Menopause Matters

#Menopause Matters event

2011-03-24T14:01:00.000-07:00

Menopause matters event

Menopause Matters is a free afternoon event for women in Carlisle – with leading specialist in the field Dr Heather Currie leading the session.

Dr Currie is the founder of http://www.menopausematters.co.uk/ and she will be joined on the day by local specialist Dr Jenny Lyons of Carlisle.

Supported by Carlisle Partnership, the event will take place at Tullie House in Carlisle on Tuesday, March 29 from 12 noon until 4.30pm.

There will be information and advice on everything from diet and fitness to skin and beauty.

For more information or to book a free place at the event visit www.cumbriatherapists.com/menopause or call 01228 409090.

#Menopausal #hormone therapy and cardiovascular disease

2011-03-08T13:38:00.000-08:00

Cardiovascular disease remains the single largest cause of death in women. Much interest has been shown in the effects of Hormone Replacement Therapy on the risk of cardiovascular disease, with observational studies showing a significant reduction in risk, and randomised controlled trials (RCTs) showing an increase.
The Timing Hypothesis suggests that the time since menopause that HRT is commenced influences the effect of hormones on the cardiovascular system and continues to be questioned as an explanation for the discrepant outcomes. A group has recently reported on the evidence regarding the basis of the hypothesis and its suitability to explain differences in outcomes between trials of hormone therapy commenced early following the menopause, as in observational studies, and therapy which is delayed as in RCTs.
From a literature review, reports of laboratory, animal and human studies were shown to support the different effect of HRT on normal versus diseased vessels, with a beneficial effect when HRT is commenced early with healthy blood vessels, compared to a negative effect when therapy is delayed with vascular disease. Age and time since menopause have been related to the extent of vascular disease in women. The group concluded that there is ample evidence of the validity of the Timing Hypothesis as an explanation of the different outcomes of observational studies and RCTs and recommend that research on cardiovascular disease prevention by early HRT should be the highest national priority.
Read more about Menopause, hormones and cardiovascualr disease at www.menopausematters.co.uk/cvd.php

#Menopause and bowel function

2011-02-23T14:06:00.000-08:00

Previous research, including surveys on Menopause Matters, has shown that many women experience poor bladder control. which often starts or is worsened by the menopause. Despite this causing significant distress, many women do not seek help because of embarrassment, acceptance of the problem, or lack of awareness of treatment options. It is possible that the same mechanisms leading to urinary incontinence, pelvic floor damage during childbirth and then later reduced strength of the pelvic floor muscles due to the estrogen deficiency of the menopause, can also affect bowel control. We have no idea how many women may be affected by lack of bowel control, ie faecal incontinence, and how many are suffering in silence.
To shed some light on this potentially huge problem, please take a few minutes to complete this anonymous questionnaire, whether or not you are affected.
Visit www.menopausematters.co.uk/questinco2011.php

Preventing #menopausal vaginal changes

2011-02-21T07:29:00.000-08:00

For many years, the menopause was associated with hot flushes, night sweats and mood swings, with little regard for either the “intermediate” or “long term” consequences of estrogen deficiency. We now have increased awareness of the later effect of estrogen deficiency on bone density with increasing risk of osteoporosis and we are still learning about the significant effects on the cardiovascular system. Although we have unquestionable evidence that estrogen deficiency leads to significant effects on the vagina and bladder, (urogenital atrophy), we are still very poor in both identifying and treating the “intermediate” symptoms.

It is thought that urogenital atrophy causes signs and symptoms in up to 50% of all postmenopausal women, yet why do only about 25% of those with symptoms seek medical help and of those, even less are treated? Both women and healthcare professionals seem to continue to be reluctant or unable to address this serious issue perhaps due to embarrassment, lack of time, acceptance of the symptoms being an inevitable part of ageing, or lack of appreciation of the scale of the problem. It was heartening to see the International Menopause Society focus on Vaginal atrophy with the publication of recommendations, a slide set and patient information leaflets to mark World Menopause Day this year. It is hoped that the surrounding publicity will go some way in enabling women to feel able to report symptoms, and in encouraging healthcare professionals to ask appropriate questions when offering menopause counselling, and opportunistically, for example when women are attending for cervical smears.

