Welcome

Janet Michelmore AO 
Director, The Jean Hailes Foundation.

Dear Friend, 

The world has been forced to focus yet again on issues of terrorism and Australia is now in the forefront. The recent tragic events in Bali and at Monash University have left us all with a feeling of great sadness. Our hearts go out to grieving families and friends who have lost loved ones.

On the subject of women's health worldwide, the US study findings about hormone therapy (HT) was a confusing time for women around the world, who were left wondering what they should do about their menopause management. The Jean Hailes Foundation sprang into action immediately following this announcement. Our Research Unit, headed by Associate Professor Susan Davis, put together factual information and a statement from The Foundation.

Our Medical Centre, headed by Dr Sue Reddish, including our medical and administration staff handled the rush for appointments. And our Education Unit, headed by Sarah Hardy, literally took thousands of phone calls and disseminated hundreds of packs of information to women across the country.

My personal thanks go to the whole Jean Hailes team for moving so quickly on this issue. They put aside school holidays, small babies and other plans to analyse the results of the study and put pen to paper to make statements on behalf of The Foundation so that women around Australia could understand the situation. Special thanks go to Henry Burger, Sue Davis, Helena Teede, Liz Farrell and Natalene Muscat, our new National Communication Manager, who all worked tirelessly on our behalf and formed a cohesive and dynamic expert team.

In all we were able to clarify the issues, encouraging women to ask questions about their own health care. In many ways this experience highlights the need for us all to be vigilant in seeking out information. We have seen a change in the way people deal with things. No longer do people simply blindly accept information given to them - on anything, not just their health. Today, we as consumers are demanding accurate and up to date health care information from trusted and reputable sources.

In this magazine you will find good, basic information on navigating your way through the menopause maze. I hope this is helpful in assisting your decision-making on your journey through midlife.

On other issues I am thrilled to announce that The Jean Hailes Foundation has been awarded a Clinical Centre for Research Excellence (CCRE). This highly prestigious grant, awarded every five years, is a major acknowledgement by the Federal Government of The Foundation's significant contribution to the field of women's health in research, education and training. The Centre will be led by Susan Davis, Director of Research.

Over the next five years funding from the grant will provide an opportunity for comprehensive and multidisciplinary research into the major health issues affecting Australian women from the mid reproductive years. The Jean Hailes Clinical Centre for Research Excellence will surely help us to create healthier futures for each and every woman in Australia. I encourage you to read our update on the Sue Ismiel International Study into Women's Health and Hormones. 

In our last magazine we told you the exciting news that we were starting the world's most comprehensive study into women's health funded by the extraordinary vision and generosity of Sydney businesswoman, Sue Ismiel. The study is underway and we bring you the latest information.

I'd like to take this opportunity to acknowledge our Board members. The Jean Hailes Foundation Board is fortunate to have vibrant, dynamic and hands-on Board members, who collectively, form a highly professional team with varied experience who are all committed to The Jean Hailes Foundation and its vision.

As we get closer to the end of the year and the holiday season approaches I wish you all a happy and fun filled festive season.

Take care of yourself as much as you take care of your families. We look forward to your ongoing interest and support in 2003.

Navigating the Hormone Therapy Maze 
 

The science of HT has been plagued with ongoing controversies and studies that are confusing to women who are struggling with conflicting information. Doctors, gynaecologists and women's health clinics worldwide have been inundated with a deluge of women who want up to date, credible information so they can make the decisions for their own personal health situation.

What does all this mean for the estimated 600,000 Australian women (or approximately 40% of women aged 45 - 64) who were taking HT prior to the US trial being stopped? Just as each woman's experience with menopause is different, so too is the rationale behind her decision about whether to take hormone therapy (HT). 

About menopause

Menopause, known also as the "change of life", is literally the very last menstrual period in a woman's life. It is said to have occurred when a woman has not menstruated (had a period) naturally for 12 consecutive months. 

Menopause is a natural event. At menopause a woman's ovaries no longer release an egg every month, she stops having periods and she is no longer able to have children naturally. As the ovaries are the main source of female hormones (oestrogen, progesterone and testosterone), the levels of these hormones drop considerably, affecting other parts of her body.

 Menopause usually occurs between the ages of 45 and 55. Among Australian women, the average age is about 51 to 52 years. However, there are some women who experience menopause much earlier and others may still be menstruating in their late fifties. 

The age at which a woman goes through menopause is not influenced by race, height, the age that she experienced her first period, the number of children she has had, or whether she used the contraceptive pill as a method of birth control. However, cigarette smoking can influence the age at which a woman may go through menopause with smokers and even former smokers reaching menopause an average of two years earlier. 

Menopause that occurs before the age of 40 is called premature menopause. It may occur spontaneously as a result of early failure of the ovaries or be caused surgically when a woman has her ovaries removed, or caused chemically by chemotherapy for cancer. As the average life span for Australian women, other than indigenous women, is now about 80 years and increasing, women are now living around one third of their lives after menopause. 

Before menopause occurs there are usually two to six years of menstrual variation, known as the perimenopause. It is during this time that some women may experience menopausal symptoms. There is a great variation in women's experiences of menopause. In some women, physical symptoms like hot flushes and night sweats are predominant, while other women may have few or no physical symptoms but experience significant psychological symptoms.

