1. Menopause Update Dr Fiona Jacklin April 2018

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

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

4. 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

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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

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

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

18. Menopause Update Dr Fiona Jacklin April 2018