Managing menopause: Your guide to optimal wellness

Discover treatment options and lifestyle adjustments to help you manage the symptoms of menopause.

Symptoms of menopause

Menopause, once a taboo topic, is now widely spoken and written about in both mainstream and medical media. That’s excellent news for the many women who experience a variety of unpleasant or even distressing menopause-related symptoms from the time they enter their fifth decade.

Dr Dalene Barnard, a gynaecologist at Mediclinic Kloof, says three out of four menopausal women experience hot flushes, with a quarter of them describing these episodes as “severe” and “frequent”. Around 45% of women experience vaginal dryness – some reporting that besides affecting sexual function, it makes simple activities like sitting and standing uncomfortable, too.

Still more will suffer from brain fog, sleeplessness, and confusion, which ultimately affect their ability to concentrate and perform in the workplace.

As awareness grows of the impact on productivity, menopause and the need for effective symptomatic treatments are increasingly being taken seriously.

Personalised treatment for menopause

One of the key changes to have taken place in the approach to treatment is that it’s now personalised, says Dr Barnard. “I conduct a full history and clinical examination with each patient, which covers everything from their family history to their dietary and exercise habits,” she explains.

Menopausal hormone therapy (MHT)

Another key change is the switch from hormone replacement therapy (HRT) to menopausal hormone therapy (MHT), as hormones are now seen as a crucial element in easing symptoms. This makes sense, Dr Barnard says. “When men are deprived of the male hormone testosterone, perhaps because of cancer or chemotherapy, they experience a few uncomfortable symptoms. It stands to reason that the consequences would be similarly negative for women, even if the depletion of oestrogen is a natural process.”

Previously, concerns about HRT existed because of the preliminary findings of a study conducted by the Women’s Health Initiative (WHI) that showed some women experienced an increased risk of breast cancer and cardiovascular issues, with the study being discontinued for those reasons. “However, it’s since been proven that if doctors are more selective about when we prescribe hormones, the effects are positive,” Dr Barnard confirms. “For example, we won’t consider someone a good candidate if they have a family history of female cancers, have been in menopause for more than 10 years, or there are strong risk factors for cancer present.”

Based on this understanding, the WHI study was reintroduced, looking at the effects of menopause hormone therapy on three cohorts: one group received no hormones, one received a mix of oestrogen and progesterone, and one received oestrogen only. “This study showed that in women who have not had a hysterectomy, the mix of oestrogen and progesterone decreases the risk of endometrial cancer, while the risk of breast cancer decreased by 20% on oestrogen alone.

“There was a very slight increased risk of breast cancer among those who took oestrogen and progesterone only, but this equated to seven women out of 100 000 – and, interestingly, we found they had a 44% higher chance of surviving the cancer if they were on hormone therapy.”

Alternatives to menopausal hormone therapy

The evidence is strongly in favour of MHT, but there are plenty of options available for those who have reservations about it, or who show contraindications, says Dr Barnard. These therapies target specific symptoms:

• Hot flushes – nerve stimulators, antidepressants, or neurokinin blockers (regulate the nervous and immune system) and alpha receptor blockers (determine blood pressure).
  
• Mood swings – non-pharmacological interventions like cognitive behavioural therapy (CBT), yoga, and mindfulness. Sometimes antidepressants are also prescribed.
• Osteoporosis – calcium supplements, bone-building agents, and exercise to help strengthen bones.
• Weight gain – increasingly targeted through medication.
• Vaginal dryness – topical preparations.

“Many women feel embarrassed about these conditions, but it’s important to remember that they’re very common – and, most importantly, there are ways to help,” assures Dr Barnard.

To find a gynaecologist near you, go to www.mediclinic.co.za.