Absent = 0 Mild = 1 Moderate = 2 Severe = 3
How Long Does the Menopause Last?
The word ‘menopause’ means the cessation of menstrual bleeding – that is, the last menstrual period. When this occurs your ovaries no longer contain any viable eggs (follicles), and so they can no longer produce significant amounts of sex hormones. So no more eggs means no more hormones, and technically we could say that once the menopause has arrived, it is here to stay.
However, the menopause is not a disease – it is merely a state of relative sex hormone deficiency; we do not want women to think that now they are menopausal, they have incurred a permanent disease that requires long-term medical intervention.
During the early 1980s I worked in a missionary hospital in India, which I found a fascinating anthropological and spiritual experience. Luckily I spoke some Hindi and had a solid training in Obstetrics and Gynaecology, as we were presented with all sorts of female emergencies that are no longer common in Western countries. I was in my early 30s at the time, and although I knew how to deliver babies and treat gynaecological problems, I was still very naive about the ways of the world and about cultural differences. I was quite surprised to find that Indian women saw the menopause as a completely different experience to the majority of my patients in Australia. Indian women welcomed the menopause and saw it as a liberating time in their lives; they no longer had to worry about unwanted pregnancy, continual anaemia from menstrual bleeding and childbirth, and the load of a big family. However, their liberation was not due to the loss of fertility alone, it was also because they were now free to be themselves. I found that many of the older Indian women, even up to their late 70s, were still sexually active, notwithstanding their lack of HRT. They were pleased to be able to have their vaginal and bladder repairs done, not just to overcome urinary incontinence but also to feel good about themselves as women, and also so they could have a better sex life. So this experience taught me a lot – the way we see the menopause has a lot to do with the expectations that have been brainwashed into our subconscious minds. The menopause is just a new phase of life, and really we are lucky to be able to live long enough to experience it!
Some women will have very few menopausal symptoms, and so the time that the menopause lasts becomes quite insignificant. In those women who continue to experience symptoms of hormonal deficiency right up into their late years, we can use either nutritional medicine or a combination of natural HRT and nutritional medicine to relieve their symptoms completely. So although the menopause is a permanent stage of your life, any unpleasant symptoms do not have to be permanent.
HRT can be taken for a short period of time, or for many years. We now know that oral forms of oestrogen and/or progestogens are not safe to take for more than several years, due to the increased risk of breast cancer and blood clots. They can be taken for one to two years, if you prefer to take oral forms of HRT.
If HRT is to be used for many years to relieve unpleasant symptoms in older women (over 55), then I personally believe that the natural forms of oestrogen, progesterone and testosterone, administered in the form of creams, patches or low-dose lozenges (troches) are a very safe alternative. As a woman ages, she will generally need smaller doses of HRT, and the amount of hormones in the creams can be easily adjusted accordingly. In many cases it is only necessary to use the creams in the vaginal area, making the amount of hormones absorbed into the bloodstream much lower.
What Are the Myths Surrounding the Menopause?
Many women are reluctant to consider HRT anymore, because of sensational media coverage, or books they may have read. However, many of these things are nothing more than hormonal myths. Below we look at some of these common misconceptions, as well as the true facts about HRT.
| MYTH | TRUTH |
| If I start on HRT, I will never be able to come off it. | Not true,HRT is not addictive. |
| Homoeopathic hormones such as DHEA and melatonin will relieve my symptoms as well as real hormones do. | Homoeopathic hormones do not work like real hormones, as they are present in infinitesimal doses. |
| Herbal preparations are converted into real hormones in my body. | There is no proof that herbal hormones can be converted in the body into real hormones. |
| Natural HRT is the same as herbal hormones (phytoestrogens). | Not true, natural hormones are human hormones and some require a doctor’s prescription. |
| HRT should always be taken for the shortest possible time. | If we use small doses of natural hormones that are administered via the skin or vulva, they can be used for long periods of time. |
| HRT never causes weight gain. | If potent hormones are given orally, they may cause weight gain in some women. |
| Menopause is a short phase of my life. | Menopause is a permanent state of relative sex hormone deficiency. |
| Blood tests are not an accurate way to tell if I have become menopausal. | It is necessary to check the FSH levels. |
| I will not need any HRT until after my periods have finished completely. | Some women need natural progesterone to help balance their hormones, well before the menopause arrives. |
| Once I lose my sex drive, there is nothing I can do about it. | Wrong, natural HRT, used in the correct way, can make you sexually young again. |
| All HRT will definitely increase my risk of breast cancer. | Small doses of natural hormones in the form of creams or patches have not been shown to increase the risk of cancer. Natural progesterone and oestriol may exert anti-cancer effects. |
| All HRT will definitely increase my risk of blood clots and strokes. | Natural HRT given in a way that bypasses the liver, such as in patches or creams, has not been shown to increase blood clots or strokes. |
| I am too old to take HRT. | Possible benefit from HRT has little to do with your age, but rather your lifestyle, sexual needs and symptoms. |
| If I take HRT, I do not need to take a calcium and mineral supplement. | It is always vital to take a good calcium-mineral tablet, as this will improve bone density and will reduce your risk of osteoporosis. HRT alone is not adequate to protect against osteoporosis. |
What Tests Should I Have During the Menopause?
Every peri-menopausal woman should have a Dexa Bone Mineral Density test to determine her risk of osteoporosis. If bone density is abnormally low, the test should be repeated regularly, either annually or biannually.
She should see her doctor every 12 months for a breast examination and a vaginal and pelvic examination.
A mammogram and pap smear should be done every two years.
Blood pressure measurement, weight, urine and cholesterol testing should be done annually.
A Menopause Examination Checklist
This table provides you with a general checklist of important tests that are often performed at the menopause, together with what the doctor is looking for when doing them. Your doctor will decide if any special tests, such as blood tests or pelvic ultrasound, are needed in your individual case.
| EXAMINATION | WHAT THE DOCTOR LOOKS FOR |
| THE PHYSICAL EXAMINATION |