Menopause
If your change of life is taking away your quality of life, it's time to talk about solutions.
Menopause is an inevitable life stage in all women’s lives if we live long enough. Menopause is a natural process not a disease and does not need to be ‘treated’. However risk factors for many diseases such as cardiovascular disease and osteoporosis dramatically increase at menopause and menopausal treatment is a choice.
Around 80% of women will experience some menopausal symptoms, with 20% of menopausal women experiencing severe, debilitating symptoms.
For these women, their quality of life will usually improve significantly with menopausal treatment.
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If you’re looking for a compassionate and experienced women’s health clinic in Sydney to help you navigate this life stage, Clinic 66 is here to support you.
Menopause means the end of menstruation (periods)
The average age of menopause is 51 Years, but it can happen earlier or later. Menopause actually means “last period” and the term perimenopause refers to the time period before and after menstruation stops.
Perimenopause can last for years, and symptoms commonly occur between 45-55 yrs. Symptoms can be life changing, both physically and emotionally.
In previous generations, menopause was not usually discussed and many women suffered in silence. However, it was common even 3-4 generations ago, that the average lifespan was around the late 50s. Modern advances mean that women can now live up to a 3rd of their life after menopause and that is a long time to live in a state of hormone deficiency .
What causes Menopausal symptoms?
When women have completed their reproductive years, the production of eggs from the ovary is no longer required.
The natural, gradual reduction in hormone levels, as the ovaries become inactive, which occurs around menopause can produce symptoms, such as hot flushes, insomnia, vaginal dryness, reduced libido, and mood changes.
Many women accept these changes and don’t seek assistance, as they may be unaware that there are simple and safe interventions which can be life-changing. Depending on your medical history, lifestyle and health beliefs, there will definitely be something which can help alleviate these symptoms.
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Individual treatments plans can be decided using a shared decision-making approach, after discussion between you and one of our doctors.
​​Time to check your cardiovascular and bone health...
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At this time of menopause, women need to have a comprehensive risk assessment for their health. Modifiable risk factors (e.g. weight, lifestyle) and non-modifiable risk factors (e.g. genetics) are very important in the mature woman, as it is at this age, that risk factors start to show.
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Bone density decreases very quickly after menopause with a whopping 1 :2 women meeting the criteria for reduced bone density (osteopaenia or osteoporosis). Osteopaenia has no symptoms and can only be detected on imaging so a check up is vital to detect changes.
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Medicare rebatable Tele-Health
consultations now available with our Specialised Sexual Health GPs
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Menopause Hormone Treatment (MHT)
As perimenopause and menopause are effectively a hormonal deficiency and menopausal symptoms are caused by low levels of the hormones oestradiol, progesterone and testosterone, it comes as no surprise that Menopausal Hormonal Therapy (MHT) gives the most effective relief for menopausal symptoms.
Menopausal hormone treatments (MHT) can be in the form of tablets, patches or creams which are absorbed systemically into the body.
The types of menopausal hormone therapy have evolved over the past 20 years, with body-identical transdermal preparations now being the preferred option.
Body identical means that the MHT used are the same oestrogen and same progesterone that is made by the ovaries and are not synthetic hormones. Body-identical MHT is usually more effective at treating symptoms and is biologically safer with lower risks and side effects. Body-identical is not the same as bio-identical MHT.
Transdermal oestrogen is prescribed in the form of a patch or a gel. The hormone is absorbed through the skin into the bloodstream directly. This means that the clotting risk is less than for oral tablets.
Oestrogens should always be balanced by a progestogen in women who still have their uterus to prevent the risk of endometrial cancer. This progestogen may be in the form of a higher dose hormonal IUD IUD or a micronised progesterone tablet.
Testosterone treatment in the form of creams and gels is becoming increasingly popular for the woman who wants to improve libido, although there are no PBS concessions for use of testosterone in women.
However, testosterone treatment is effective and used by thousands of perimenopausal and postmenopausal women. We can assess the likelihood that testosterone will be helpful and advise and monitor you while you are taking it. Menopausal hormonal therapy can be tailored to the individual response.
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At Clinic 66 we do not support the use of compounded hormones for menopausal women, based on the advice given by the Australasian Menopause Society due to the lack of evidence for safety and efficacy for compounded treatments.
For women who predominantly have genitourinary symptoms of menopause (GSM), topical treatments are available in the form of Oestrogen and Prasterone (DHEA) pessaries and oestrogen cream.
Mona Lisa Touch Treatment is also available for women as another option for treating GSM.
Other Non-Hormonal Treatment Options for Menopause
Whilst there is little scientific evidence to recommend natural remedies, some women find them helpful. These include black cohosh, agnus castus, dong quai, or other herbal combinations.
Isolated symptoms may be effectively treated by non hormonal treatments such as Fezolinetant for hot flushes. For women who are experiencing hot flushes and mood problems, such as depression, they may be prescribed SSRI or SNRI medication with good effect.
