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.
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.
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...
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.
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.
Medicare rebatable Tele-Health
consultations now available with our Specialised Sexual Health GPs
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 the Mirena® 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.
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. Other medications that may be helpful for control of some symptoms are gabapentin, clonidine and oxybutinin. For women who are experiencing hot flushes and mood problems, such as depression, they may be prescribed SSRI or SNRI medication with good effect.
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.
MonaLisa Touch treatment
MonaLisa Touch is an innovative, safe and effective new treatment for vaginal symptoms such as dryness, irritation and recurrent urinary infections.
It uses a fractionated CO2 laser technology to produce changes in the vagina and vulval area which are helpful to the perimenopausal and post-menopausal woman.
Clinic 66 offers this treatment as part of a range of interventions for menopause.
Generally, a woman has 3 treatments over the course of 6 months initially, and then once per year thereafter.
Some women need more frequent treatments, and some need less.
Research evidence is looking very promising regarding the benefits of MonaLisa Touch treatments although currently there is no Medicare or Private Health Fund rebate available for this treatment.
Dr Emma Boulton, CEO at Clinic 66 answers many of the questions you might have about the vaginal symptoms of menopause, and explains how the MonaLisa Touch treatment works.
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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Vaginal Dryness — When does it happen, why is it important and what can I do about it?
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MonaLisa Touch - A breakthrough in the non-invasive treatment of vaginal atrophy. (pdf brochure)
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.
Last updated on 29/08/2024