Perhaps we need to take even further measures to really tackle the burden of this problem. Some women have such severe atrophy that even the gentlest of examinations to exclude a serious cause of postmenopausal bleeding is impossible without causing significant discomfort. Many such women may not have been able to be sexually active for many years, living with discomfort, distress and sometimes relationship problems and rejection. At this stage, the changes may be irrevocable whereas early treatment can halt the progression of the condition, restoring the physiology of the urogenital tract to normal. Why do we allow the vagina to become so fragile and painful when safe effective treatments are available? Why do still, so many women with postmenopausal bleeding have to go through the frightening experience of fast track investigation with the worry of an underlying cancer when, for so many, vaginal atrophy is the cause? Why do so many women suffer from urinary symptoms and have repeated courses of antibiotics when local estrogen can have such a beneficial effect?

Even if these symptoms and presentations are recognized, vaginal estrogen tends to be tarred with the same brush as systemic HRT with concerns about risks and uncertainty about duration of use. With more evidence appearing to show that systemic absorption of low dose vaginal estrogen is minimal, perhaps it is time to consider the case for preventetive estrogen in women who either choose to stop HRT, or do not require HRT at all. If even very low dose vaginal estrogen is undesired, then a range of lubricants and moisturizers which can ease symptoms are now available.

The answer must lie with grasping the opportunity to discuss urogenital health whenever possible, looking for early signs such as flattening of the vaginal walls, and having the knowledge and experience to offer effective treatment, even if symptoms are not yet apparent or are very mild, and to continue treatment long term, before the changes become untreatable.

See a whole section on vaginal problems at http://www.menopausematters.co.uk/

Risks for #breast cancer

2011-02-08T00:04:00.000-08:00

There was much interest in the media last week about the current incidence of breast cancer in the UK, with 1 in 8 women now being affected, while this figure was previously 1 in 9. Much discussion took place about the possible cause of this increase, with diet and lifestyle factors featuring. It has been recognised that drinking 2 or more units of alcohol per day, or being overweight after the menopause are associated with significant increased risk of breast cancer yet there is generally a low level of awareness of these important factors. I was delighted that the recent publicity highlighted these issues.
However, much mention was also made of the risk associated with the use of HRT. While it is known that using certain types of HRT for a long time is associated with a small increased risk of breast cancer, there is no evidence that HRT actually causes breast cancer. More likely is that it may stimulate the growth of abnormal cells which are already present in some women. This association must be taken into account when considering the risks and benefits of HRT and when deciding on how long to take HRT, but the risks should be kept in perspective, and there should be more awareness that alcohol intake and being overweight are by far greater risks. See a useful chart demonstrating this at http://www.menopausematters.co.uk/pdf/breastCancerRisklinks.pdf

Managing the #menopause

2011-02-03T10:20:00.000-08:00

We are due to hold a symposium with the leading menopause specialists in the UK and would like to present the public perception of the menopause and its management by the medical profession. Consequently, we would be most grateful if you would complete a short questionnaire. It will be anonymous, but your views will be invaluable for the ongoing management of menopause in the UK. Please help by taking just a few minutes to complete the questionnaire at www.menopausematters.co.uk/questmanage2010.php

Perimenopause

2011-02-01T23:22:00.000-08:00

The perimenopause is the stage when ovarian function is changing, often leading to a change in periods and the early signs of estrogen deficiency. It can be a very confusing time since the ovaries can produce different levels of hormones from month to month. This fluctuating stage can last for a few years before the ovarian hormones are very low, the lining of the womb stops being stimulated and hence periods stop--THE MENOPAUSE. Following the menopause, defined as the last period, estrogen deficiency symptoms may occur but then the situation is less fluctuant and can be easier to treat.
Treatments around the time of the perimenopause have to take into consideration control of bleeding, contraception requirements, and control of early estrogen deficiency symptoms, not to mention all the life stresses which often occur at the same stage, all very challenging at times.
Don't miss the Medical Matters programme, BBC Radio 4, on perimenopause on Wednesday 2nd Feb 2011 at 3.30pm, with an interview with myself. After the programme has aired a link to the prog will be on our Multimedia page www.menopausematters.co.uk/podcasts.php .

