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Menopause: more than hot flushes

Jean Hailes Magazine | Medical & health articles 11 Jan 2021
woman in menopause wearing glasses

Women’s knowledge of the long-term effects of menopause remains poor, researchers have found.

By Jo Roberts

There is a “concerning” lack of knowledge among women about the long-term effects of menopause on their health, such as osteoporosis and cardiovascular disease, according to a new Melbourne study.

Further, many women still hold negative attitudes towards menopausal hormone therapy (MHT), despite its broad effectiveness and safety.

The study, led by the Women’s Health Research Program at Monash University, says the knowledge gaps among women “urgently need to be addressed to enable women to make informed health choices” around the management of menopausal symptoms.

Menopause is defined as the final menstrual period. Most women in Australia reach menopause between the age of 45-55 years, with the average age of menopause 51-52 years.

Researchers found that while women had a good understanding of the immediate effects of menopause – that they no longer had periods, could no longer fall pregnant and may get hot flushes and mood swings – few understood the long-term health impacts of menopause. Professor Susan Davis, who led the study, said she was “shocked that almost nobody” among the participants mentioned osteoporosis.

Women are at greater risk of osteoporosis, or brittle bones, after menopause due to the drop in their levels of the hormone oestrogen, which plays a role in bone health.

And certainly no one mentioned cardiovascular disease, changes in cholesterol levels, cognitive changes – they didn’t appear to have any appreciation of the metabolic effects of menopause,” said Prof Davis.

Professor Susan Davis, Monash University

The fall in oestrogen around menopause also contributes to increased abdominal fat in women, which is associated with an increased risk of cardiovascular disease, the number-one cause of death of women in Australia as well as diabetes, breast and colon cancer.

The study – ‘Australian women’s understanding of menopause and its consequences: a qualitative study’ – was published in the Climacteric medical journal in July.

The study’s 32 participants were aged from 46 to 69 years, and ranged from pre-menopausal to late postmenopausal. The women were invited from a larger cohort of about 2000 recruited about five years ago, and chosen from a diverse range of urban, rural and remote locations.

Prof Davis was surprised about the women’s views of MHT, that it was “something you only do if your back’s against the wall”.

They don’t even feel like they should be going to their doctor about [menopause],” Prof Davis said. “They are not confident that their GP can help them.”

The main concern of five of the study’s 10 premenopausal women about MHT was the risk of cancer and using ”synthetic stuff”. Use of MHT is a controversial topic, even though evidence to date suggests the benefits for healthy women around the time of menopause far outweigh the small risks. And there is still little supporting evidence that complementary and alternative medicine (CAM) can help treat menopausal symptoms.

About 13% of Australian women use CAM therapies for managing hot flushes, with the three most commonly used CAM therapies being phytoestrogens (plant-based substances that are similar to female hormones), evening primrose oil and ginseng.

However, only about 25% of these women consult an expert for advice about these therapies. Therefore, many women may be making inappropriate – or indeed, ineffective – choices.

Also, despite their names, natural therapies, like MHT, are also made in laboratories.

“Everything alternative is synthetic too,” says Prof Davis. “There’s no vitamin C tablet tree.”

Prof Davis says about 75% of postmenopausal women in Australia younger than 55 who were not using MHT had what are called vasomotor symptoms (VMS), such as hot flushes, while more than 28% of women had moderate to severe VMS. Yet resistance to MHT use remains high, with a common view that menopause “is something women just have to get through.” “It’s like some women say, ‘there are some women who can’t deal with it, so they might need something’ … it’s almost like a failure if you can’t deal with it,” she says.

Much of the negativity still surrounding MHT stems from the Women’s Health Initiative, a 2002 study conducted in the United States. The study was thought to suggest MHT caused a sharp rise in the incidence of breast cancer, prompting millions of women around the world to abandon it.

The reporting of the study’s findings was later found to be flawed, but the damage was done. Many women either stayed away from MHT or refused to try it.

“Once you get a negative belief in someone’s brain, it’s very hard to change it,” Prof Davis said.

Prof Davis urges women to seek out credible information about MHT, from websites such as Jean Hailes, the Australasian Menopause Society, and the International Menopause Society. “Get the facts, not just random things off websites,” she says.

“Menopause is truly the gateway to your ageing health. So, take it seriously, it’s not a five-minute experience. Your hormones change now for the rest of your life and you’ve got to be aware of the health consequences of no longer having your ovaries working.

“You’ve got to attend to your cardiovascular and bone health, and metabolic health. And if you have symptoms, go and talk to someone with expertise in women’s health.”

3 things to know about menopause

1. The effects of menopause go far beyond hot flushes and no more periods

2. The fall in oestrogen levels after menopause means an increased risk of brittle bones, cardiovascular disease and colon cancer

3. MHT is safe for most women.

Learn more about menopause and MHT, here.

This article was originally published in the 2020 issue of Jean Hailes Magazine