identical Hormone Replacement Therapy (BHRT)

Bioidentical hormones are man-made hormones derived from plant estrogens that are chemically identical to those the human body produces. Estrogen, progesterone, and testosterone are among those most commonly replicated and used in treatment. Bioidentical hormones come in various forms, including pills, patches, creams and gels.

BHRT is generally used in compounded medications. However, there are concerns about their use due to the lack of regulation.


BHRT Myths

Some people often take BHRT because they are “natural”. However, to set the record straight, BHRT is not natural chemicals; they are synthetic, man-made chemicals. However, they are identical to the chemicals our human body produces. Unlike traditional hormone replacement therapy (HRT), they are not identical to the human chemicals, they are obtained from animals such as horses, so they contain animal-like hormones.


Non-hormone options

Non-hormonal therapies are used by approximately 50% of women in western societies to manage vasomotor symptoms of Menopause. Many are not supported by high-quality evidence. Non-hormonal options for vasomotor symptoms include cognitive behavioural therapy (CBT), hypnosis, diet and supplements, vitamins, weight loss and acupuncture.

High-quality evidence supports the use of purpose-designed CBT, hypnosis, acupuncture and weight loss for vasomotor symptoms management. The evidence for mindfulness, relaxation, exercise, yoga, paced breathing, dietary supplements and herbal medicine is not as strong. Black cohosh, red clover, St. John’s wort and Ginkgo are not currently recommended.


In Summary

The symptoms of Menopause are long and wide, and each woman is different. There are risks and benefits of receiving treatment. Women wishing to start HRT or other therapies should carefully discuss the benefits and risks of treatment with their doctor to see what is right for them, considering their age, medical history, risk factors and personal preferences.