MENOPAUSE has a bad reputation. It is often associated with not just the freeing of a woman from her monthly menses, but also a host of undesirable symptoms – from hot flushes to mood swings and dry skin.
It is no wonder women approaching their 50s see it as the advent of old age itself.
But it doesn’t have to be so. Obstetrician and gynaecologist Dr Kim Wong says she knows women who continue taking good care of themselves through menopause and sail through it with minimal symptoms.
The problem is that most women are not prepared and don’t equip themselves with enough information, says Dr Wong, who is also president of the Malaysian Menopause Society.
Usually menopause starts when women are around the age of 51 and perimenopause (the pre-menopause period) begins about five years before that, at around 45.
It starts with irregular and fewer periods. For some women, the symptoms would begin then. For others, it would only begin when their periods totally stop.
The good news about menopause is that you no longer have to worry about pregnancy, and if you have fibroids and endometriosis, these will shrink a bit when you menopause.
Most people think that hot flushes is the most common symptom, but it is not.
According to a study conducted last year by Dr Wong on 100 women, the most common symptoms are: dry skin (90% of patients), vaginal dryness (83%), reduced libido (70%), joint and muscle pain (63%), hot flushes (63%), painful intercourse (61%), night sweats (61%), mood swings (60%), depressive mood (54%), headache (51%), sleep disturbance (50%) and urinary incontinence (40%).
After dry skin, what affects women in Malaysia the most, she says, is the drop in sexuality.
“These are very intimate symptoms and women usually don’t tell us unless we ask them. If they see male doctors they will also not reveal these symptoms.
“It could be partly to do with ageing – they are tired, they’re at the peak of their career, the time factor, the husband is also busy, but when you treat them, the libido improves,” says Dr Wong.
In most countries, hot flushes is still one of the common symptoms. In Malaysia, hot flushes is the next most common symptom, after vaginal dryness and reduced libido. This is consistent with the American population which is also at around 63%. This percentage is quite universal for hot flushes, reveals Dr Wong.
How do you know that you’re having hot flushes and it’s not just a terribly warm day?
If you’re sitting in an air-conditioned room at night and still sweating, it is probably hot flushes. If you’re the only one in the room sweating profusely … that’s a good indication, too.
Women going through menopause would also have muscle and joint aches. This means, after a few climbs up the stairs, you may feel uncomfortable, or you may no longer be able to go out shopping the whole day without feeling aches and pains.
Menopausal women also have mood swings – one moment you feel very happy and the next you feel miserable, and you feel like your mood swings are out of control. You may even react very angrily over small things.
They may also be more prone to getting headaches and having sleep disturbances. You might be tired but after a few minutes of sleeping, wake up and be unable to go back to sleep.
These are the short-term effects of menopause.
These symptoms are caused by the fluctuations in the hormones, and the drop in oestrogen, plus the rise in follicle-stimulating hormone (FSH) and the luteinising hormone (LH) which are known as the menopause hormones.
Besides the short-term symptoms, there are also the long-term effects like memory loss which happens a few years into menopause.
The other long-term symptoms are osteoporosis, weight gain, hair loss (this is loss of hair across the whole head and not just at the front of the head) and tooth loss.
The HRT question
The great HRT (hormone replacement therapy) debate rages on today as it did 10 years ago.
While there are many benefits, the risks are still there, and although these are minimal, Malaysian women are still reluctant to go on HRT.
In Dr Wong’s study last year, a whopping 92% of respondents were not keen to take HRT.
The best preventive method for hot flushes and osteoporosis is still HRT, informs Dr Wong.
“Taking HRT won’t stop ageing but it will delay the effects like joint pains. If you take it for five years, you delay your bone ageing by five years. If you’re 65, you will feel like you’re 60. When you’re older, every five to 10 years makes a lot of difference,” says Dr Wong.
With HRT, the main concern is getting breast cancer, but the risk is very low. According to Dr Wong, only eight in 10,000 women on regular HRT for more than five years are at risk of getting breast cancer.
The other HRT risks are cardiovascular and gallstones. Dr Wong informs that about three to five in 10,000 women on HRT are at risk of getting a stroke and thromboembolism, while the risk of getting gallstones is even lower.
According to the 2013 Global Consensus Statement on Menopausal Hormone Therapy, if you want to start HRT, you should start early, within six years of perimenopause. It should be very safe to take it for three to five years. It doesn’t cause much side effects like breast cancer and thromboembolism because it is used for a short period of time. It is not recommended that HRT be used for the long term.
“The benefits can be quantified because you can see the women have a reduction in menopause symptoms. In addition, there is the effect on the bones because before osteoporosis takes place, the patient is put on HRT. These are the guidelines of the IMS (International Menopause Society).
