In the UK, the average age of the menopause is around 51 years, and is marked by the ending of menstrual bleeding. It is a result of the cessation of production of oestrogen from the ovaries, and can be diagnosed generally on symptoms and blood tests. Some women will develop signs of an early menopause and it is important that these women are offered treatments to lower some of the health risks associated with an early menopause.
Most women will suffer with some associated symptoms, for a few years leading up to and after the menopause. These symptoms typically include hot flushes, night sweats, mood swings and depression, joint pains, tiredness, libido changes, and vaginal dryness. There are also chronic conditions such as thinning of the bones (“osteoporosis”) and heart disease that are more markedly prevalent in menopausal women.
The menopause is a time when women should be aware of health maintenance and disease prevention. Lifestyle factors should be explored, including dietary modification and (weight bearing) exercise, both of which can be helpful in preventing some of the long term adverse sequelae of the menopause.
For many years, hormone replacement therapy (HRT) was the mainstay of treatment for menopausal symptoms, and was heralded as the panacea for women leading to injudicial prescribing. Some decades later, damaging reports of possible adverse effects of HRT were zealously publicised leading to many women and doctors shying away from prescribing HRT. As with many things, the reality is somewhere in between, and there are undoubtedly some health benefits to be accrued by taking HRT and some women will notice dramatic improvements in their quality of life by taking treatment. What is clear is that women need a careful assessment of their symptoms and a risk analysis of developing future diseases such as breast cancer or osteoporosis. Only on the basis of this can an appropriate evaluation of the risks and benefits of various treatments be made. For some women, hormone replacement therapy is likely to be a very sensible and effective treatment, for others, non-hormonal or even non-pharmacological treatments may be suggested.
Hormone replacement therapy itself may commonly be administered in tablet, gel, small body patch or implant forms. Again there are merits of different administration routes that will depend on a woman’s preferences and medical history. As with most medication, there may be side effects noted when commencing treatment, but for most women these are short-lived. In addition some subtle changes in some of the different hormonal components of the HRT may be required before settling on the ideal preparation for the individual woman.