When to stop #contraception?

2011-01-18T02:36:00.000-08:00

Many women are unsure about what type of contraception they can use as they become older, and when it can be safely stopped. Indeed, a recent survey on http://www.menopausematters/ showed that many women who are potentially fertile do not use contraception, and of those that do, many are unhappy with the type used. With so many effective types available, it is a terrible shame that women are still putting themselves at risk of an unplanned pregnancy, or are having problems with contraception used.
Generally, no type of contraception is advised against beacause of age alone, but some medical conditions may preclude the use of certain types of contraception after the age of 35.
If periods stop before the age of 50, contraception should be used for a further 2 years, and if periods stop after the age of 50, it should be used for a further year.
For more information, visit www.menopausematters.co.uk/contra1.php

Women, #heart disease and the #menopause

2011-01-04T01:56:00.000-08:00

Many women are completely unaware that the single greatest cause of death in women after the menopause is cardiovascular disease (CVD), which includes heart disease and stroke. Many women fear breast cancer as the biggest threat to their health and while breast cancer is a terrible disease, women generally are much more likely to die from CVD than breast cancer. Much work is being done by organisations such as Menopause Matters and the British Heart Foundation to increase awareness of CVD in women, and to encourage women to consider simple changes in diet and lifestyle which can reduce their risk, with online information, magazine articles, tv ads, and the show "The Angina Monologues", yet more is needed.
Go to www.menopausematters.co.uk/cvd.php for information, advice, video links and online aids to learn more and reduce your risk, and subscribe to the only magazine specifically for women approaching or experiencing the menopause at www.menopausematters.co.uk/magazine.php

News on Hormone Replacement Therapy from #Menopause Matters

2010-12-19T23:06:00.000-08:00

A recent report from the San Antonio Breast Cancer Symposium showed that estrogen only use in postmenopausal women reduced the incidence of breast cancer. The information is based on further analysis of the Women’s Health Initiative ( WHI ) trial, and in fact, this finding was reported in 2004, two years after the initial publication from the trial, but received very little publicity at that time. The message in 2002 was that HRT had been shown to have significant risks and that the risks may outweigh the benefits. Almost overnight, the confidence in the use of HRT was lost, such that many women stopped taking HRT and many doctors stopped prescribing.

So why now the complete turn around according to information from the same study?

The results reported in 2002 were from the whole age range of women in the trial, who were aged between 50 and 79 years and these women had taken combined HRT (estrogen plus progestogen) or placebo. The highly publicised risks, which included increased risk of breast cancer, were in fact very small and when different age groups were later reviewed, the risks of combined HRT for women under 60 years, who are most representative of women who generally take HRT for symptom control, were minimal and for most of these women, combined HRT provided more benefits than risks. The risk of breast cancer in this group was increased only if women had taken combined HRT before the trial, and then for the 5 years of the trial and thereafter was of the order of 8 extra per 10,000 women per year.

This new report confirms the findings published in 2004 for the group of women in the trial who had had a hysterectomy and took either estrogen only HRT or placebo. In the women taking estrogen only, the risk of breast cancer was reduced, suggesting that estrogen alone acts differently on the breast compared to estrogen combined with progestogen. It could be suggested then that more women should be encouraged to take estrogen only HRT , but if the uterus is still present, some form of progestogen must still be given to prevent estrogenic stimulation of the lining of the uterus. Research and developments should now be focused on HRT which provides the benefits of estrogen on symptom control, bone protection and cardiovascular protection, while minimising the need for progestogen.

