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Keeping intimacy alive after menopause

When sex is no longer enjoyable due to the changes brought on by menopause, many women sadly give up, wrongly believing there is no solution. This can result in loneliness within a relationship even leading to separation or divorce. But there is help available and it comes down to addressing genitourinary syndrome of menopause (GSM), a syndrome no one talks about despite the fact it affects all post-menopausal women and unlike hot flushes, doesn’t go away. GSM covers a range of menopausal symptoms including incontinence, burning, stinging or itching of the vagina, delayed or impaired orgasm and reduced libido. The good news is, there is help available, even for women who are unable to use hormone therapy and it’s never too late to seek help and take action. Treat the pain Pain and discomfort during intimacy is often the result of vaginal dryness. This can be addressed in many ways including the use of lubricants or vaginal moisturisers but it’s worth talking to your GP about a longer term solution. For many women, menopause hormone therapy (MHT) will help. An alternative to MHT is radiofrequency treatment with <a title="https://www.inmode.com.au/pages/empower-rf" href="https://www.inmode.com.au/pages/empower-rf" data-outlook-id="5a8b7279-e5dc-4ab9-9f3d-b788bb0310ee">EmpowerRF</a> to rejuvenate the tissue and increase collagen and elastin. Take it slowly Often women want to rekindle intimacy with their partner but are not sure how to go about it and fear often inhibits them initiating any intimacy at all. A staged return to intimacy can help. This is achieved by an agreement to limit the intimacy to non-sexual cuddles, no matter the level of desire, for an agreed period of time such as two weeks. It’s a great way to reignite that spark in a comfortable way, before taking things to the next level when both partners are ready. Try new positions Laying side by side can give the woman greater control over the rate of entry and the depth of penetration. If there is pain, stop at that point and breath and only increase penetration once the tissues have relaxed. If pain is still preventing penetration, it is important to seek professional help to find a solution. An examination will determine whether there is any other reason for the pain. A doctor can discuss options including estrogen cream, radiofrequency treatment and even Botox to help relax the muscles. Address incontinence One in two post-menopausal women experience incontinence, which can be a large barrier to sexual intimacy. I have helped many women overcome their struggles with incontinence, using electrical muscle stimulation treatment (V Tone) and radiofrequency technology (Forma V and Morpheus8V) to rejuvenate the tissues and strengthen the pelvic floor muscles. It can be life changing. Dr Judy Craig is a Perth-based GP and cosmetic physician. She has practiced medicine for over 40 years. Image credits: Getty Images