Between 10 and 20 percent of women have no symptoms, 60 percent experience mild to moderate symptoms and 10 to 20 percent have severe symptoms. Common symptoms include hot flushes and night sweats. Some women report vaginal dryness/discomfort, irritability, tiredness, reduced sex drive (libido), lack of self esteem, forgetfulness, aches and pains, sleeping difficulty and headaches. 

About your hormones 

Hormones are chemical messages passing from one part of the body to another. Sex hormones work together in an intricate pattern to make the reproductive cycle function properly, and they also play a role in your overall health. 

The major female sex hormones are oestrogen and progesterone. They are produced primarily by your ovaries during your reproductive years. 

Why does menopause happen? 

As a woman approaches menopause, hormone levels increasingly fluctuate and often a woman notices changes in her menstrual cycle. For example:

Changes in the hormone levels can also contribute to some of the symptoms that might be experienced at this time. This process can take up to six years in some women. Eventually the hormone levels fall to a level where menstruation stops altogether and menopause is reached. A woman needs to continue using contraception for a further 12 consecutive months after the last natural period.

About hormone therapy 

Hormone therapy (HT) replaces some of the natural female hormones that the ovaries stop producing after menopause. Three different hormones may be involved, depending on the woman's needs: oestrogen, progesterone and testosterone. 

Oestrogen is the main hormone prescribed to relieve menopausal symptoms and for women who have had a hysterectomy, this is all that may be needed. In women who still have their uterus, oestrogen alone can overstimulate the cells lining the uterus causing an increased risk of endometrial cancer (cancer of the uterus). This risk is reduced by giving the hormone progesterone along with the oestrogen. It is given in a synthetic form known as a "progestin" or "progestagen". Women experiencing loss of libido, lack of energy and ongoing fatigue, even when taking oestrogen therapy, sometimes benefit from low dose testosterone replacement. 

Oestrogen and progesterone are produced in the ovaries during a woman's reproductive life. At menopause levels of these hormones fall dramatically until, in postmenopausal years, small amounts of each are produced by the adrenal glands instead of the ovaries and also in fat cells. 

Testosterone is produced by the adrenal glands and the ovaries. Production declines gradually over a woman's life, but is significantly reduced in women who have had both ovaries removed. There are benefits and risks associated with using HT and research continues in this area. 

How is it prescribed? 

There are different ways of taking HT and different combinations of the three hormones; oestrogen, progesterone and testosterone. HT can be prescribed as tablets, patches, skin gel, implants, oestrogen injections, vaginal preparations such as creams, tablets or pessaries (suppositories) or ring for local application inside the vagina. 

The tablets are taken orally on a daily basis. The patch is applied to the skin on the lower body once or twice weekly, the gel is applied daily and the implant (hormone pellet) is inserted under local anaesthetic beneath the skin and usually lasts 4 - 6 months. In all the non-oral routes the hormones are absorbed directly into the blood stream whereas with tablets they are absorbed through the intestine first.

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Short term use of hormone therapy (HT) 

Short term use of HT may be useful for women experiencing troublesome symptoms of menopause by: 

Symptoms disappear in most women within about five years after menopause and so short term HT is all that is required assuming that there are no other medical reasons. 

HT and early menopause (surgical or natural) 

The risks of developing osteoporosis or heart disease are considerably higher for women with early menopause than for women reaching menopause within the usual age range. This is due to the long term effects of declining oestrogen. It is therefore very important that these women seek advice from their health practitioner. To minimise these risks, women with early menopause are often prescribed HT until such a time as they would have gone through a natural menopause (50-51 years of age). There is no evidence that these women are exposed to any risks greater than if their own natural hormones were present, to the age of 50. To not have oestrogen for significant periods of time, especially before the age of 45 years, can put women at risk of significant health problems.

The Women's Health Initiative (WHI) trial 

Aim of the study 

The study looked at the long term use of oral HT in older women in the United States for the prevention of disease. 

There were 16,608 women (who were postmenopausal and had a uterus) who randomly received either Prempro (0.625mgs of conjugated equine oestrogen + provera 2.5mgs) or a placebo (dummy pill). 

Why was the study stopped? 

The study was stopped after an average of 5.2 years participation because the incidence of invasive breast cancer exceeded the safety level set by the WHI. 

However, the oestrogen only arm (for women without a uterus) of the study remains ongoing. This part of the study has not been stopped early, as the risks do not outweigh the benefits. We should have more information on these results in the next few years and we await these results with interest.

The Women's Health Initiative (WHI) results at a glance 

Where to Now? 

• Short term use of HT (up to 5 years) for menopause symptoms remains a very reasonable option when the benefits and risks are weighed up in each individual woman. This especially applies to younger women with early menopause. 

• Combined oestrogen/progestin therapy is not recommended to prevent disease. 

• It is important that ALL women using HT should be reviewed annually by their prescribing physician. Risks and benefits can be discussed for that individual woman.

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The Jean Hailes Foundation magazine is designed to be informative and educational. It is not intended that The Jean Hailes Foundation magazine provide specific medical advice or replace advice from your health professional. The Jean Hailes Foundation does not accept any liability to any person for the information or advice (or the use of information or advice) which is provided in this magazine or incorporated into it by reference. Information is provided on the basis that all persons reading the magazine undertake responsibility for assessing the relevance and accuracy of its content. 

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Note: This article is an archive. Whilst the Jean Hailes Foundation for Women’s Health has made every effort to ensure this information was accurate at the time of publication, the article content has not been updated since the date listed below.

Content December 07, 2002