October 2019 Health Bulletin

World Menopause Day – October 18, 2019

Menopause and its management remain as controversial as ever, with women and health care providers still uncertain as to how best to deal with menopause and the postmenopausal years. Spontaneous menopause is a natural component of a woman’s life span. However, many women experience menopause because of surgical removal of their ovaries (surgical menopause affecting an estimated 10% of women) or as a consequence of treatment for cancer (chemotherapy) and 1–2% of women will experience menopause before the age of 40 years (premature ovarian insufficiency).

Some women breeze through and hardly notice a change - they are the fortunate few. BUT, the majority of women will experience symptoms associated with menopause. NOT having symptoms does not mean that bone loss and other metabolic changes aren’t happening as these do not cause symptoms.

To support women and health practitioners, the International Menopause Society has developed an array of accessible materials to enable women’s informed decision making and to upskill health care providers.

Menopause management tips

Menopausal hormone therapy (MHT) remains the most effective way for women to alleviate symptoms and prevent bone loss, and other negative consequences of menopause. With respect to safety, the evidence overall is that for most women who experience menopause after the age of 45 years, MHT will neither reduce or increase life expectancy. For younger women, MHT is restorative therapy, replacing what is natural for a young woman, with the benefits outweighing the risks. As with all therapies, treatment needs to be individualised in terms of dose and formulation, and there are absolute and relative contraindications to MHT use.

What about herbal or nutritional alternatives?

Claims that nutritional supplements or herbs will “balance your hormones” cannot be substantiated. These are unproven therapies and not without potential side effects – that’s why Chinese doctors call them “medicines” to be prescribed after a personalised assessment (face to face to ensure potential side effects are minimised) and in individualised doses, not thrown together in a pill.

Studies have consistently shown no meaningful benefits of herbal remedies (such as phytoestrogens, black cohosh, sage etc.) over placebo for hot flushes/night sweats, and these treatments do not prevent bone loss or protect against heart disease. Women considering herbal or naturopathic remedies should have a face-to-face consultation with a qualified therapist (as opposed to an internet-based chat) to ensure their full symptom and health profile is documented and any other medications they are taking are known to avoid drug interactions.

Information provided might not be relevant to a particular person's circumstances and should always be discussed with that person's own healthcare provider.