Ways to manage the menopause

ON average, women start the menopause at 51, though it can begin much earlier (before the age of 40, it’s known as ’premature menopause’).

It can bring with it a range of symptoms, from irregular periods, hot flushes and mood swings, to the brittle bone disease osteoporosis. In the years following the menopause, a woman’s heart disease risk rises too.

TO HRT OR NOT TO HRT?: Over the last decade, there has been much debate about the possible risks and benefits of HRT, which helps relieve menopausal symptoms by replacing oestrogen.

While it’s been suggested that HRT may be linked to an increased risk of breast cancer and cardiovascular disease, HRT doesn’t increase cardiovascular disease risk when started in women aged under 60, and doesn’t affect the risk of dying from cardiovascular disease either.

In addition, medical guidance states that HRT doesn’t affect the risk of dying from breast cancer, and that HRT with oestrogen alone is associated with little or no increase in the risk of breast cancer. HRT with oestrogen and progestogen can be associated with an increased risk.

But any increase in breast cancer risk is related to treatment duration, and reduces after stopping HRT.

Mr Edward Morris, a consultant in obstetrics and gynaecology, says only around 10-15% of the women who could benefit from HRT actually take it, observing: “That’s a personal choice, and I can understand why a lot of women think that after the age of 50, they’re not designed to live with hormones, but we’re not necessarily designed to live as long as we do, either.

“HRT’s a choice that not many women make, and a lot of it’s due to news stories about HRT over the last 10 years or so.

“It’s like any medicine — you’ve got to have a cautious approach, and make sure it’s the right drug for the right person at the right time. Nothing’s a cure-all, and you’ve really got to think hard about it.

“When women reach a certain age and need medical treatment, it’s best to go and see someone and get advice about what’s best for you.”

ANY ALTERNATIVES? Surveys have suggested that around 70% of menopausal women try alternative remedies.

Such remedies include phytoestrogens — plant substances that have effects similar to those of oestrogens— black cohosh, evening primrose oil and ginkgo biloba, as well as therapies like homeopathy, acupuncture and reflexology.

There’s little scientific evidence that complementary and alternative therapies can help menopausal symptoms or provide the same benefits as conventional therapies.

However, Morris suggests: “They can make a difference, although sometimes it’s just the reassurance that the woman’s in control. In some women, the difference these remedies make is sustained, but in the vast majority the initial effect dwindles.”

LIFESTYLE PLAYS A PART: Losing weight can reduce the severity of hot flushes, notes Morris. “Women who are overweight have more severe hot flushes, so if you can lose weight, that makes a big difference,” he stresses.

“Exercise and a healthy diet are good from an osteoporosis point of view, as exercise reduces the incidence of fractures, and getting the right amount of vitamins is good for the cardiovascular system the bones.”