Relationships

How tracking menopause symptoms can give women more control over their health

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/deborah-lancastle-1452267">Deborah Lancastle</a>, <a href="https://theconversation.com/institutions/university-of-south-wales-1586">University of South Wales</a> Menopause can cause more symptoms than hot flushes alone. And some of your symptoms and reactions might be due to the menopause, even if you are still having periods. Research shows that keeping track of those symptoms can help to alleviate them. People sometimes talk about the menopause as though it were a single event that happens when you are in your early 50s, which is <a href="https://www.mayoclinic.org/diseases-conditions/menopause/symptoms-causes/syc-20353397#:%7E:text=Menopause%20is%20the%20time%20that,is%20a%20natural%20biological%20process.">the average time</a> to have your last period. But the menopause generally stretches between the ages of 45 and 55. And some women will experience an earlier “medical” menopause because of surgery to remove the womb or ovaries. The menopause often happens at one of the busiest times of life. You might have teenagers at home or be supporting grown-up children, have elderly parents, be employed and have a great social life. If you feel exhausted, hot and bothered, irritable and can’t sleep well, you might be tempted to think that it is because you never get a minute’s peace. But that is why monitoring symptoms is important. <a href="https://journals.lww.com/menopausejournal/Abstract/2023/03000/Symptom_monitoring_improves_physical_and_emotional.7.aspx">My team recently tested</a> the effects of tracking symptoms and emotions during the menopause. We asked women to rate 30 physical and 20 emotional symptoms of the menopause. The physical and psychological symptoms included poor concentration, problems with digesting food, stress and itchy skin, as well as the obvious symptoms like hot flushes and night sweats. Women tracked positive emotions like happiness and contentment, and negative emotions like feeling sad, isolated and angry. There were two groups of women in this study. One group recorded their symptoms and emotions every day for two weeks. The other group recorded their symptoms and emotions once at the beginning of the fortnight and once at the end. The results showed that the women who monitored their symptoms and emotions every day reported much lower negative emotions, physical symptoms and loneliness at the end of two weeks than at the beginning, compared to the other group. As well as this, although the loneliness scores of the group who monitored every day were lower than the other group, women in both groups said that being in the study and thinking about symptoms helped them feel less lonely. Simply knowing that other women were having similar experiences seemed to help. One participant said: “I feel more normal that other women are doing the same survey and are probably experiencing similar issues, especially the emotional and mental ones.” <h2>Why does monitoring symptoms help?</h2> One reason why tracking might help is that rating symptoms can help you notice changes and patterns in how you feel. This could encourage you to seek help. Another reason is that noticing changes in symptoms might help you link the change to what you have been doing. For example, looking at whether symptoms spike after eating certain foods or are better after exercise. This could mean that you change your behaviour in ways that improve your symptoms. Many menopause symptoms are known as “non-specific” symptoms. This is because they can also be symptoms of mental health, thyroid or heart problems. It is important not to think your symptoms are “just” the menopause. You should always speak to your doctor if you are worried about your health. Another good thing about monitoring symptoms is that you can take information about how often you experience symptoms and how bad they are to your GP appointment. This can help the doctor decide what might be the problem. Websites such as <a href="https://healthandher.com">Health and Her</a> and <a href="https://www.balance-menopause.com">Balance</a> offer symptom monitoring tools that can help you track what is happening to your physical and emotional health. There are several apps you can use on your phone, too. Or you might prefer to note symptoms and how bad they are in a notebook every day.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/209004/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/deborah-lancastle-1452267">Deborah Lancastle</a>, Associate Professor of Psychology, <a href="https://theconversation.com/institutions/university-of-south-wales-1586">University of South Wales</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/how-tracking-menopause-symptoms-can-give-women-more-control-over-their-health-209004">original article</a>. </div>

Body

What are the most common symptoms of menopause? And which can hormone therapy treat?

