Menopause: Time for Change.

Menopause: Time for change

Women need clear, evidence-based information to break through the conflict and confusion about menopause treatments

Often referred to as “the change”, the menopause refers to the biological stage in every woman’s life when their periods stop and the ovaries lose their reproductive function. Usually, this occurs between the ages of 45 and 55, but in some cases, women may become menopausal in their 30s, or even younger.

The recent launch of the NICE guideline on the diagnosis and management of the menopause was a monumental menopausal moment! For the first time, leading experts in the field have examined all of the existing evidence and we have been presented with information and advice which will not only enable women to better understand the consequences of the menopause and make informed choices about their treatment, but also ensure that healthcare professionals can provide women with evidence-based information about the benefits and risks of different treatment options in order to come to decisions on an individual basis.

Every woman experiences the menopause differently. Symptoms can last from a few months to several years and up to 80% of women experience physical and/or emotional symptoms during this time. These can include; hot flushes and night sweats, tiredness and sleep disturbance, joint and muscle ache, mood swings and depression, forgetfulness or lack of concentration, vaginal dryness and loss of interest in having sex.

With life expectancy at 83.2 years, many women are living in this post-menopausal phase for half to one third or their life, and these symptoms can have a significant impact on their health and wellbeing as well as their work and relationships. The menopause is not something that just affects ‘older women’ but those in ‘mid-life’ - often when they are juggling demanding jobs, school-age children and elderly parents. Despite this, many women are unaware of the impact of symptoms and later health problems and that diet and lifestyle changes can help improve their symptoms. Sadly, many are also often confused about the benefits and risks of treatment options.

We know that many women choose to go through the menopause without seeking treatment. Others prefer to help to manage their symptoms either by using hormone replacement therapy (HRT) or an alternative treatment option such as cognitive behavioural therapy, relaxation techniques or herbal medicines such as black cohosh, isoflavones (plant estrogens) or St John’s wort. 

HRT has been controversial for many years and has frequently divided opinion. The evidence underpinning the benefits and risks has been accumulating for many years and this guideline has focused specifically on the risks of breast cancer, heart disease, stroke and bone health in women aged between 50 and 59.

This guidance is unequivocal in recognising that HRT is an effective treatment for menopausal symptoms, particularly with the management of hot flushes. However, the benefits and risks will stack up differently for each woman, and whether or not to take HRT is an individual choice.

Let’s start with the good news. The evidence tells us that HRT not only reduces symptoms but can also improve bone health and reduce the risk of osteoporosis and fractures in later life.

The slight increased risk of breast cancer associated with HRT has been widely documented and is not disputed in this guidance. To put this into perspective, breast cancer is the most common cancer in women and approximately 23 in every 1,000 women in the general population will suffer from breast cancer over a period of 7.5 years. For women taking estrogen and progesterone HRT, we will see around five extra cases of breast cancer over the same timeframe. Estrogen only treatment, which is given to women who’ve had a hysterectomy, shows four fewer cancers in same time frame. It’s the progesterone which appears to have effect of increasing disease. This risk is related to the treatment duration and reduces after stopping HRT, suggesting that HRT may, in a small number of women, promote the growth of breast cancer cells which are already present rather than cause the cancer .

Heart health and stroke risk are other areas that are widely debated. Looking at the most recent evidence from the Cochrane collaboration, we can conclude that if 1,000 women under 60 years old started HRT, we would expect six fewer deaths, eight fewer cases of heart disease and five extra blood clots over about seven years, compared to 1,000 similar women who did not start HRT.

We must remember that HRT is just a small component of post-reproductive health and the treatment of menopause depends on a clear and complete understanding of an individual woman’s circumstances as well as the health of women in their later years. Our focus as healthcare professionals is to ensure that women receive clear, evidence-based information to help them make decisions about their health.

It’s also important to remember that lifestyle factors such as obesity and smoking play a huge role in a woman’s short and long-term health and we encourage all women, no matter what their age is, to maintain a balanced diet, engage in regular physical activity and refrain from smoking. This advice is particularly relevant for menopausal women, as lifestyle factors – particularly being overweight - impacts on the severity and length of menopausal symptoms and on later health.

Women deserve high-quality information on their choices. Although we appreciate that too much information may be confusing for women, who may want their health professional to tell them ‘what’s best’, managing the menopause is an area of medicine that is truly individual and we hope this guidance will empower both health professionals and women to work together on deciding the best treatment options for them.

---

Women’s Views on HRT and Alternative therapies.

Women’s Views on HRT and Alternative therapies.

It is well known that many women and healthcare professionals are uncertain about the pros and cons of treatment options for menopausal symptoms and are particularly concerned about risks of Hormone Replacement Therapy. 

