MENOPAUSE

from Menopause? By W. Gifford-Jones MD and Diana Gifford There’s a universal fact for women. If they live long enough, their capacity to bring forth children will end, and they will become menopausal. Menopause can be when the thermostat becomes their most prized possession. But not all women have hot flashes. Some go through this period wondering why they have no symptoms. The best advice for them is, “Enjoy the smooth sailing!” Other women endure needless suffering. There are treatments, and these women should see their doctors. The medical journal, The Lancet, has urged women to become educated about hormone replacement therapy (HRT). Menopause should not be considered a disease. It is a natural process. Be cautious with commercial interests of pharmaceutical companies’ propaganda. Seek information from a medical specialist. The authors of the Lancet report stress they are not opposed to HRT as it can be effective in treating hot flashes, vaginal dryness, and genital urinary symptoms. Many years ago, HRT was often used by women to control menopausal symptoms. The standard treatment involved the hormones estrogen and progestin, a synthetic form of progesterone. But a large and widely publicised study called the Women’s Health Initiative identified problems with HRT. Doctors and patients concluded HRT was dangerous and this misconception lingers today. The study had significant shortcomings however, and subsequent studies have more nuanced conclusions. For women under 60, or for those less than a decade out of menopause, the benefits of HRT in fighting debilitating symptoms outweighed the risk. There was one other caution. Those using HRT should not have a family history of stroke, breast cancer, or coronary heart disease. Which women suffer the most from menopause? It’s those who are affected by severe symptoms. Imagine a stalwart high school principal. She has handled the tough job for years. But with the onset of menopause, the slighted provocation has her bursting into tears behind closed doors. For the first time, she feels incapable of the task. If she meets the criteria mentioned above, then she is a textbook case for HRT. Within a week, her problem would be history. Menopause is not just one event or one symptom, such as hot flashes. A gradual decrease in the production of estrogen influences organs such as the vagina and urinary bladder. It’s these organs that women are loath to discuss with their family doctor, to say nothing of their partners. It may come as a shock to younger people to know that seniors have sexual relations. But menopause can make vaginal tissues thinner and more easily irritated. Past columns have tried to explain this with a touch of eloquence, noting that it’s hard for females to sing with a sore throat. Put plainly, it’s hard for menopausal and post-menopausal women to enjoy sex with an inflamed vagina (atrophic vaginitis). Sometimes neither the woman nor her partner knows what’s causing the severe pain. Unfortunately, many women suffer silently. Those who ask for help will find there are good remedies. Something as simple as an estrogen cream can resolve an irritated vagina within two weeks. Other consequences of menopause, like the accelerated loss of bone density, may also be treated with HRT. Sometimes problems are missed because a vaginal examination is not done during a check up. Or patients don’t mention issues to the doctor. The comedian, Joan Rivers, made a joke about news that having a dog makes you ten years younger. “My first thought was to rescue two more,” she said, before adding, “but I don’t want to go through menopause again.” Today, women can and should get their symptoms treated. Sign-up at www.docgiff.com to receive our weekly e-newsletter. For comments, contact-us@docgiff.com. Follow us Instagram @docgiff and @diana_gifford_jones