Enjoying your menopausal years

The current life expectancy of Malaysian women at 77.3 years means they will spend a third of their lives in the post-menopausal years.

By 2025, the number of post- menopausal women is expected to rise to 1.1 billion worldwide.

This period greatly puts them in an oestrogen-deficiency state, which affects more than 400 bodily functions. As they struggle to cope with symptoms such as hot flushes, fatigue and depression, they are also at risk of health problems including osteoporosis and cardiovascular disease.

Enter the great debate on Hormone Replacement Therapy (HRT), or now rebranded as Menopause Hormone Therapy (MHT).

“Oestrogen is a female hormone that plays a major role in regula- ting and developing the female reproductive system, as well as parts of the female body where oestrogen receptors are present, such as the brain, liver, bones and heart.

“That is why MHT not only serves as a valuable form of treatment for menopause symptoms, but also protects against bone loss that contributes to the growing incidence of hip and spine fractures in women,” said consultant obstetrician and gynaecologist Dr Ho Choon Moy at the recent launch of a low dose MHT drug.

Women began shying away from MHT when a Women’s Health Initiative study in 2002 found that it increased the risk of developing heart disease and breast cancer.

After the study was published, there was a reported decline in the number of prescriptions in Britain and the United States, and a decline in the number of breast cancer cases.

She said, “Over 80% of breast cancers in postmenopausal women occur in women who have never taken hormone therapy.

“Breast cancer is caused by an accumulation of up to 200 abnormal mutations of genes within the cell and the majority of these mutations probably occur prior to menopause.

“Oestrogen does not cause mutations, but may accelerate the growth of a cell that has already accumulated some of the mutations if the cell contains a receptor for oestrogen.

“MHT is not for breast cancer survivors, so a mammogram should be done to rule out breast cancer before MHT prescription.

“After 50, the risk doubles every 10 years regardless of whether you’re on oestrogen therapy or not.

“Many women stopped HRT and research confirmed that what was feared could happen did happen – osteoporosis and hip fractures among them had increased by 55%.”

Dr Ho pointed out that in the 2002 study, the average woman’s age at entry was 63 years, the average time since menopause was at least 12 years, and over 50% of the participants had no vasomotor symptoms.

“The intention of WHI was to look at health outcomes in MHT use in older women. It is not straightforward to transpose the outcomes of a 50-79-year-old population to the majority of likely users of MHT who are largely under 60 years of age,” she said.

This negative result was reanalysed in 2012, and focused on women aged 50-59, the group most likely to take MHT.

The new findings revealed a lower risk of breast cancer in first-time MHT users, compared with previous findings; a non-significant 30% reduction in mortality rate; and a 7% reduction in coronary heart disease.

The risk of osteoporotic fractures was reduced by 33% in the total population.

“The WHI 2013 report concluded that MHT is a reasonable option for the management of moderate-to-severe menopausal symptoms among generally healthy women during early menopause.

“The benefits of oestrogen started within the first few years of menopause far outweigh any potential side-effects.

“A delay of 10 years and/or more before beginning MHT allows time for adverse changes such as arteriosclerosis to develop, so it’s no point starting after this period.

“Oestrogen therapy begun during the window of opportunity was beneficial in lowering the risk of breast cancer, osteoporosis, bowel cancer, and reducing the incidence of calcium deposits in the walls of arteries,” said Dr Ho, who is also the president of the Malaysian Menopause Society.

Previously, it was reported that women should be on MHT for only five years, but the latest studies show there is no “end date” to MHT as long as there are no contraindications.

She said, “The earlier you start, the better the benefits. Every woman has at least one menopausal symptom. Some women get depressed during this period and seek psychiatric help without rea-lising that this is one of the symptoms of menopause.

“MHT should not be recommended without a clear indication for its use, i.e. significant symptoms or physical effects of oestrogen deficiency. Get assessed by your gynaecologist first because there’s no one dose that fits every size.”

Healthy eating and regular exercise also helps alleviate the symptoms.

Septuagenarian Jagjeet Singh shared her journey through menopause during the event. She recalled how she “transformed” into a different person during her menopausal years – temporarily.

“I was a very active person and gradually I began having headaches, anxiety, was irritable and moody.

“This went on for two years before I sought help from a clinic and was told the symptoms were all due to menopause,” she shared.

She was put on HRT and within weeks, started seeing improvement in her condition. She went back to being “normal” again.

Now 76, the fitness coach said, “I enjoyed life for eight years until I read a report that HRT causes cancer. I became worried and fear made me stop taking HRT. I think my good skin, bones and health can be attributed partly to HRT. Now I want to go back to taking it, but I’m told it’s too late!”