<a href="https://theconversation.com/profiles/susan-davis-10376">Susan Davis</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> Despite decades of research, navigating menopause seems to have become harder – with conflicting information on the internet, in the media, and from health care providers and researchers. Adding to the uncertainty, a recent <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00462-8/fulltext">series in the Lancet</a> medical journal challenged some beliefs about the symptoms of menopause and which ones menopausal hormone therapy (also known as hormone replacement therapy) can realistically alleviate. So what symptoms reliably indicate the start of perimenopause or menopause? And which symptoms can menopause hormone therapy help with? Here’s what the evidence says. <h2>Remind me, what exactly is menopause?</h2> Menopause, simply put, is complete loss of female fertility. Menopause is traditionally defined as the final menstrual period of a woman (or person female at birth) who previously menstruated. Menopause is diagnosed after 12 months of no further bleeding (unless you’ve had your ovaries removed, which is surgically induced menopause). Perimenopause starts when menstrual cycles first vary in length by seven or more days, and ends when there has been no bleeding for 12 months. Both perimenopause and menopause are hard to identify if a person has had a hysterectomy but their ovaries remain, or if natural menstruation is suppressed by a treatment (such as hormonal contraception) or a health condition (such as an eating disorder). <h2>What are the most common symptoms of menopause?</h2> <a href="https://srh.bmj.com/content/early/2024/02/21/bmjsrh-2023-202099.long">Our study</a> of the highest quality menopause-care guidelines found the internationally recognised symptoms of the perimenopause and menopause are: <ul> <li>hot flushes and night sweats (known as vasomotor symptoms)</li> <li>disturbed sleep</li> <li>musculoskeletal pain</li> <li>decreased sexual function or desire</li> <li>vaginal dryness and irritation</li> <li>mood disturbance (low mood, mood changes or depressive symptoms) but not clinical depression.</li> </ul> However, none of these symptoms are menopause-specific, meaning they could have other causes. In <a href="https://journals.lww.com/menopausejournal/abstract/2015/07000/moderate_to_severe_vasomotor_and_sexual_symptoms.6.aspx">our study of Australian women</a>, 38% of pre-menopausal women, 67% of perimenopausal women and 74% of post-menopausal women aged under 55 experienced hot flushes and/or night sweats. But the severity of these symptoms <a href="https://journals.lww.com/menopausejournal/abstract/2015/07000/moderate_to_severe_vasomotor_and_sexual_symptoms.6.aspx">varies greatly</a>. Only 2.8% of pre-menopausal women reported moderate to severely bothersome hot flushes and night sweats symptoms, compared with 17.1% of perimenopausal women and 28.5% of post-menopausal women aged under 55. So bothersome hot flushes and night sweats appear a reliable indicator of perimenopause and menopause – but they’re not the only symptoms. Nor are hot flushes and night sweats a western society phenomenon, as has been suggested. Women in Asian countries are <a href="https://journals.lww.com/menopausejournal/fulltext/2022/05000/prevalence,_severity,_and_associated_factors_in.9.aspx">similarly affected</a>. Depressive symptoms and anxiety are also often linked to menopause but they’re less menopause-specific than hot flushes and night sweats, as they’re common across the entire adult life span. The <a href="https://srh.bmj.com/content/early/2024/02/21/bmjsrh-2023-202099.long">most robust guidelines</a> do not stipulate women must have hot flushes or night sweats to be considered as having perimenopausal or post-menopausal symptoms. They acknowledge that new mood disturbances may be a primary manifestation of <a href="https://www.cell.com/cell/abstract/S0092-8674(23)00905-4?_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS0092867423009054%3Fshowall%3Dtrue">menopausal hormonal changes</a>. The extent to which menopausal hormone changes impact memory, concentration and problem solving (frequently talked about as “brain fog”) is uncertain. <a href="https://www.tandfonline.com/doi/full/10.1080/13697137.2022.2122792">Some studies</a> suggest perimenopause may impair verbal memory and resolve as women transition through menopause. But strategic thinking and planning (executive brain function) <a href="https://www.tandfonline.com/doi/full/10.1080/13697137.2022.2122792">have not been shown to change</a>. <h2>Who might benefit from hormone therapy?