“I became terribly forgetful and irritable – I was short tempered and would start crying for no reason.”

For women menopause is the bridge between an ending and a beginning – but the crossing is fraught with hot flushes, night sweats, mood swings and forgetfulness. Is help available? Is hormone therapy safe or dangerous? And what about the so-called male menopause? Here’s the low-down
By Mariëtte Crafford

I’m on fire!’’ my middle-aged neighbour complains at a mutual friend’s 50th birthday tea party. She fans herself with a magazine. ‘‘I can’t sleep. I toss and turn all night,’’ another joins in.

‘‘I jerk awake drenched in sweat,’’ says a third. ‘‘And my family has to watch out – I wake up happy but by lunchtime I’m miserable and cry for no reason. I don’t know what’s wrong with me.’’

Most of the women at the tea party are going through their menopause. Th e birthday girl however is as cool as a cucumber. ‘‘I can’t complain about menopause yet,’’ she says. ‘‘But my husband! It’s like living with a stranger. New car, new hairstyle, new clothes . . . but nothing new in bed!’’

THE MENOPAUSE AFFECTS EVERYONE DIFFERENTLY
The flood of complaints around me reminds me of what lies ahead. So I question an expert about the menopause. It’s not just that I want to be prepared; I also want to understand what my friends – female and male – are going through.,/p>

There’s much confusion about the various treatments and I have plenty to ask. In fact the words ‘‘menopause’’ and ‘‘hormone therapy’’ are words that can cause hot flushes by themselves. ‘‘Male menopause’’ (or andropause) is even more bewildering . . . And this is all because of a series of misconceptions, doctors say.

Dr Tobie de Villiers, gynaecologist and committee member of both the South African Menopause and International Menopause Societies, clears up some of the confusion.

YOU Pulse: What’s the best treatment for the symptoms of menopause?

TdV: The only treatment that results in a dramatic improvement of all the symptoms is hormone therapy (HT). HT involves either only oestrogen hormone therapy (EHT) or a combination of oestrogen and progesterone therapy (EPT).

Women don’t all experience the same symptoms in the same way. However no woman should have to suffer because oestrogen therapy, whether on its own or with progesterone, really works.

Your hot flushes and night sweats (which are actually hot flushes at night) should stop within14 days after starting HT. You’ll also sleep better and be less moody and your quality of life will improve.

HT also reduces the possibilities of osteoporosis and heart disease if you start the therapy as soon as possible after menopause. Because hot flushes and the other unpleasant menopausal symptoms don’t usually last longer than five years your doctor will interrupt the treatment after that time to see if you still need it.

If HT is used to treat or prevent osteoporosis the treatment could last longer, with a specialist’s approval. But women older than 60 should preferably use a skin patch, which releases a lower dose.

If you’re a suitable candidate for EHT the sooner you start using it the more effective it’ll be. It’s available in pill form, as a patch and in gels.

YOU Pulse: Should all menopausal women have HT?

TdV: No! Firstly only one or two in every five women experience symptoms so severe they need treatment. Secondly not all women are suitable candidates for EHT. It’s important to remember that while menopause can be uncomfortable it isn’t a disease. It’s a physiological reality all women go through. Many women say they feel more relaxed, wiser and more at peace with themselves once the uncomfortable bit is over.

In fact, menopause is an excellent opportunity for women to pay attention to their overall health. Take a look at your eating habits and weight. Get fitter and try to stress less. Go for the tests your doctor recommends, including cholesterol, blood glucose, thyroid function and bone density tests. Also have a mammogram done.

YOU Pulse: Why do doctors change their tune about HT every few years? Is the treatment safe or not?

TdV: Forget about researchers’ interpretations of the Women’s Health Initiative (WHI) findings. The WHI writers owe women and doctors around the world an apology for the confusion. They’ve exaggerated the dangers of HT. Hormone therapy is perfectly safe, provided it’s used correctly.

These are the risks

• A slightly higher risk (47 in 10 000 instead of 45 in 10 000 women) of breast cancer as time goes on, but only when oestrogen and progesterone are used together (as is the case with women who still have a womb). It doesn’t occur among women who use only oestrogen.


• The risk of blood clots is higher among patients older than 60 – 34 in 10 000 instead of 16 in 10 000 women. The risk is small and increases with age but is at its greatest during the first year of treatment.
• There is a slightly greater risk of a stroke if you start HT after 60 – 29 in 10 000 instead of 21 in 10 000 women. Unlike blood clots the risk remains the same after the first year of treatment.


