Frequently Asked Questions

What is the menopause and when does it usually occur?

The menopause literally means stopping of menstruation. The ovaries no longer produce eggs and the hormones estrogen and progesterone. They still continue to produce a small amount of testosterone. The average age of the menopause is 50 to 51. It can happen as early as 30 or as late as 58.

What are the symptoms that can be expected?

The common symptoms are hot flushes, night sweats, tiredness, muscle pain and mild depression. In some people they can be absolutely debilitating. In others there are no symptoms or they are very mild. They can last anywhere from several months to 20 years.

Is there anything that can be done about the symptoms?

Hormone therapy is the only treatment that can take the symptoms away completely. Within days to a week of treatment the symptoms go away. Usually if you stop treatment they will quickly return. By taking hormones you can feel totally normal and menopause does not have to be a big change or something terrible that you have to get through.

Can everyone take Hormone Therapy?

Most people can take hormone therapy. The only absolute contraindications are a history of breast cancer and a history of clotting or deep vein thrombosis.

Are there any other benefits to taking hormones?

The vagina gets dry after the menopause and taking hormones will prevent this. Hormones therapy is also a very good treatment for osteoporosis or thinning of the bones. Studies have shown that women who take hormones have a lower incidence of colon cancer.

What about natural remedies?

Herbal remedies are often expensive and have very little benefit. In fact some of them containing Black Cohash may cause liver toxicity in some people. The progesterone cream that is widely touted is expensive and has been found to be no better than taking placebo. It is very poorly absorbed. The bioidentical hormones are said to be natural but contain the same ingredients as pharmocologically tested medicine. The dosage is based on saliva tests which are very unpredictable. If one takes hormones that have been rigourously tested in trials we know exactly what dose people are getting and of course the medical aid will pay. I would only use soy based natural products for patients with very mild symptoms who want relief but don’t want to use hormones.

What is Osteoporosis?

Osteoporosis is thinning of bones that occurs after the menopause. There will be no symptoms until a vertebrae collapses causing intense pain and loss of height. A slight fall can lead to a hip fracture. Hip fractures in older people are a leading cause of mortality. If the patient survives there is often loss of independence. It is important to detect osteoporosis before it causes fractures. The best way of assessing bone density is a bone density scan. People who are most at risk are those with a family history of disease, smokers, small fair people, on medication such as cortisone. Hormone therapy is a very good way to prevent loss in women between 50 and 60. After this we would be more inclined to use other medication. Weight bearing exercise and calcium and Vitamin D supplementation are also important

Doesn’t Hormone therapy cause breast cancer?

We have always been worried about hormone therapy and breast cancer. The big study WHI or Womens Health Iniative study that was published in 2002 showed that patients taking Estrogen and Progesterone had a slightly increased risk of breast cancer. Breast cancer is slow growing and remains undetected for quite a few years. We actually think that estrogen and progesterone do not cause cancer but promote the growth of an existing cancer. The women who were taking hormones and developed breast cancer had a less aggressive form of disease. Interestingly the women who were just taking Estrogen that is those women who had had a hysterectomy had a lower incidence of breast cancer than the women who were taking the placebo. So yes there may be a small increase in risk in patients taking combination therapy but to put it into perspective a woman who drinks 2 alcoholic drinks every evening or is obese has the same increased risk.

Explain a little more about hormones and heart disease

Most women are very concerned about breast cancer but do not realize that most women die of heart disease and not cancer. We think of heart disease as something that men get but in reality after the menopause women catch up. We always thought that hormone therapy prevented heart disease. There was a big observational studies that followed nurses taking hormone therapy. It was seen that the nurses who took hormones after the menopause had less heart disease than those who didn’t. However the first big randomized study WHI showed that there was an increase in heart attacks and strokes in the women who took hormones. The difference was that in this study they used older women in their 60’s many of whom were overweight were diabetic and probably had heart disease already.. If you look at the younger women in that study their incidence of heart disease and overall mortality was decreased by taking hormones. We talk about a window of opportunity. If you start hormone therapy in early menopause before there is significant hardening of the arteries you protect your heart. If however you start hormones in your 60’s when there is already hardening of the arteries and heart disease, hormones will accelerate the process.

Why can’t you take hormones if you have had a deep vein thrombosis or clot?

Estogen makes the blood hypercoagulable by its effects on the liver. The patch is absorbed through the skin and bypasses the liver. If your doctor thinks that you are at higher risk for clotting eg. if you are overweight or older you may be put on a patch rather than a tablet. Some people have an inherited tendency to clotting. In this case it is better to avoid hormone use.

A lot of women complain that their memory is much worse after the menopause. Will hormones help. Should you take hormones to prevent Alzheimer’s disease?

It has been shown that there is a small but measurable verbal memory loss that occurs around the time of menopause. Hormones may help for this. If you can’t take hormones it has been seen that the memory loss improves after several years. Alzheimers is a pathological disease different from temporary memory loss. Once a person has Alzheimers, hormone treatment makes it worse. It is probably true that as with heart disease that if hormones are taken at the time the menopause begins it may help to prevent Alzheimers. The only thing that has really shown to be of value in prevention is exercise.

How long should hormones be used for?

Initially after the WHI study it was thought that hormones should be used at a lowest dose as possible and for no longer than 5 years. We have come to a better understanding of what is happening. The studies have clearly shown that mortality is decreased in women who take hormones until the age of 60. I review the indication for taking hormones every year with my patients. Certainly after 60 I would want to either stop hormones or use an ultra low dose.

If a person can’t take hormone therapy can anything else be used for hot flushes?

In breast cancer patients we have seen that certain anti depressants are quite good for relieving hot flushes. Avoiding caffeine alcohol and smoking all help. Exercise also helps.

What about sexual desire or libido?

Lack of hormones can cause vaginal dryness. This can make intercourse unpleasant or even extremely painful. Hormone treatment especially vaginal treatment can completely reverse this process. Even patients who have had breast cancer can use the vaginal route. One of the symptoms of menopause is tiredness. I find that if a person is tired the first thing that suffers is libido. Again conventional hormone treatment is helpful. In some women especially if their ovaries have been removed even if they use hormones libido is still a problem. In these women we add testosterone treatment. \

Contact Details

Dr. Alice Shaw
Pr No.:1606263


dralice@aliceshaw.co.za
Tel: 044 384 0926
Fax: 044 384 0970