</h2> The Lancet papers <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00462-8/fulltext">suggest</a> menopause hormone therapy <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)02799-X/fulltext">alleviates</a> hot flushes and night sweats, but the likelihood of it improving sleep, mood or “brain fog” is limited to those bothered by vasomotor symptoms (hot flushes and night sweats). In contrast, the highest quality <a href="https://srh.bmj.com/content/early/2024/02/21/bmjsrh-2023-202099.long">clinical guidelines</a> consistently identify both vasomotor symptoms and mood disturbances associated with menopause as reasons for menopause hormone therapy. In other words, you don’t need to have hot flushes or night sweats to be prescribed menopause hormone therapy. Often, menopause hormone therapy is prescribed alongside a topical vaginal oestrogen to treat vaginal symptoms (dryness, irritation or urinary frequency). However, none of these guidelines recommend menopause hormone therapy for cognitive symptoms often talked about as “brain fog”. Despite musculoskeletal pain being the most common menopausal symptom in <a href="https://journals.lww.com/menopausejournal/abstract/2016/07000/prevalence_and_severity_of_vasomotor_symptoms_and.6.aspx">some populations</a>, the effectiveness of menopause hormone therapy for this specific symptoms still needs to be studied. Some guidelines, such as an <a href="https://www.tandfonline.com/doi/full/10.1080/13697137.2023.2258783">Australian endorsed guideline</a>, support menopause hormone therapy for the prevention of osteoporosis and fracture, but not for the prevention of any other disease. <h2>What are the risks?</h2> The greatest concerns about menopause hormone therapy have been about breast cancer and an increased risk of a deep vein clot which might cause a lung clot. Oestrogen-only menopause hormone therapy is <a href="https://www.nice.org.uk/guidance/ng23">consistently considered</a> to cause little or no change in breast cancer risk. Oestrogen taken with a progestogen, which is required for women who have not had a hysterectomy, <a href="https://www.moh.gov.my/moh/resources/Penerbitan/CPG/Women%20Health/CPG_Management_of_Menopause_2022_e-version-1.pdf">has been associated with a small increase</a> in the risk of breast cancer, although any <a href="https://www.bmj.com/content/bmj/371/bmj.m3873.full.pdf">risk appears to vary</a> according to the type of therapy used, the dose and duration of use. Oestrogen taken orally has also been associated with an increased risk of a deep vein clot, although the risk varies according to the formulation used. This risk is avoided by using estrogen patches or gels <a href="https://www.bmj.com/content/bmj/364/bmj.k4810.full.pdf">prescribed at standard doses</a> <h2>What if I don’t want hormone therapy?</h2> If you can’t or don’t want to take menopause hormone therapy, there are also effective non-hormonal prescription therapies available for troublesome hot flushes and night sweats. In Australia, most of these options are “off-label”, although the new medication <a href="https://australianprescriber.tg.org.au/articles/management-of-menopause.html">fezolinetant</a> has just been <a href="https://www.tga.gov.au/resources/artg/401401">approved</a> in Australia for postmenopausal hot flushes and night sweats, and is expected to be available by mid-year. Fezolinetant, taken as a tablet, acts in the brain to stop the chemical neurokinin 3 triggering an inappropriate body heat response (flush and/or sweat). Unfortunately, most over-the-counter treatments promoted for menopause are either <a href="https://srh.bmj.com/content/early/2024/02/21/bmjsrh-2023-202099.long">ineffective or unproven</a>. However, cognitive behaviour therapy and hypnosis <a href="https://journals.lww.com/menopausejournal/abstract/2023/06000/the_2023_nonhormone_therapy_position_statement_of.4.aspx">may provide symptom relief</a>. The Australasian Menopause Society has useful <a href="https://www.menopause.org.au/health-info/fact-sheets">menopause fact sheets</a> and a <a href="https://www.menopause.org.au/health-info/find-an-ams-doctor">find-a-doctor</a> page. The <a href="https://www.tandfonline.com/doi/full/10.1080/13697137.2023.2258783">Practitioner Toolkit for Managing Menopause</a> is also freely available.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/225174/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/susan-davis-10376">Susan Davis</a>, Chair of Women's Health, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/what-are-the-most-common-symptoms-of-menopause-and-which-can-hormone-therapy-treat-225174">original article</a>.

