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Managing menopause
Are you having any of the menopausal symptoms? Do you find your menopausal symptoms as something unpleasant or uncomfortable, and wonder if there is anything you can do to help relief your symptoms? Read the following to find out how you can deal with your menopausal symptoms.

Do I need any treatment for my menopausal symptoms?

Treatment or medication may not be necessary if your menopausal symptoms are mild. Sometimes, you can even self-manage your symptoms by living a healthy lifestyle, such as eating a healthy and balanced diet, as well as exercising regularly.1 Some women, however, may experience symptoms that are severe enough to influence their daily life, as a result of oestrogen depletion. Under this circumstance, you may want to consider hormone replacement therapy (HRT), a treatment that supplements your body with adequate levels of oestrogen, either with or without progesterone, to help improve some of your menopausal symptoms.1,2

Hormone replacement therapy can be divided into two main types:

  • Oestrogen therapy: This is a therapy in which the lowest-effective dose of oestrogen is taken alone on a daily basis, either in pill form, cream or gel. This type of HRT is suitable for women who have had their uterus removed.2
  • Oestrogen progesterone/progestin hormone therapy: This is a therapy that combines oestrogen and progesterone (or progestin, the synthetic form of progesterone). This type of HRT is suitable for women who have not had their uterus removed. Addition of progesterone/progestin prevents bleeding or thickening of the lining of the womb, thus reducing the risk of uterine cancer.2,3
In addition to providing symptoms relief, HRT may also offer the following benefits2:
  • Reduces the risks of osteoporosis and bone fractures;
  • Improves mood swings;
  • Protects against tooth loss;
  • Lowers the risks of colon cancer and diabetes;
  • Moderately improves joint pains; and
  • Lower death rate in women who received HRT in their 50s.
Hormone replacement therapy can be initiated as soon as a woman started to experience menopausal symptoms. However, be aware that HRT may not be suitable for you if you4:
  • Are pregnant;
  • Have a history of breast cancer, ovarian cancer or womb cancer;
  • Have a history of blood clots;
  • Have a history of heart disease or stroke;
  • Have untreated high blood pressure; or
  • Have liver disease.
You can always consult your doctor if you have doubts about HRT, or if you want to find out other treatment options that may work best for you.

Will I get any side effects from HRT?

Like all other medications, the initial stage of using HRT may result in some common side effects including3:

  • Breast tenderness;
  • Water retention;
  • Headache; and
  • Bleeding (irregular bleeding is probably due to a missed pill).
However, these side effects usually subside over time. You are advised to stay on your prescribed treatment plan for at least 3 months. Should your side effects persist after this duration, you may need to see your doctor so that he/she can4:
  • Switch you to a different route of HRT administration;
  • Change the type of your prescribed HRT; or
  • Adjust the dose of your HRT.

There are rumours that HRT is associated with other unwanted medical conditions. Are they true?

First and foremost, it is important to understand that all kinds of treatment carry some degree of risks. As for HRT, although it has been the mainstay treatment in helping women to get through menopause, there have been concerns with regard to its effects on women's health, especially on the breast and the heart.

Hormone replacement therapy and the breast3
Hormone replacement therapy as a cause to breast cancer is one of the common fears among women. It has been said that long-term use of HRT is associated with an increased risk of developing breast cancer. However, statistics have shown that only eight out of 10,000 of women developed breast cancer due to HRT after 4 years of therapy.3 This shows that the risk of breast cancer due to HRT is actually low and the benefits offered by HRT clearly outweigh the risk.

In addition, you must remember that many other factors can also increase a woman’s risk of developing breast cancer, even if she does not take HRT. In fact, breast cancer is now diagnosed in younger women of less than 50 years whom still have their menstrual periods. This means that there are other more worrying factors for breast cancer than HRT. Anyway, talk to your doctor if you still have any concerns about this.

Hormone replacement therapy and the heart
Hormone replacement therapy affects each woman differently. Therefore, whether HRT is suitable for you will be also dependent on how strong is your risk for cardiovascular disease.3 In general3:

  • Hormone replacement therapy may not be suitable for you if you are at high risk for cardiovascular disease.
  • Hormone replacement therapy may be suitable for you if you are at low risk for cardiovascular disease, and the benefits that you may obtain from HRT outweigh the risk.
There are also many other reported risks associated with HRT (eg, blood clots, stroke, gallstone formation and dementia). However, the real risks of HRT remain inconclusive, as the balance between risks and benefits of HRT can be very different for each woman, depending on her age, family history, and personal medical history.2 This is why every woman should be assessed on an individual basis.3

It is important for you to have a detail discussion with your doctor about the risks and benefits of HRT on you, and for how long you should be on HRT.

