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.
