By Rhonda Garad
“Menopause is all in the mind!” I read that recently and it caused me to reflect on all the other times in history when women’s conditions have been dismissed in this way.
Remember the psychiatric term “hysteria” that literally meant “disturbance of the uterus”, a condition characterised as “unmanageable emotional excess”!? It seems when it comes to hormonal conditions, it becomes all too hard to understand and we women are repeatedly told we are imagining it. It’s funny, but I can’t think of one male condition that has been trivialised as “unmanageable emotional excess”. It seems men are manageable and women clearly are not.
Just tell the one in five women who suffer severe menopausal symptoms such as hot flushes, sleep-destroying night sweats and vaginal dryness that can make intercourse a living hell – tell them that it is all in their minds. I dare you!
During menopause, the ovaries effectively stop making oestrogen. Over the two- to three-year lead-up to the final menstrual period, oestrogen levels drop by around 90 per cent. About one in five women won’t experience any symptoms, but the same proportion will experience symptoms so severe that their quality of life is greatly reduced. They may have to leave work or reduce their hours, resulting in financial hardship, strained relationships and depression and anxiety becoming part of their everyday reality.
It does not help to trivialise menopause for many reasons, not least because women need to be aware that it is a time to take greater care of their heart and bone health. The dramatic drop in oestrogen, which plays a protective role in heart and bone health, means our risks increase and we need to be proactive in reducing our risk of heart disease and bone fractures.
Recent research shows that women still believe they are at greater risk of breast cancer than heart disease and are more likely to be concerned for male partners and sons rather than themselves. The reality is that women have the same number of heart attacks as men but have them later (post menopause) and are three times more likely to have heart disease than breast cancer. Heart disease is still the number one killer across all ages of women. Young women on the pill who smoke are also at high risk.
What can you do to reduce your risk?
Knowledge is power, so you need to check that your blood pressure is within normal range (between 80 and 120 mmHg), your good cholesterol (HDL) is adequate (between 1.1 and 1.4 mmol/L) and your bad cholesterol (LDL) is not too high (below 3.5mmol/L). Check that your waist circumference and weight are within a healthy range, and eat with your heart health in mind. There is good evidence that the Mediterranean diet (see http://www.mayoclinic.com/health/mediterranean-diet/CL00011) has a positive effect on heart health. Oh, and don’t forget to exercise regularly and move often throughout the day.
We lose about a third of our bone density after menopause, which places us at greater risk of bone fractures and bone thinning (osteoporosis and osteopenia). Around 1.2 million Australians live with osteoporosis but a further 6.3 million men and women have osteopenia, which means they have lost some bone mass and strength and are at greater risk of fracture or broken bones in the future.
“You need to think about your bone health, make time for it and make it a priority,” says Dr Sonia Davison, an endocrinologist at Jean Hailes for Women’s Health. “Risks can be reduced if we think about our bone health sooner rather than later.”
What you can do to reduce your risk
Eat with your bone health in mind. Ensure you have three serves of calcium-rich foods daily (check online for the best sources). Unless recommended by your doctor, don’t rely on calcium supplements as there is not good evidence of their effectiveness and, in high doses, they may create further health issues. Vitamin D plays a critical role in bone health so make sure your levels are adequate. Finally, weight-bearing exercise is also vital for strong bones. If indicated, your doctor may order a bone density (DXA) scan to monitor bone thickness.
What are the risks and benefits of hormone replacement therapy?
According to Professor Henry Burger, a leading expert in this field, the benefits of hormone replacement therapy (HRT) are the relief of the symptoms of menopause in the 20 per cent of women who have severe symptoms. It’s also suitable for women who want to be treated for moderate symptoms.
Other benefits include reduced risk of osteoporotic fractures and, with oral HRT therapy, a reduced risk of colorectal cancer. Plus there is growing evidence that it may also reduce the risk of dementia and heart disease. While there is a small increase in the risk of venous thromboembolism if the hormone is given orally, this risk is reduced if HRT is absorbed through the skin via an oestrogen patch. There’s also a small increase in the risk of breast cancer. This risk varies depending on the duration of the therapy, the type of therapy and other individual risk factors.