It is also recognised that many women consider using Alternative therapies for control of menopausal symptoms, a previous survey published in 2007 showing that 96% of women would try alternatives before using HRT.

With much media attention and sometimes conflicting reporting of study results, it is understandable that both women and healthcare professionals are unsure what to believe and so what decisions to make.

Results of a recent survey on the Menopause Matters website has provided further information about women’s views on alternative therapies and hormone replacement therapy. 1476 responses were received from 33 countries, with 92% from the UK.

Regarding women’s views on HRT, almost 70% had used or would consider using HRT with almost 30% saying that their views on the use of HRT had changed for the better over the last 5 years. There appears to have been an improvement in women’s understanding of HRT since the previous survey, with now the majority feeling that they were clear about risks and benefits, many aware that different types were associated with different risks and over half were aware that the age at which HRT was started affected an individual’s risk.

While the percentage of women who felt that they know enough about HRT to make an informed choice has increased from 27% in 2007 to 53.2% in 2014, it is still concerning that almost half from this survey did not know enough. Most women obtained their information from their health professional or the internet and so it is essential that health professionals are up to date and able to provide correct information. Sadly, over half felt that their family doctor did not recognise the importance of the menopause.

Regarding women’s views on Alternative therapies, still the majority of women (76%) would try alternatives before taking HRT for menopausal symptoms. Around 55% of women had used alternatives despite almost 40% of those women stating that they did not know enough to make an informed choice. The main reasons for trying alternatives were desperation, concern with risks of HRT, seeming to be more natural than HRT and recommendation by a friend. Of those women who had not used alternatives, almost 40% were unconvinced that they were effective or had concerns about safety.

Whatever is decided for managing menopausal symptoms whether it be diet and lifestyle changes, alternative therapies or hormone replacement therapy, women should be supported to make the right individual decision. The recent survey suggests that much is still required to help this to happen.

It is very much hoped that more and more women will have access to accurate information so that they can make truly informed choices about what treatment option they choose.

www.menopausematters.co.uk

Award winning Menopause Magazine, what is it all about?

The Menopause affects ALL women and is a phase of significant hormonal, physical and psychological change. While all women are affected very differently, they should all have access to accurate, non-biased information to empower them to make informed choices about the management of their menopause. At Menopause Matters, our mission is to provide such information and support. To achieve this aim,Menopause Matters Ltd was founded in 2001, and in January 2002 launched what is now the leading UK based, award winning menopause website www.menopausematters.co.uk attracting an average of 4,500 visitors per day.

To provide essential information and support in a complementary, glossy format, reach a wider audience, and satisfy an evident need for a hard copy resource, Menopause Matters magazine was launched in summer 2005. Menopause Matters magazine is currently the only magazine of its kind, written specifically for women approaching and experiencing the menopause. Menopause Matters combines medical facts with glamour in an upbeat, readable style. Menopause Matters magazines are posted out to individual subscribers, GP's surgeries and menopause clinics and to gyms and yoga studios. While our print run has increased, so too has the use of our website where the online magazine can be viewed, the two mediums complementing and promoting each other, achieving our aim of a continued increase in the use of both.

With the medical background and knowledge of Dr Heather Currie, a national expert in Women’s Health and the menopause, the editorial skills and extensive publishing experience of Mr Andrew MacKay, the website expertise of Mr Rik Moncur and the advertising expertise of Mrs Annie Preuss, this innovative team cross public and private sector, medical and non-medical boundaries to provide accessible, accurate, readable, attractive information and support which is essential for all women.

Surveys of both women and health professionals showed:

• 90% considered Menopause Matters to be very useful
• 96% found Menopause Matters content good or very good
• 91% found the advertisements useful
• 90% said that the magazines were received well or very well by patients
• 97% wish to keep receiving the magazines
• 99% felt that the magazines should be available in all GP’s surgeries and menopause clinics
• 98% felt that Menopause Matters helped women be better informed

While providing general menopause information, Menopause Matters magazine also sensitively tackles embarrassing menopause related topics, enabling women to understand, seek help when necessary and go on to lead as healthy, full lives as possible. With current NHS constraints, Menopause Matters goes a long way in empowering women to cope with an inevitable health process, without necessarily needing to use NHS resources.

 

Testimonials

I have just picked up a copy of 'Menopause Matters' at the GP surgery and I found it really refreshing and confidence boosting - the fact that somebody out there believes that we 55+ women are not on the sexual decline was heartening and in particular, that vaginal atrophy is treatable. I want to thank you sincerely for producing this magazine which offers such a ray of light in the apparent gloaming. You have given me such great hope.