Body

How long does menopause last? 5 tips for navigating uncertain times

<a href="https://theconversation.com/profiles/yvonne-middlewick-1395795">Yvonne Middlewick</a>, <a href="https://theconversation.com/institutions/edith-cowan-university-720">Edith Cowan University</a> Around half of the world’s population are women or people who menstruate – yet the way their body works can be a mystery, even to them. Most women will experience periods roughly every month, many will go through childbirth and those who live into midlife will experience menopause. While menopause is a significant time of change, it isn’t talked about much, other than as a punchline. This may contribute to keeping it a <a href="https://www.theguardian.com/membership/2019/sep/21/breaking-the-menopause-taboo-there-are-vital-stories-we-should-continue-to-pursue">taboo topic</a>. So, what happens during menopause? How do you know when it is happening to you? And – the thing most women want to know – how long will it last? <h2>What is menopause?</h2> Menopause is <a href="https://www.nia.nih.gov/health/what-menopause">defined</a> as the permanent cessation of menstruation, which is medically determined to be one year after the final menstrual period. After this time women are considered to be postmenopausal. The <a href="https://pubmed.ncbi.nlm.nih.gov/26598775/">average age</a> of “natural menopause” (that is not caused by a medical condition, treatment or surgery) is considered to be around 51 years. However, natural menopause does not occur suddenly. <a href="https://www.researchgate.net/profile/Riitta-Luoto/publication/46425690_Prevalence_of_menopause_symptoms_and_their_association_with_lifestyle_among_Finnish_middle-aged_women/links/5c5704ac458515a4c7553c7b/Prevalence-of-menopause-symptoms-and-their-association-with-lifestyle-among-Finnish-middle-aged-women.pdf">Changes can begin</a> a number of years before periods stop and most often occur in a woman’s 40s but they can be earlier. Changes <a href="https://pubmed.ncbi.nlm.nih.gov/25686030/">can continue</a> for 10 years or more after periods have stopped. Using hormones such as the oral contraceptive pill or hormone intrauterine devices may make it more <a href="https://pubmed.ncbi.nlm.nih.gov/31934948/">difficult to determine</a> when changes start. Menopause that occurs <a href="https://www.womenshealth.gov/menopause/early-or-premature-menopause#:%7E:text=Menopause%20that%20happens%20before%20age,to%20come%20earlier%20than%20usual.">before 45</a> is called “early menopause”, while menopause before 40 is called “premature menopause”. <h2>What about perimenopause?</h2> Various <a href="https://www.menopause.org.au/hp/information-sheets/glossary-of-terms">terms</a> are used to describe this period of change, including “menopause” or “the menopause”, “menopausal transition”, “perimenopause” or “<a href="https://pubmed.ncbi.nlm.nih.gov/12188398/">climacteric</a>”. These terms tend to refer to the period before and after the final menstrual period, when changes are considered to be related to menopause. The difficulty with the definition of menopause is it can only be decided retrospectively. Yet women can experience changes many years before their periods stop (a lead up usually called “perimenopause”). Also, any <a href="https://www.sciencedirect.com/sdfe/pdf/download/eid/1-s2.0-S0889854518300627/first-page-pdf">changes noticed</a> may not be associated with menopause (because people might not be aware of what to expect) or changes may be associated with a combination of factors such as stress, being busy or other health issues. <h2>So, what is going on?</h2> Through a feminist lens, menopause can be seen as a <a href="https://www.researchgate.net/publication/354652248_The_volcano_within_a_study_of_women's_lived_experience_of_the_journey_through_natural_menopause">complex and diverse experience</a>, influenced by biological, psychological, social and cultural aspects of women’s lives. However, it is usually viewed from the biomedical perspective. This sees it as a biological event, marked by the <a href="https://www.sciencedirect.com/science/article/pii/S0091302220300418">decline</a> in ovarian hormone levels leading to a reduction in reproductive function. The female reproductive system operates because of a finely tuned balance of hormones managed by the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6466056/#:%7E:text=The%20hypothalamic%2Dpituitary%2Dovarian%20(HPO)%20axis%20must%20be,priming%20the%20endometrium%20for%20implantation.">hypothalamic-pituitary-ovarian axis</a>. International <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3340903/">experts</a> have developed a staging system for female reproductive ageing, with seven stages from “early reproductive” years to “late postmenopause”. However, female reproductive hormones do not just affect the reproductive system but <a href="https://www.sciencedirect.com/science/article/pii/S0091302220300418">other aspects</a> of the body’s function. These include the <a href="https://pubmed.ncbi.nlm.nih.gov/26007613/">neurological system</a>, which is linked to hot flushes and night sweats and disrupted sleep. Hormones may also affect the <a href="https://www.nature.com/articles/nrdp20154">heart and body’s blood circulation</a>, bone health and potentially the <a href="https://www.sciencedirect.com/science/article/pii/S0091302220300418">immune system</a>. Menopausal hormone changes may <a href="https://www.thewomens.org.au/health-information/menopause-information/menopause-symptoms/">cause</a> hot flushes, night/cold sweats, mood swings, sleep disruption and tiredness, vaginal dryness. Medical confirmation of menopausal changes in women over 45 years is based on two biological indicators: vasomotor symptoms (those hot flushes and night sweats again) and an <a href="https://www.womenshealth.gov/menopause/early-or-premature-menopause#:%7E:text=Menopause%20that%20happens%20before%20age,to%20come%20earlier%20than%20usual.">irregular menstrual cycle</a>. In early perimenopause the changes to the menstrual cycle may be subtle. Women may not recognise early indicators, unless they keep a record and know what to watch for. <h2>How long does it last?</h2> The body demonstrates an amazing ability to change over a lifetime. In a similar way to adolescence where long-lasting changes occur, the outcome of menopause is also change. Research suggests it is difficult to give an exact time frame for how long menopausal changes occur – the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3085137/">average</a> is between four and eight years. The <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3085137/">Penn Ovarian Ageing Study</a> found 79% of the 259 participants experienced hot flushes starting before the age of 50, most commonly between 45 and 49 years of age. A later report on the same study found one third of women studied experienced <a href="https://womensmidlifehealthjournal.biomedcentral.com/articles/10.1186/s40695-016-0014-2">moderate to severe hot flushes</a> more than ten years after their periods had stopped. A <a href="https://journals.lww.com/menopausejournal/Abstract/2017/03000/Cultural_issues_in_menopause__an_exploratory.11.aspx">2017 study</a> found a small number of women continued to experience hot flushes and other symptoms into their 70s. So overall, the research cannot offer a specific window for perimenopause, and menopause does not appear to mark the end of changes for everyone. <h2>5 tips for uncertain times</h2> Shifts and changes can be recognised early by developing knowledge, paying attention to changes to our bodies and talking about menopause and perimenopause more openly. Here are five tips for moving from uncertainty to certainty: 1. talk to people and find out as much information as you can. The experiences of mothers and sisters may help, for some women there are familial similarities 2. notice any changes to your body and make a note of them, this will help you recognise changes earlier. There are <a href="https://www.redonline.co.uk/wellbeing/a36980118/menopause-apps/">menopause tracking apps</a> available 3. keep a note of your menstrual cycle: start date, duration, flow and note any changes. Again, an app might help 4. if you are worried, seek advice from a GP or nurse that specialises in women’s health. They may suggest ways to help with symptoms or refer to a specialist 5. remember changes are the indicator to pay attention to, not time or your age. Menopause is a natural process and although we have focused here on the time frame and “symptoms”, it can also be a time of freedom (particularly from periods!), reflection and a time to focus on yourself.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/195211/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <figure><iframe src="https://www.youtube.com/embed/lhosPUwWhfI?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe><figcaption>Women speak about their experiences of menopause.</figcaption></figure> <a href="https://theconversation.com/profiles/yvonne-middlewick-1395795">Yvonne Middlewick</a>, Nurse & Lecturer, <a href="https://theconversation.com/institutions/edith-cowan-university-720">Edith Cowan University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/how-long-does-menopause-last-5-tips-for-navigating-uncertain-times-195211">original article</a>.