When considering the use of HRT, women and their doctors or nurses need to consider potential risks and benefits of HRT , and of different types. Balancing risks and benefits is not unique to HRT and takes place with the use of many medications. Other risk factors for breast cancer exist and include a history of breast cancer in mother or sister, paternal aunt or grandmother, increased breast density at mammograms, certain types of breast disease, obesity, alcohol and physical inactivity. Factors that reduce the woman’s risk of breast cancer include an early age of first full-term pregnancy, long-term breast feeding, exercise and no history of fibrocystic breast disease. These findings should be considered when prescribing or considering hormone therapy in postmenopausal women.

It is becoming very clear that the initial reports from the WHI trial exaggerated risks of HRT and that in fact for most women, when use appropriately, the benefits of HRT outweigh the risks, especially in women able to use estrogen only.

Commenting for the International Menopause Society, Professor David F. Archer, MD ( Norfolk , VA , USA ) said:

The re-analysis of the WHI data is reassuring to both women and physicians that women at low risk for breast cancer do not increase the incidence of breast cancer while using conjugated estrogen-only therapy. This finding supports the position of the International Menopause Society that any decision on the use of hormone therapy be based on an assessment of individual risks and benefits. These are different for each woman, and so the decision on hormone use should be taken after evaluating the risks and benefits, and subsequent discussions between a woman and her physician.

See much more about the menopause, and treatment options at http://www.menopausematters.co.uk/

News from #menopause matters

2010-12-12T23:07:00.000-08:00

It really is worth trying really hard to lose weight if you are menopausal! A new study looking at the effects of weight loss on urinary symptoms in menopausal women also showed a reduction in menopausal symptoms. Weight loss of course also reduces cardiovascular risk, which increases in women after the menopause and is by far the number one cause of death in postmenopausal women. Use the time of the menopause to think about diet and lifestyle factors which can not only reduce menopausal symptoms, but also reduce risk of later health problems.
Woman's Hour featured an interesting discussion on HRT, listen again at www.menopausematters.co.uk/podcasts.php
The WHI trial continues to hit the headlines, the latest confirming the finding that women in the trial who had had a hysterectomy and took estrogen only, had a lower risk of breast cancer than those taking placebo. Increasingly, estrogen has been shown to have many benefits and HRT should be seen as an important option for treating menopausal symptoms.
We have upgraded our website to include a new section on Premature Menopause at www.menopausematters.co.uk/prematuremenopause.php , information on psychological symptoms of the menopause at www.menopausematters.co.uk/psychological.php , an updated section on Contraception at www.menopausematters.co.uk/contra1.php and a redesigned index which is clearer and easy to navigate.
Finally, issue 22 of Menopause Matters magazine is now available and you can subscribe for only £15.00 per year. Subscriptions help us to continue to fund and develop Menopause Matters, helping women UK-wide, and world-wide.

Psychological symptoms of the #menopause

2010-12-07T23:09:00.000-08:00

Many women are aware that the menopause can cause hot flushes and sweats, which may be mild or severe and can last for a short time, or for many years. Although hot flushes (known as flashes in the USA) are the most well recognised symptom of the menopause, there is still much to learn about their actual cause and why they affect women so differently. There is even more to learn about the psychological symptoms of the menopause, which are often unrecognised with little awareness of their association with the menopause. See our new section on psychological symptoms, from a respected author at www.menopausematters.co.uk/psychological.php

Gastric cancer risk and #hormones

2010-12-01T12:36:00.000-08:00

A new study has shown a link between hormone exposure, both before and after the #menopause, and reduced risk of gastric cancer. See full story at www.menopausematters.co.uk/news.php

Menopause Matters News

2010-11-28T03:02:00.000-08:00

We are delighted that we have again been awarded the seal of approval from the Health on the Net Foundation who have recommended http://www.menopausematters.co.uk/ as a good quality health information site. This international award is reviewed annually and it is fantastic to have been awarded this recognition for the 7th year running.
We are also delighted with the next issue of Menopause Matters magazine, out soon and bursting with essential information, personal stories, exercise tips, recipes and much more. Subscribe at www.menopausematters.co.uk/magazine.php for only £15.00 per year. Your support helps us to continue to fund and develop Menopause Matters and help women UK and world wide.
Finally, please take a few minutes to complete our nationwide survey at www.menopausematters.co.uk/questmanage2010.php

Vaginal Dryness

2010-11-24T23:22:00.000-08:00

Oils, gels, lubricants, what to use?