I am sure there must be many colleagues who equally find balancing careers with the menopause a real challenge.............I cannot thank you enough for putting me back in the driver’s seat.

 

ALL females should have access to the magazine young & old!

 

Fabulous magazine. Really helpful tool and good for staff too

 

Brilliant. Magazines go like hot cakes

 

Excellent up to date glossy mag for ladies. I give copies to all my menopausal patients

 

Read by staff and patients alike – excellent

 

Please can we have some more magazines for the surgery- they go like hot cakes!

 

I just LOVE Menopause Matters magazine!  Thank you for sending to the United States.

 

My patients have found the magazines very useful, especially when they realised that other women had similar symptoms of the menopause to them and they were not alone.

 

Was just reading the articles in your last edition about STD issues in my age pocket, awesome piece!!! Glad to see someone getting the info out there!

 

Magazine extremely useful and allows women to look information for themselves and educates and builds confidence

 

Excellent resource for profession and public

Preventing endometrial cancer - is it possible?

Endometrial cancer (cancer of the womb lining) is known to be associated in many cases with being overweight, since an imbalance of hormones and growth factors which then stimulate the womb lining can be produced in fat cells. But can maintaining a healthy weight prevent this common disease? According to a new report, it is estimated that 59% of the cases of endometrial cancer (about 29,500 annually in the United States) could be prevented if women engaged in physical activity for at least 30 minutes per day and maintained a healthy body weight, with a body mass index (BMI) from 18.5 to 25.0 kg/m².

The Endometrial Cancer 2013 Report, which was published by the American Institute for Cancer Research (AICR) and World Cancer Research Fund International (WCRF), also notes that coffee consumption reduces the risk.

Increasing evidence has suggested a link between cancer risk and physical activity and body weight. Physical activity and a healthy body weight have been associated with a reduced risk for a number of cancers, including breast, prostate, and colon.

But in the case of endometrial cancer, the relation is quite striking. Currently it is thought that 7 of 10 American women are overweight or obese, and more than half do not get enough exercise to protect themselves against endometrial cancer.

The researchers also found that a high glycemic load, a diet rich in sugar-laden drinks and processed foods high in carbohydrates boosted the risk of developing the disease; it seems that diets that contain a lot of processed foods and sugary drinks can make a difference in the metabolic environment.

Coffee consumption is also associated with a reduced risk for endometrial cancer. Although too much caffeine can affect sleep quality and have other detrimental effects such as on bone health, this study shows that moderate amounts of coffee can be part of a healthy diet, and drinking decaffeinated coffee was also protective.

However, despite the increasing number of studies linking lifestyle and weight to cancer risk and the subsequent media coverage, many people are still unaware of the connection. Surveys have shown that while many people are aware that being overweight increases the risk of type 2 diabetes and heart disease, about half do not see it as a risk factor for cancer.

For someone who is sedentary and overweight, change can be a daunting task. Weight loss should be viewed as a long-term effort, not something that needs to be done immediately. Changes should be made gradually both for weight loss and for increasing exercise. This report did find that activity of all types is important, not just recreational but occupational as well. Physical activity can be done in short bursts of time, even during the work day - go for a 15-minute walk, get up from your desk periodically, take the stairs instead of the lift. It is possible to work physical activity into daily life, even if you have a sedentary job.

It's All About The Ovaries

Through Menopause Matters website and magazine, we have told many personal stories, covered many aspects of the menopause, and hopefully helped many women steer their way through the tangled web which is the transition from reproductive years to the stage of post-reproduction.

The key aspect is the activity of the ovaries. Ovaries working normally release an egg each month and produce the hormones estrogen and progesterone, which affect many systems of the body - this is the normal state in the reproductive years. Ovaries failing to release eggs and failing to produce estrogen and progesterone, whether due to the natural running out of eggs, the removal of ovaries surgically, or the damage to ovaries from other drugs, is the state in the post-reproductive years.

Although emphasis is frequently given to the Menopause, the last menstrual period, the Menopause is in fact only one part of the inevitable process. A term which much more accurately reflects the process is Estrogen deficiency, or, in medical terms, Hypo-estrogenism, not unlike the term Hypo-thyroidism which refers to thyroid failure.

One of my missions is to encourage women and healthcare professionals to think more broadly than just “Menopause” and its early consequences such as hot flushes, and to think more in terms of estrogen deficiency and its early, intermediate and long term consequences.

Only then can the true effects of estrogen deficiency be more widely recognised, so that women can be better prepared to cope with the next phase of their lives as healthily as possible.

To find out more about menopause, and how to improve symptoms, visit Menopause Matters.

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.

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.