Eulalee Thompson - BE WELL

A colleague of mine has been having some of the distressing menopausal symptoms - hot flashes and sleepless nights. But she is staying clear of hormone replacement therapy (HRT); she prefers to hunker down and wait out the storm.

This reaction is apparently not unusual. Dr Fay Whitbourne, family practitioner and menopause management specialist, believes that the media have put such a scare into women about HRT and its possible side effects that many of them prefer to suffer silently with menopausal symptoms.

"We need to have a more balanced approach to the use of hormone replacement therapy. We have reached a middle ground which is more balanced - we give the smallest dose (of HRT) for the shortest time." she said. "We now only give hormone therapy for two years and for young menopausal women. It seems to be safe for them."

The Women's Health Initiative

The 'media scare' to which Whitbourne referred, surrounds coverage of The Women's Health Initiative (WHI) - research by the US National Institute of Health, initiated in 1991 - on the major health problems (osteoporosis, cancer and cardiovascular disease) affecting older women. One of the findings of the study was that long-term use (meaning five or more years) of HRT combining two hormones, oestrogen and progestin, increased women's risk of heart disease, stroke, blood clots, and breast cancer, although it seemed to lower risks of bone fractures and colorectal cancer.

Subsequent studies have suggested that the heart disease risk in WHI may be more related to the older age of the study population and not the HRT; that there is no overall difference in heart attack risk among women who take HRT and those who don't, and that in fact, those taking oestrogen between age 50 and 59 may gain some heart-healthy benefits.

"We must also remember that the majority of women get through this period (of menopause) without any symptoms. About 25 per cent of them have symptoms, and only a percentage of these women will have severe symptoms, which are mainly hot flashes, mood changes, night sweats and vaginal dryness," Whitbourne said. And symptoms of menopause usually last for about two years.

A woman reaches menopause when she has not had a menstrual period for one year. For most, women this change, signalling the end of her childbearing age, happens around age 50, but it is not unusual for some women to stop menstruating at mid-40s, and others may continue having menses into their 50s.

There is a period leading up to menopause, the perimenopause, lasting two-eight years, where women experience irregular menses and other symptoms. In some women, perimenopause can start as early as the late 30s, or as late as the early 50s.

Alternatives to HRT

As Whitbourne indicates, women don't need treatment for menopause unless they are experiencing really bothersome symptoms. There are also some alternatives to HRT and lifestyle adjustments, which she integrates in her management of menopausal women. These include:

Using plant oestrogens and supplements on the market with oestrogen-like properties, for example, red clover, Promensil, black cohosh and dong quai. They work well and may not abolish hot flashes but will reduce their intensity and improve the woman's quality of life.

Adding soy in diet. Whitbourne said that although the use of soy products in menopause has also come in for some bashing and controversy, using them in moderation is actually useful for post-menopausal women. A glass of soy milk per day, she said, is actually healthy.

Making common-sense changes like dressing in cool clothing instead of heavy lined suits. Recognising the things that trigger your symptoms and avoiding them. For example, alcohol, peppery/spicy foods, hot drinks, being in a hot environment, and stress.

Adding exercise to your day is also important in the management of menopause symptoms.

Interested in more information on menopause? You can attend the Jamaica Midlife Health Society (formerly the Jamaica Menopause Society) public forum on maximising sexual health during midlife on October 16, at Knutsford Court Hotel, New Kingston.

Eulalee Thompson is health editor and a professional counsellor; email: eulalee.thompson@ gleanerjm.com.

Symptoms of menopause

Hot flashes

Irregular menstrual periods. Some women may have light periods, others, heavy ones and the menstrual cycle may be longer or shorter or you may skip periods.

Vaginal dryness

Trouble sleeping (insomnia).

Mood changes or feeling depressed or worried.

Headaches.

Palpitations, that is feeling your heart beating too fast or unevenly.

Sometimes not thinking clearly or remembering things.