The Change Of Life

For women, menopause marks the end of their childbearing years. But it also signals new beginnings and freedom from the monthly hassle of menstruation.

In Greek, menopause means ‘month’ and ‘terminate’ – in other words, the ‘end of the monthlies’. Biologically speaking it refers to the end of menstrual cycles and signals the depletion of oocytes or eggs in the ovary. During menopause, the body undergoes a period of tremendous hormonal changes that can affect women both emotionally and physically.

The end of an era

Menopause is a natural event and an unavoidable phase of a woman’s life. It occurs around the age of 50 and is determined when a woman has had no periods for one year. When the body ceases to produce its normal level of female hormones, there are a range of changes that a woman has to deal with. Menopausal symptoms include:

• Hot flashes
• Night sweats
• Mood swings
• Anxiety
• Insomnia
• Lack of energy and drive
• Increased risk of depression
• Vaginal dryness and pain during sex

In some cases, these symptoms can be so severe that even daily activities and responsibilities become a burden. For the naturally anxious, hormonal changes may aggravate feelings of stress. Women who have numerous familial or career obligations may become overwhelmed and unable to cope. The physical changes, if severe, may also cause upheaval in one’s social life and relationships and result in embarrassment and social isolation.

Finding a balance

Hormone replacement can address these problems. Hormone Replacement Therapy (HRT) is a mode of treatment where medications containing hormones are prescribed. These help provide a woman with the female hormones that she no longer produces. HRT is very effective in bringing relief to the symptoms of menopause such as hot flashes, night sweats and mood changes. These symptoms tend to be at their worst during the menopausal transition period, particularly during the two to three years leading to actual menopause. HRT comes in different forms:

Vaginal hormones effectively treat vaginal and urinary symptoms. These include low-dose vaginal preparations of oestrogen-which come in the form of tablets, creams or vaginal rings.

Systemic hormones are the most effective treatment for relief of troublesome menopausal hot flashes and night sweats. They may come in the form of oral pills, skin patches or skin creams.

HRT needs to be taken regularly and over time for treatment effects to be seen. Patients will need to follow up to review symptoms and for the dosage to be titrated according to their response.

What to consider about HRT

While HRT is no doubt useful in managing severe menopause symptoms, there are some considerations. It has been shown that combination oestrogen-progestin pills increase the risk of heart disease, stroke, blood clots and breast cancer. All of these risks should be considered in deciding whether hormone therapy might be an option for you.

The risk of hormone therapy varies with whether oestrogen is given alone or with a progestin, and one’s current age, age at menopause, the dose and type of oestrogen, and other health risks and family medical history. Despite the potential health risks, systemic oestrogen is still the most effective treatment for menopausal symptoms so the benefits of HRT may outweigh the risks if you’re healthy and experience moderate to severe hot flashes or other menopausal symptoms. Women who experience early menopause (before age 40) have a higher risk of conditions such as osteoporosis, heart disease, earlier death, Parkinsonism and anxiety or depression. Because this group of women also has a lower risk of breast cancer, the protective benefits of hormone therapy usually outweigh its risks.