The transition into menopause, or perimenopause, can have an insidious onset that can last years before the final menstrual period. It is characterized by irregular menstrual cycles and bleeding patterns, as well as other symptoms such as hot flashes, sleep disturbance, fluctuations in mood, vaginal dryness and low libido. These are all due to changes in hormonal levels.
At times, some of the symptoms of menopause can be quite debilitating. Treatment options depend on the primary symptom. We recommend vaginal oestrogen therapy for women with a dry vagina. For hot flushes and other systemic symptoms of menopause, Dr Jabbour and Dr Gonzalez will assess suitability for Hormone Replacement Therapy (HRT). There are numerous studies assessing the safety of HRT. HRT is effective in treating the symptoms of menopause. The risks with HRT are low when treatment is commenced at the onset of menopause (aged 50-59 and < 10 years postmenopausal). Women can take HRT up to 5 years, after which there is an increase in the risk of breast cancer. Combined HRT with oestrogen and progesterone is required for a woman unless she has had a hysterectomy in which case she requires only oestrogen HRT. The progesterone functions as a protector to the lining of the uterus against cancer. HRT comes in different forms: oral tablets, skin patches and cream. The risk of developing blood clots (eg in the legs and lungs) is increased with HRT. The risk of blood clots is much higher with the combined oral form of HRT as opposed to the skin patch HRT. The risk is further reduced with oestrogen-only HRT. A good approach to reduce the risk of blood clots with HRT would involve applying an oestrogen skin patch (alone in the case of a patient with a surgical history of hysterectomy) or combined with a Mirena IUD in patients who have a uterus.
We encourage you to present to Sunnybank Centre for Women to obtain the appropriate counselling and guidance for what may be a difficult transition.