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The particular management package which is right for you, will not be the same for all women. We need to see you in person to find out what is important to you, what is safe for you, and what is likely to give you benefit.
Can I get pregnant during perimenopause?
Natural fertility is reduced with increasing age, especially after the age of 45Y, but the chances of conception are not zero! A late unplanned pregnancy can be a shock and distressing to deal with.
Many women think that they cannot fall pregnant in the perimenopause as their egg levels have dropped very low, but perimenopause can cause huge fluctuations in hormonal levels. Occasionally a hormonal surge can trigger an egg to ovulate and the timing of this can be unpredictable and not necessarily linked to menstruation.
This is why contraception is recommended to be used until 1 Year post menopause (2Y if your menopause age is under 50Y). Some methods of contraception do become less suitable or even contraindicated as you get older so it is important to check in with your doctor regarding this.
Also see:
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Pelvic floor & other changes that rob your quality of life in menopause, & what you can do about it!
In this presentation, Clinic 66's Dr Susan McSweeney discusses the often cruel and debilitating genitourinary symptoms of menopause, which affect over 50% of menopausal women to some degree. And more importantly, she provides some real solutions for managing those symptoms.
FAQ's
1. How long does menopause last?
Menopause is made up of three stages; perimenopause, menopause, and post menopause.
The symptomatic stages (perimenopause and menopause) last for around seven years for most women, while post menopause refers to the years following the completion of menopause.
Perimenopause is indicated by the onset of irregular periods, hot flushes, and mood swings, and is followed by menopause, which is indicated by the absence of a period for 12 months or more.
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2. When does menopause end?
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The perimenopause stage (which is the most symptomatic stage) is considered complete once a period has been absent for 12 months.
At this time, most women notice that their symptoms reduce, disappear, or become more manageable overall. Following menopause, women enter a stage called ‘post menopause’, which lasts for the remainder of their lives.
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3. What causes hot flushes apart from the menopause?
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Anyone can experience a hot flush, and the symptom isn’t limited to menopausal women.
For some, sudden bursts of heat can be brought on by consuming too much caffeine, alcohol, or spice, or experiencing stress or anxiety.
Medical conditions like low blood sugar, thyroid conditions, and obesity can also cause fluctuating rises in temperature.
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4. What are the worst menopause symptoms?
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Everyone is different, in terms of both the severity of their symptoms and what symptoms they find least tolerable.
Struggling with hot flushes and night sweats is common, but there are also mood swings, sleep disturbances, and an overall loss in confidence that can be difficult to reckon with for many women.
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5. Does menopause affect libido?
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Yes, declining levels of oestrogen and testosterone can lead to a decrease in libido.
Specifically, the drop in oestrogen can cause vaginal dryness, pain during intercourse, and reduced arousal.
Additionally, menopause can be a stressful time, with many people experiencing uncertainty and anxiety, which can also contribute to a lower sex drive.
This period often coincides with significant life changes, such as children becoming teenagers, elderly parents, a long-standing relationship, and potential declines in physical fitness.
All of which can impact your ability to relax and enjoy life.
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6. Can you get pregnant after menopause?
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No, after menopause (which is defined as 12 months without a period) you can no longer become pregnant naturally, as you no longer ovulate.
However, it is possible to become pregnant after menopause using in vitro fertilization, typically with frozen eggs or embryos from earlier in life or with donor eggs.
Post-menopausal IVF can be expensive, and pregnancy at this stage may take a toll on your health.
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7. How to reduce the impact of menopause?
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You can naturally reduce the symptoms of menopause by avoiding smoking, maintaining a healthy weight, eating a diet rich in fruits, soya, vegetables, legumes, and oily fish, and limiting alcohol consumption.
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8. How to stop menopause weight gain?
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Unfortunately, weight gain is a common side effect of menopause, and many women experience a slowdown in metabolism.
This can be managed through increasing daily exercise, limiting sugary foods and alcohol, and building a diet based on whole foods.
You may also need to reduce portion sizes to accommodate changes in metabolism.
Additionally, ensuring good sleep habits and limiting stress can also help to manage weight gain.
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9. What are the top 3 vitamins for menopause?
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The three most important vitamins for women going through menopause are Vitamin D, B vitamins (particularly B6 and B12), and Vitamin E.
Make sure to maintain a varied diet with plenty of fresh, home-cooked foods.
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Vitamin D plays a crucial role in maintaining strong bones and supporting immune system health, which is particularly important as bone density can decline during menopause.
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Vitamin B helps keep the nervous system functioning optimally and support energy production, helping to combat fatigue that is common during this time.
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Vitamin E protects cells from oxidative stress, and also contributes to cardiovascular health, which can be a growing concern during menopause.
Last updated on 29/08/2024