• Higher risks end with the treatment – but so does the protection against osteoporosis and colon cancer.

YOU Pulse: What about natural and herbal remedies?

TdV: Unlike HT alternative remedies don’t have to conform to the strict requirements of the SA Medicines Control Council before they’re made available to the public.

Research has proved beyond all doubt HT works, and works well. Unfortunately that can’t be said for alternative remedies. Some researchers believe plant oestrogen in the herb black cohosh and in soya (but not in soya tablets) can relieve hot flushes.

Although some women swear by them a new American study by the National Institutes of Health has once again proved plant oestrogen is nothing more than a placebo.

People often assume medicines derived from plants are safe but there’s no proof this is really the case. Some herbal medicines can have serious side-effects, such as damaging your liver. They also interfere with the effects of other medication. Talk to your doctor before you start using them.

OVERWEIGHT WOMEN EXPERIENCE MENOPAUSE AT A LATER AGE AND FOR LONGER

During menopause the ovaries cease to produce oestrogen but precursor hormones released by the adrenal gland remain in circulation. These hormones are transformed into oestrogen in fat cells, which is why overweight women who have many fat cells have more oestrogen for longer than thinner women.

It’s ironic: people who want to use natural remedies avoid EHT yet all oestrogen prescribed by doctors has a natural origin (either plant or animal). The oestrogen is adjusted slightly so it corresponds exactly with the oestrogen naturally produced by the human body. It’s so natural the female body can’t distinguish between its own oestrogen and EHT.

YOU Pulse: Who shouldn’t use HT?

TdV: HT isn’t suitable for patients with a personal or family history of blood clots, strokes or breast cancer. It should also not be used for the first time if you’re older than 60.

Women with wombs are treated with a combination of oestrogen and progesterone. Although oestrogen alone is slightly safer the combination treatment is also very safe and highly effective, provided it isn’t used for more than four years and not by women older than 60.

It’s definitely not worth having a hysterectomy to benefit from the minimal advantages of oestrogenonly treatment.

YOU Pulse: What about women who don’t want to use HT or natural remedies?

TdV: Try to use common sense to manage your symptoms. It’s only when this practical approach doesn’t help that medical treatment should be considered. This also applies to women who can’t use HT because of its annoying side-effects such as bloating, tender breasts and mood swings.

Tips to survive the symptoms

HOT FLUSHES
This is the most common symptom, experienced by 75 to 80 per cent of menopausal women. A hot flush usually lasts about five minutes but some women experience a hot flush every 15 minutes. These get worse in the late afternoon, when it’s hot, after hot drinks, after hot or spicy food and when you’re stressed. They decrease after about two years.

It’s a good idea to dress in layers so you can take off or put on clothing as needed. Sit in front of a fan at home or at the office.

Avoid hot drinks and spicy food and drink cold water. Although hot flushes can occur during exercise regular exercise can help beat flushes and relieve insomnia. Low dosages of certain antidepressants can also help relieve hot flushes.

NIGHT SWEATS
Wear light pyjamas. Have a brief shower if you wake up drenched.

SLEEP DISTURBANCES
Half an hour’s exercise every day will help insomnia as long as you don’t exercise late in the afternoon or at night. Avoid smoking, heavy meals, coffee and alcohol after 4 pm and don’t work late. Make sure your room is dark and cool.

MOOD SWINGS
These can be a problem particularly for women with a history of premenstrual syndrome or post-natal depression. HT can help – and be assured, mood swings aren’t the same as depression.

DRYNESS
Use over-the-counter internal creams (such as K-Y® Jelly) or oestrogen cream.

FORGETFULNESS
You’re not alone if you’re feeling absentminded. This too will pass. Make sure you get enough sleep and exercise every day.

In conclusion
Remember, hormone therapy isn’t suitable for everyone. But for those who can use it it’s a safe option – and it works. Every patient has the right to make an informed decision but it’s important to remember HT isn’t a fountain of youth.

Menopause made simple
The word menopause is derived from a Greek word meaning ‘‘the last period’’. In modern times however it has come to mean the transition phase after a woman has experienced her last menstruation.

Worldwide the average age for the onset of menopause is 51 but it can begin at any age between 45 and 55. A small number of women experience premature menopause before they reach this age. This is abnormal and is treated differently. The stage leading up to menopause (called perimenopause) usually begins after the age of 45 and is characterised by missed or irregular periods. In general, treatment is not necessary at this stage.

