Tuesday, 23 April 2013

Menopause in the Workplace

Women currently make up a huge proportion of the workforce. For those of us who are 'baby boomers' and are now experiencing the hormonal changes of the perimenopause and of the menopause, demands of work can become even more challenging. Many women report great difficulties coping with what was previously manageable due to sleep disturbance and hence tiredness and, in some cases, exhaustion, difficulty concentrating, lack of confidence, anxiety, joint aches, not to mention the embarrassment of the well-known flushes and sweats. Throw into this the demands from teenage children and elderly relatives, and one might wonder how women cope at this stage at all!

The sad truth is that some really struggle and need help, yet often try to get through in the knowledge that for many, these symptoms will pass. The problem is that there is no way of predicting how long the 'early' symptoms of estrogen deficiency of the menopause will last. Many women report sad tales of significant symptoms which they openly admit have affected their ability to do their job necessitating changes in their role, time off work and even early retirement. Not all have received appropriate support and there appears to be a lack of awareness of the impact that menopausal symptoms can have - “isn’t it just about a few flushes?”!

So what can we do? As a doctor working in the field of menopause, I would wish that all women could receive appropriate advice and information about the effects of estogen deficiency, what simple changes women can make to reduce symptoms and improve long term health and what specific treatments are available. Sadly, this vision is a long way off but meanwhile, if symptoms are affecting you and your work, do seek help; ask your GP or Practice Nurse, make an appointment with Occupational Health, and above all, do not battle on alone!

For more information and for support, visit Menopause Matters and the Menopause Matters Forum.

Please let us know below if menopausal symptoms have affected your working day, and what support you've received from health professionals or colleagues.

Tuesday, 9 April 2013

Renewed Confidence in HRT

Since July 2002, there has been a huge downturn in the confidence of, and use of HRT. The concern about risks of HRT followed publication of results the Women's Health Initiative trial in 2002 and of the Million Women study in 2003. The massive publicity around the apparent risks shown by these studies understandably led to HRT being viewed as dangerous and that it should rarely be used.

Both these studies have since been reviewed and reanalysed and the revised outcomes, along with new studies which have now been published paints a much different picture - when used appropriately, HRT provides more benefits than risks for most women. Yet this message has not yet been widely circulated and I continue to hear of women who have distressing menopausal symptoms, have read thoroughly, weighed up the pros and cons and know that HRT is the best option for them but have to battle with their doctor to be allowed to take it.

To sort out the ongoing confusion, a global team of representatives of Menopause Societies and organisations associated with Women's Health met in November 2012 and have published a global consensus statement. The conclusions are clear:

• HRT is the most effective treatment for symptoms related to the hormonal changes of the menopause, and is beneficial for bone health and may decrease mortality and cardiovascular disease.

• Risks are acknowledged, but benefits will generally outweigh the risks for women under sixty, or within ten years of the menopause. The risks are generally small.

• Taking HRT is a decision which needs to be individualised, in consultation with a suitably qualified physician.

This statement is extrememly important and must be widely circulated and discussed. Women should be able to be access accurate, non-biased information so that they can make informed choices and in managing the consequences of the hormonal changes of the menopause, HRT should once again be considered as a safe option.

Full statement on menopausal hormone therapy.

Read more about hormone replacement therapy.

What do you think? Have you encountered problems with getting your doctor to prescribe you HRT? Please let us know below.

Wednesday, 3 April 2013

Vaginal Dryness - Lube or Hormones?

Many women experience vaginal changes and vaginal problems due to the lack of estrogen after the menopause. Initially, this can be in the form of dryness during sex. At this stage, lubricants can be used and many effective preparations are available. Some are applied just during sexual activity, others can be applied regularly to maintain the moisture. It is often a case of trial and error to find what works best.

While lubricants and moisturisers can reduce the dryness and ease the discomfort, to treat the underlying problem of the lack of estrogen and consequent changes in vaginal blood flow, secretions, thickness, elasticity and support of the vaginal skin and acidity level, consideration should be given to replacing estrogen which can either be in the form of HRT (hormones which circulate throughout the body and would be used if other generalised menopausal symptoms are also present) or vaginal estrogen.

The debate around the risks and benefits of HRT continues, but it should be understood that vaginal estrogen provides a very low dose of estrogen which is concentrated in the vagina and bladder with minimal absorption around the body. Therefore, vaginal estrogen can be used by women who either do not want to take HRT, or have been advised not to take HRT.

Various types of vaginal estrogen treatments are available and again, it may require trial and error to find which suits best. Preparations include small vaginal tablets inserted by an applicator, vaginal creams, pessaries and a three monthly vaginal ring. Vaginal tablets, creams and pessaries are used every night for two weeks, during which time there may be a little absorption and some women may notice breast tenderness. This should not cause concern. After the first two weeks, the maintenance dose is twice weekly, during which the absorption is minimal and any breast tenderness should settle. The vaginal ring is changed every three months and produces a small regular amount of vaginal estrogen. Vaginal estrogen used at the maintenance doses can be used long term, there being no known risks with many years of treatment. Indeed, we know that if vaginal estrogen is stopped, the symptoms frequently return and long-term treatment is recommended.

Whatever you choose, be aware of menopausal effects on the vagina and look after your vagina in the happy, healthy years ahead!

See more at Menopause Matters.

What do you think? Is this a problem you've encountered yourself? If so, what impact has it had on your relationship and sex life?