Menopause is one of life’s inevitable constants; all women will undergo this process whenthey reach the end of their reproductive age.

Peri-menopause is the process immediately before menopause and a year after menopause. It signifies the last menstrual period and the end of reproductive life. This period between reproductive and non-reproductive life is associated with vasomotor symptoms such as hot flushes, night sweats, palpitations and headaches as well as vaginal symptoms such as dryness, burning and pain during intercourse. Psychological symptoms may include insomnia, poor concentration, irritability, decreased libido, anxiety and depression.

The averageage for women to undergo menopause is around 50 but smokers may reach menopause earlier. Premature menopause may also occur in a small percentage of women before the age of 40. Menopause is diagnosed by a blood test, history of symptoms and a time span free of periods.

Approximately10% of women will require medical help. The main aim of treatment should be symptomatic relief. Treatments are varied and many are untested. These include pharmacological agents, alternative therapies, psychological support and lifestyle alterations. The main modalities include Hormone Replacement Therapy (HRT), Clonidine, Selective oestrogen reuptake inhibitors (SERMs), Tibolone, exercise, diet, Phyto-oestrogens, red clover, St John’s Wort, acupuncture andother herbal remedies.

These may relieve symptoms for some women but have no effect on others. Some also haveside-effects that may be significant enough to rule them out as in the case ofcancer (especially breast cancer), heart conditions, clotting problems, uncontrolled blood pressure, high cholesterol and previous strokes to name buta few. Before starting any treatments advice from a medical professional shouldbe sought or, in the case of herbal treatments, you should consult aknowledgeable pharmacist or homeopath.

HRT

As there isconfusing evidence regarding the use of HRT you should have a good medical check-upbefore treatment is started. There are however proven benefits in the use of HRT especially if started early. There are many administration options, depending on your symptoms, that can prevent some of the side-effects.

Osteoporosisis a disease characterize by low bone mass and deterioration of bone tissue. HRT is no longer the first line of treatment for osteoporosis, and care shouldbe taken when prescribing/ taking treatment thereof. Hip and vertebralfractures can happen as a result of osteoporosis and HRT may prevent certain hip fractures.

The durationof use must be individualized with realistic goals and treatment solutions inmind. The balance between risk and benefit should be carefully weighed by thepatient and the doctor involved. Regular breast mammograms and examinationsshould be performed to detect developing cancers.

Many studieshave evaluated the use of HRT and women should arm themselves with thisinformation when considering treatment. Two major studies are The Million Womenstudy and the Women’s Health Initiative (WHI). They may seem complicated to you but doctors, whether they are pro or anti the use of HRT, should look at these studies to give you the best possible advice.

When in doubt discuss alternatives with your doctor. You are also welcome to email me.

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