IN THE OLD DAYS
At the end of the 19th century the average age for the onset of menopause was 51 – as it is today. But female life expectancy then was just 40 years and women often died before menopause. Today women living in First World countries can expect to live well into their eighties.

PHYSICAL CHANGES
Periods end because the ovaries no longer release eggs for fertilisation every month. As a result production of the female hormone oestrogen stops. In normal circumstances egg-cell production stops when the number of eggs a woman was born with has been exhausted or their quality has deteriorated.

SYMPTOMS
The sudden absence of oestrogen has a huge impact on a woman’s body and emotions. One of the first things to become seriously mixed up is the temperature-control centre in the brain, and that’s the reason you keep feeling hot. In the beginning hot flushes, night sweats (nocturnal hot flushes), insomnia, mood swings and joint pains are the most common symptoms. These are followed by the thinning of the vaginal wall which can lead to sexual discomfort. There is also a greater risk of heart disease and osteoporosis. Forgetfulness is often a symptom. Your skin and hair gradually thin and you have a greater chance of developing a belly.

There’s magic in maturity
By Miranda Pretorius

“I’M A clinical psychologist and I’ve just turned 50. Both my kids are students. Menopause lies ahead – or as the doctors put it, I’m perimenopausal.

‘‘In other words, I’m a normal woman at the stage of my life where I’m looking back at the years gone by and ahead at the ones to come. Just before my 50th birthday I thought about the past year. How have I changed? Because something was definitely happening, both physically and psychologically.

‘‘I remember the first night sweat, about a year ago. It didn’t really worry me but it was the beginning of lots of other things. As the months passed I saw my body changing. My hair got thinner and fell out in clumps. One day I noticed I had fi ne wrinkles on my throat and my skin was getting drier. It got so bad I had to use a night cream during the day as well.

‘‘I’m naturally thin but I started getting a bulge around my middle. And I was tired all the time – so tired I couldn’t stay awake after 9 pm. I’d always had nice hands but they started to age by the day. My menstruation cycle was completely screwed up. I wouldn’t have a period for a couple of months and then the floodgates would open.

‘‘The worst was that my face changed – as if it was retaining water. My body felt out of proportion: my breasts were too big and my legs too thin. I got headaches and cramps all over my body, including leg cramps at night.

‘‘But the absolute worst for me were the psychological symptoms. As a psychologist I have always listened patiently to people talking about their midlife crises – but now it was happening to me.

I realised I was feeling depressed. I knew all the symptoms: I was listless, nothing excited me any more, one week I couldn’t get to sleep and the next week I couldn’t wake up.

‘‘I became more reserved and withdrawn. Anxiety followed. My breathing was shallow and my hands were cold and damp – I felt like I was about to write an exam for which I hadn’t prepared. ‘‘I became terribly forgetful and irritable. I was short-tempered and would start crying for no reason.

‘‘One day I decided the time had come to do something about it. I made appointments with my gynaecologist and a psychiatrist. I had my hormone levels, bone density and thyroid function tested, and I had a mammogram. The psychiatrist put me on antidepressants and antianxiety medication.

‘‘Today I feel in control. I understand what’s going on in my body. I was able to celebrate my 50th birthday in the knowledge that hot flushes and all the other symptoms were temporary. I still have a lifetime ahead of me. I’ve come to terms with the way my body’s changing and I’m looking forward to the day I can say I’m over perimenopause, I’ve conquered menopause and I’ve come out the other side a happier and wiser person – someone who’s made peace with the seasons of her body and soul.’’

As a woman and a psychologist I can give you these tips from my experience of this transition:

• Tell your spouse or life partner about your symptoms. It’s important for him to be informed about your physical changes and what you’re going through emotionally. Be honest.


• Talk to your kids. They also need to understand why you’re having mood swings. .


• See a gynaecologist and empower yourself with information about your condition. Ask for a complete explanation of menopause. .


• See a psychologist who can help you change and adapt. .


• See a psychiatrist if depression and anxiety get worse.


• Try to exercise every day, even if it’s just walking for a kilometre to clear your head.


• Accept you’re going through a confusing time but that it’ll pass. Talk to a friend who’s going through the same thing and support each other.


• Focus on the positive side: you’re entering a new and challenging phase of your life. You’ll be able to learn new skills, indulge in new hobbies, possibly start a new career and do things you’ve never had the opportunity to do.

Woman centre