Vaginal dryness is a very common consequence of the menopause and is due to the effect of estrogen deficiency on the vagina; blood supply, secretions and natural lubrication are all reduced. When this occurs along with thinning of the vaginal walls and loss of elasticity, the vagina can feel dry, itchy and generally uncomfortable, sometimes described as “broken glass” or like a “cheese grater”. Inevitably, this discomfort, reduced sensitivity and reduced response in the vagina, labia and clitoral areas, can have a significant effect on the pleasure of and desire for sexual activity, often leading to emotional distress and relationship problems. Further, vaginal dryness doesn’t just affect sexually active women, discomfort can occur just from sitting or wearing tight clothing.

To treat the underlying cause of estrogen deficiency, replacing estrogen can be extremely effective. This can be either in the form of Hormone Replacement Therapy (HRT) and would be used when other menopausal symptoms such as flushes, sweats, mood changes etc are also present, or, if the vaginal/genital symptoms are the main complaint, can be in the form of vaginal estrogen as a small vaginal tablet (Vagifem), pessary (Orthogynest), cream (Gynest or Ovestin) or a vaginal ring (Estring). These provide a very low dose of estrogen concentrated in the vaginal/genital area and are effective and safe, treating the cause—estrogen deficiency. Both HRT and vaginal estrogens need to be prescribed by a doctor or prescribing nurse.

Many women notice reduced lubrication during sexual activity early on in the menopausal process and wish to manage this, at least initially, with simple lubricants. Many types and brands of lubricants are now available and it can be difficult knowing which one to choose.

Some vaginal products may affect the effectiveness of condoms, whether used for contraception or for preventing sexually transmitted infections. Petroleum-based products (Vaseline, mineral oil and baby oil) may break down latex and can increase the risk of sexually transmitted diseases (or pregnancy) whereas water based products are unlikely to do so.

The most commonly used preparation is K-Y Jelly. K-Y Jelly was first patented in 1904 as a surgical lubricant, for short lasting lubrication during a vaginal examination, perhaps not ideal for a longer lasting effect required during sexual activity. More recently, preparations have been developed which are designed more specifically for reducing vaginal dryness and discomfort. These include Replens, Yes, Sylk, Astroglide, a range of Durex products and, the vaginal ovule, Repadina.

With many options to choose from, vaginal dryness can be treated and need not be simply endured.

Insomnia and the menopause

2010-10-20T14:00:00.000-07:00

The menopause affects all women and occurs, on average, at the age of 52 years in the western world. Despite around half the population being affected, there is still so much to learn, so much uncertainty and so much confusion around this inevitable phase of a women's life. Most people associate the menopause with flushes and sweats, but are unaware of the multitude of symptoms that can occur, several of which will be discussed in future blogs. One of the most distressing symptoms is sleep disturbance, or insomnia. Different patterns of sleep disturbance can occur: difficulty getting to sleep, difficulty staying asleep, and early morning wakening, all of which can have a devastating affect on coping, mood, attention and general functioning.
Simple measures such as reducing caffeine intake, taking a hot bath in the evening and generally having time to relax can help, but estrogen replacement in the form of Hormone Replacement Therapy will often cure the problem. Despite much publicity around risks of HRT, when used appropriately in the early menopausal years, the benefits will outweigh the risks for most women.
For more information, advice, downloadable leaflets, podcasts, video clips and a very active online support group, visit the award winning, independant clinician-led website http://www.menopausematters.co.uk/