“Having said that, some women need to be on HRT for the long-term otherwise their short-term symptoms will return once they stop the HRT. It should be okay if you are not at risk of getting breast cancer and cardiovascular problems. These days, you can find out if you are at risk of these by doing a genetic test,” says Dr Wong.
According to her, the belief that HRT is bad for women has resulted in options like placenta hormones, bioidentical hormones, natural hormones and plant hormones.
“Bioidentical hormones and HRT are the same in terms of them both being hormones. Bioidenticals however is made from plants and it does not have the approval of the US FDA (Food and Drug Administration).
“They are done in very individualised and customised dosage and therefore they don’t have any clinical backup to prove that they work. You cannot do any studies on them because each person would need a different dosage.
“We don’t encourage women to take bioidentical hormones,” says Dr Wong.
There are also non-HRT options that women can take for the various symptoms.
For example, there are certain drugs that treat hot flushes alone. There are other drugs to treat palpitations. These are drugs for very severe menopause symptoms.
Dr Wong informs that for libido, you can take a local vagina tablet or cream to increase your libido. It’s a component of oestrogen which doesn’t cause womb cancer and usually circulates around the perineum area and helps a lot in the building of the vaginal wall tissues. These vaginal wall tissues are very important for libido, lubrication of the vagina and the elasticity of the vagina.
“Actually, if your symptoms are not too serious, your can take non-medical measures like exercise, nutritional supplements, yoga, drink a lot of water and sit in an air-conditioned room if you’re having hot flushes,” informs Dr Wong.
Doing it naturally
Qigong, acupressure, massage, yoga and aromatherapy are all good to possibly alleviate some menopausal symptoms like headaches, sleep disturbance, and joint and bone aches. While all of these will help you feel more relaxed and calm, the bottom line is you will still have to deal with osteoporosis, for which there is no alternative treatment.
Having said that, Dr Wong recommends menopausal and perimenopausal women to take care of themselves, as it can help with the other symptoms.
Apart from exercising, diet is very important because your metabolism and fat distribution is now different. You should take less fat and carbohydrates, and concentrate on a high-fibre diet, which will also help reduce your cholesterol level. Remember to take protein, minerals and vitamins, fruits and vegetables, and omega oils which help improve blood flow.
If you can’t control your eating, Dr Wong recommends taking less food after 6pm because in the last few hours of the day your metabolism level goes down.
“Always remember the golden rule – eat like a king at breakfast, a queen at lunch and a little princess at dinner. You tend to metabolise most of the things you eat in the morning because that’s when your cortisol levels are high,” she says.
For memory, you can take Vitamin B complex or have a diet rich in Vitamin B complex. Even things like ginkgo biloba can help, says Dr Wong.
Sleep is very important too, if you can get it. Without enough sleep, you will be irritable and tired and you won’t be able to concentrate. So, you should make enough time for sleep as well as rest and relax.
For the skin, Dr Wong recommends Vitamin C, lotion and a sunblock when going outdoors because skin pigmentation is a major problem at this age.
For memory, she recommends playing games, reading and doing something stimulating, rather than just sitting in the house and passing the day. Keep active.
Support from family and friends is very important at this time. This is a time of changes for women and they need emotional support. Family and friends can remind them to take care of themselves. Spousal support is also important.
Dr Wong advises husbands not to use words like “old age” and “menopause” to dismiss their wife’s symptoms and feelings. Now is the time to spend more time with the wife and help her through this new phase in her life.
“Going through menopause is a big change for women. It can be quite depressing. The husband should be more understanding and accept the wife as she is. If he feels she is not up to her optimum level, he can tell her gently that perhaps HRT would be helpful.
“There are husbands who think HRT is dangerous to their wife and yet they want their wife to behave as normal as possible. It is difficult. He should understand the wife is lacking in two hormones now – oestrogen and progesterone,” says Dr Wong.
Ultimately, women taking HRT should do so because they want to and not because the doctor says so. Dr Wong says it is important for women to understand all the risks and benefits, and the reason she’s taking HRT.
“If she’s feeling very well, she’s healthy, her bone mass is very good, she doesn’t have any symptoms, she’s exercising a lot, she’s taking all the nutritional supplements, her libido is okay, everything is fine and she says she doesn’t want to go on HRT, we’re not going to push her to take it. We’ll just tell her to continue with what she’s doing.
“By her own activities and lifestyle she is delaying her bone ageing. Those on HRT are those who are really having the symptoms and the discomfort and they have a strong family history of osteoporosis. In the event that they get breast cancer, they know this is the risk they have taken. If they are on HRT we always advise them to check their breasts regularly, do mammograms and blood tests. So, they are advised to have regular supervised health checkups,” says Dr Wong.
She informs that usually if they get breast cancer it is usually found in the early stage and breast cancer due to HRT is usually not the aggressive type and it is treatable.