Menopause

I am forty three years old and am terrified of menopause. I have heard that hormone therapy has so many side effects that it has been discontinued.

What are the effects of menopause and what is the current treatment recommended?

Take courage, you may well sail through menopause. Studies have shown that about 40-50% of Indian women do not suffer from symptoms of menopause; 30 % of them may suffer from mild to moderate symptoms and do not need therapy. It is only 20 – 25 % of women who suffer from severe symptoms , effecting their quality of life, who need hormone therapy.

The symptoms of menopause are due to estrogen hormone deficiency,as the aging ovaries stop producing the hormone gradually, around the age of 50 years.

The symptoms are

• short term like, hot flushes, night sweats, mood swings, irritability, depression, loss of confidence , bloating and weight gain.
• intermediate like, vaginal dryness, loss of libido, recurrent vaginal infections, recurrent urinary tract infections, increased frequency and urgency of urination and stress incontinence ie. Passing urine while laughing, coughing and sneezing.
• Long term like, Osteoporosis, heart disease, arthritis and joint pains, Alzheimer’s disease etc.

In the past two decades, most women, especially in the West , were routinely prescribed hormone replacement therapy to alleviate the symptoms and to prevent the long term sequelae of estrogen deprivation.

However, in 2002 and 2003 the World Health Initiative study and other similar studies showed that the side effects of long term hormone therapy, outweighed the benefits.

The side effects were, increase in the incidence of strokes, deep vein thrombosis, heart disease and breast cancer,with long term use.

Hence, today the International Menopause Society and the Indian Menopause Society have laid down guidelines for hormone therapy.

Hormone therapy should be only a part of an overall strategy, including life style recommendations regarding diet, exercise, weight reduction and control, smoking and alcohol, to maintain the health of the post menopausal woman.

Hormone therapy must be individualized and tailored to prevention of symptoms. Strict medical supervision and regular follow up with one’s doctor. Annual medical examination which include Pap smear, pelvic sonography, mammography and lipid profile, bone densitometry for detection of osteoporosis etc.

Hormone therapy should be given in the smallest effective dose for the shortest duration only.
In short, a menopausal woman should change her lifestyle to include a healthy diet and aerobic exercise.Severe symptoms can be treated under careful medical supervision.