Tuesday, 26 March 2013

Why Do We Flush?

Flushes and sweats are the classic, well-known menopause symptoms, or can be caused by estrogen deficiency. We have all heard of them, yet we still know relatively little about why they happen and why there is such variation in their severity and duration. From what we do know, it seems that we have a thermostat in the brain which regulates our body temperature. If our core temperature rises, as happens if we have an infection, a fever, then our thermostat triggers cooling down mechanisms such as opening up surface blood vessels (the flush) and switching on sweat production. These measures ensure that our body organs do not become too hot. In the reverse situation, if our core body temperature falls, our thermostat switches on heating up mechanisms such as shivering, in order to maintain temperature.

During every day, our core temperature fluctuates by a few degrees but our thermostat works within a buffering zone, so that we don’t spend the whole day flushing, sweating or shivering. Even additional changes in temperature as brought about by hot or cold drinks, being outside or inside, emotion or stress do not normally lead to triggering by the thermostat. However, with estrogen deficiency of the menopause, the thermostat changes in action so that even the normal daily temperature changes and additional ones described, can lead to unnecessary flushes, sweats and shivers - the thermostat thinks that the body is over-heating, or over-cooling when it is not.

While it appears that estrogen deficiency is a cause of changing thermostat function, it is clearly not the only factor since menopausal women, with the same changing and low levels of estrogen, can have very different levels and duration of symptoms. Diet and lifestyle factors are involved with being overweight, drinking alcohol and caffeine, and smoking leading to worse symptoms. Other chemicals such as serotonin, noradrenaline and gamma aminobutyric acid are also likely to be involved and the recognition of their involvement has led to the development of other non-hormonal drugs which can be prescribed to reduce symptoms in women who are not able or willing to take HRT.

So while research continues into the mechanisms and treatments for flushes and sweats, we should try to maintain a healthy weight, eat a healthy, balanced diet, minimise alcohol and caffeine, not smoke, take plenty of exercise, wear loose layered clothing, and generally look after ourselves whilst considering treatments to minimise symptoms of the menopause and the impact that they may have on our lives.

See more at Menopause Matters.

Wednesday, 20 March 2013

Breast Cancer and HRT - Fact or Fiction?

While the role of HRT for treatment of menopausal symptoms, treatment of premature menopause and beneficial effect on bones should now be well established, the debate about HRT and breast cancer risk continues.

Following a massive drop in use of HRT after publication of the Women’s Health Initiative (WHI) trial in 2002 and Million Women Study (MWS) in 2003, an apparent drop in rates of breast cancer was claimed to provide further evidence that HRT did indeed cause breast cancer. However, researchers from Cape Town University, writing in the journal of Family Planning and Reproductive Healthcare, state that it is impossible to establish a causal link. Breast cancer rates actually started to fall in 1999, before the drop in use of HRT, and the drop seen in 2002 to 2004 was far too early to be due to the fall in use of HRT.

The same journal, in 2012, published reviews by Shapiro et al of both the WHI trial and the MWS and concluded that these studies did not in fact prove a link between HRT and breast cancer.

So, can we be completely reassured that HRT does not cause breast cancer, and can women go back to using HRT without any fear that it will increase their risk of this tragic disease? It seems that it is extremely unlikely that HRT causes breast cells to become cancerous. But it is possible that, if certain types of HRT (combined HRT containing estrogen and progestogen, rather than estrogen alone) are taken for more than five years after the age of fifty, there may be promotion of cancer cells which are already present in some women, but not in the majority. To add to the complexity, even within types of combined HRT, it appears that different progestogens have differing effects, some types appearing to be “breast-friendly”.

Finally, to try to understand the level of risk, it is known that drinking two or more units of alcohol per day, or being overweight after the menopause both provide a far greater level of risk than taking HRT for five years. Read more about the effects of diet, exercise and lifestyle on menopause.

No medicine is perfect and everything that we do carries some level of risk. It is essential that women who are considering taking HRT, and healthcare professionals who are considering prescribing HRT, should access accurate information to help them make informed choices. Currently, many women are missing out on the benefits of HRT because of fear of risk. But for the majority, when HRT is used appropriately,  the benefits outweigh the risks.

You can see more about balancing the risks and benefits of HRT at http://www.menopausematters.co.uk/pdf/breastCancerRisklinks.pdf

Monday, 4 March 2013

Mental Health and Menopause

Many women notice changes in mood around the time of the perimenopause and menopause.

It can be difficult to know if the symptoms of low mood, anxiety, panic attacks, depression and mood swings are caused by the hormone changes associated with changing ovarian function, or are due to an underlying mental health problem. Indeed, it appears that when presenting with such symptoms, many women have been offered antidepressants when they have wondered themselves if the symptoms could be hormonal.

If these symptoms occur along with evidence of change in ovarian function, from a change in the period pattern with or without other menopausal symptoms such as hot flushes, sweats, joint aches and sleep disturbance, then a trial of hormone replacement rather than an antidepressant, would seem worthwhile. In fact, many women take HRT purely for control of such symptoms, rather than control of the classic flushes and sweats. Such mood, psychological and coping symptoms are often completely unexpected and, when untreated, cause more distress than the expected flushes and sweats.

We know that women who have previously suffered from clinical depression, particularly those who have experienced postnatal depression or premenstrual syndrome, are sensitive to hormonal fluctuations and are at risk of developing depression in the perimenopause, a time of significant hormonal fluctuation. Otherwise, while depressed mood is common around the time of the menopause, new onset clinical depression is not increased purely due to the menopause.

Mental health problems are very common, and can be associated with the menopause so should be treated early.

For more information, visit the symptoms section and psychological section of Menopause Matters.