Menopause Update Dr Fiona Jacklin April 2018

MENOPAUSE Final period 45-55 (average 51) Starts in mid to late 40’s Early menopause Surgical menopause Menopause due to cancer treatment

MENOPAUSE 80 % experience symptoms 25% have severe symptoms 50% experience hot flushes for up to 7 years Tests not usually required

SYMPTOMS Change in periods Hot Flushes Night sweats and sleep disturbance Low mood and anxiety Memory and concentrations problems Generalised aches and pains Skin irritation Low sex drive

SYMPTOMS Vaginal dryness , itching or burning Vaginal discharge Painful intercourse Urinary urgency and frequency Recurrent urinary tract infections

ASSOCIATED DISEASES Cardiovascular disease - increases after the menopause Osteoporosis - decline in bone density Redistribution of body fat – risk factor for Diabetes Alzheimer's disease – high incidence than men

WHAT CAN I DO TO MINIMIZE THE EFFECTS OF THE MENOPAUSE ? Healthy diet – protect bones and heart Regular weight bearing exercise Maintain a healthy weight Stop smoking Keep to alcohol recommendations Breast self examination Take part in NHS screening Recognize increased stress and anxiety

TREATMENT OPTIONS - HRT Most effective treatment Helps hot flushes , night sweats mood swings, vaginal and bladder symptoms Reduces risk of osteoporosis Reduces risk of coronary heart disease if started within 10 years of the menopause Benefit to collagen, muscle mass and strength Possible reduction in colorectal cancer and dementia

RISKS OF HRT Blood clots - risk lower with patches or gels Stroke – only with oral preparations Breast Cancer –with combined preparations Heart Disease –if started over 60 Endometrial Cancer – progesterone protect Ovarian Cancer – not confirmed

BREAST CANCER RISK 4 extra cases per 1000 women over 5 years Same risk as drinking 2-3 units of alcohol daily No increased risk under age 51 No increased risk of dying from breast cancer Combined HRT increases breast density and risk of abnormal mammogram

SAFETY CONCERNS 1940’s –first prescribed 1960’s –widely used 1990’s- 2 large studies suggested extended use may increase risk breast cancer and HRT use may cause heart disease New guidance issued, number of women using HRT fell by 66 % 2000’s – further evidence to suggest protective for heart disease if taken within 10 years of menopause

SHOULD I TAKE HRT ? For most women it is safe and effective Need a clear indication for HRT No contraindications Taken at the lowest effect dose for shortest time Starting HRT within 10 years of the menopause Needs to discuss with own GP and assess individual benefits and risks Have an annual medical review Remember you still need contraception

WHICH HRT ? If you have had a hysterectomy – oestrogen only If womb intact – oestrogen and progesterone Periods stopped less than a year ago – sequential combined HRT Periods stopped over a year ago – continuous combined Delivery system – oral , patch , gel, nasal spray , vaginal ring , Intrauterine device

VAGINAL HRT Good evidence helps vaginal and urinary symptoms Contraindicated with active breast cancer /undiagnosed vaginal bleeding A year’s supply of vaginal oestrogen is equivalent to having one tablet of standard HRT Vaginal lubricants

ALTERNATIVE TREATMENTS Herbal - Black cohosh , Evening primrose oil , Ginseng , St John’s Wort Phyto-oestrogens – Soya , Red Clover Many not proven to be safe or effective Can have interactions with other medications Look for -THR ( Traditional Herbal Registration) on packet

ALTERNATIVE TREATMENTS CBT Mindfulness Antidepressant medication eg citalopram – can help flushes Gabapentin

Summary Menopause symptoms are individual Important to optimize lifestyle HRT can be a safe and effective treatment Can consider alternatives remedies

Menopause Update Dr Fiona Jacklin April 2018