How can I deal with my menopausal symptoms?

Here are some tips for you to help you deal with your menopausal symptoms or post-menopausal conditions:

Hot flushes and night sweats
You can relief your hot flushes and night sweats by1:

  • Exercising regularly;
  • Wearing light clothing;
  • Keeping bedroom cool at night;
  • Managing your stress; and
  • Avoiding potential triggers (eg, spicy food, caffeine, smoking and alcohol).
Osteoporosis
Bone loss is part of the natural ageing process and can lead to osteoporosis. However, depletion of oestrogen during menopause causes your bone loss to occur at a faster rate. You can reduce your risk of developing osteoporosis by1:
  • Doing regular physical activity (weight-bearing exercise such as brisk walking, jogging, hiking);
  • Taking adequate calcium (1,000 mg per day) and vitamin D (800 IU per day) every day5;
  • Quitting smoking;
  • Controlling your alcohol intake; and
  • Considering HRT6
You are also advised to have your bone mineral density test done to find out if you are at risk for osteoporosis.3

Inflammation of the vagina and lower urinary tract
Inflammation of the vagina and lower urinary tract are also common problems faced by post-menopausal women due to the decline in oestrogen level.7,8 Oestrogen deficiency induces thinning of the endometrium and increases vaginal pH. As a consequence, the vagina and the urinary tract are predisposed to infection and mechanical weakness.8

See the following chart to check out the symptoms and how you can manage both types of inflammation7,8:

Inflammation of the vagina Inflammation of the lower urinary tract
Symptoms
  • Vaginal dryness and/or discomfort/pain during sexual intercourse
  • Burning sensation of the vagina
  • Vaginal itchiness
  • Vaginal irritation
  • Yellow malodorous discharge
  • Urinary incontinence
  • A strong and sudden urge to urinate
  • Leaking of urine due to physical movement or activity that puts pressure on the bladder (eg, coughing, sneezing, running)
  • Blood in urine.
  • Pain when urinating.
Management
  • Vaginal moisturizers
  • Lubricants
  • Hormone replacement therapy
  • Oestrogen therapy
  • Pelvic muscle exercise.


Breast cancer risk
Menopause does not increase your risk of developing cancer (including breast cancer), but increasing age does.9 To check your breast health, you can3:
  • Perform breast self-exams at least once a month; and
  • Have a mammogram done every 2 years (or annually if you are at high risk of breast cancer).
Heart diseases
Menopause can also affect your heart by increasing your chances of getting a heart attack post-menopause.3 So, to avoid yourself from getting heart diseases, you should3:
  • Eat healthily;
  • Exercise moderately;
  • Monitor your cholesterol levels; and
  • Start on cholesterol-lowering medication if necessary.

References

  1. NHS Choices. Menopause. Available at: http://www.nhs.uk/conditions/menopause/Pages/Introduction.aspx. Accessed 23 October, 2015.
  2. Cleveland Clinic. Hormone Therapy. Available at: https://my.clevelandclinic.org/health/diseases_conditions/hic-what-is-perimenopause-menopause-postmenopause/hic-hormone-therapy . Accessed 23 October, 2015.
  3. Malaysian Menopause Society. What Do You Need to Know About Menopause? Available at: http://menopause.org.my/menopause/index.html . Accessed 16 October, 2015.
  4. NHS Choices. Hormone Replacement Therapy (HRT). Available at: http://www.nhs.uk/Conditions/Hormone-replacement-therapy/Pages/Introduction.aspx . Accessed 23 October, 2015.
  5. Clinical Guidance on Management of Osteoporosis. Malaysian Osteoporosis Society; 2012.
  6. Malaysian Osteoporosis Society. About Osteoporosis. Available at: http://www.osteoporosis.my/aboutOsteo/faq.asp . Accessed 23 October, 2015.
  7. Zagaria MAE. US Pharm 2011;36:22–26.
  8. Bachmann GA, Nevadunsky NS. Am Fam Physician 2000;61:3090–3096.
  9. WebMD. Breast Cancer and Menopause. Available at: http://www.webmd.com/menopause/breast-cancer-menopause . Accessed 23 October, 2015.