Body

Lots of women try herbs like black cohosh for menopausal symptoms like hot flushes – but does it work?

<a href="https://theconversation.com/profiles/sasha-taylor-1461085">Sasha Taylor</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> and <a href="https://theconversation.com/profiles/susan-davis-10376">Susan Davis</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> Menopause is the stage of life where the ovaries stop releasing eggs and menstrual periods cease. Most Australian women go through menopause between <a href="https://www.nature.com/articles/nrdp20154">45 and 55</a> years of age, with the average age being 51 years, although some women may be younger. Hot flushes and night sweats are <a href="https://www.nature.com/articles/nrendo.2017.180">typical symptoms</a> of menopause, with vaginal dryness, muscle and joint pains, mood changes and sleep disturbance also commonly reported. Up to <a href="https://pubmed.ncbi.nlm.nih.gov/25706184/">75% of women</a> experience menopausal symptoms, with nearly 30% severely affected. These symptoms can negatively impact day-to-day life and wellbeing. The main therapies available include menopausal hormone therapy (MHT) and non-hormonal prescription therapy. Some women will elect to try complementary and alternative medicines, such as herbal medicines and nutritional supplements. Black cohosh is one of them. <h2>What causes hot flushes</h2> The cause of hormonal hot flushes (also called hot flashes) still isn’t completely understood, but the decline in oestrogen at menopause appears to play a role in a process that involves the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3833827/">area of the brain that regulates temperature</a> (the hypothalamus). Factors linked to a greater likelihood of hot flushes include <a href="https://pubmed.ncbi.nlm.nih.gov/19675142/">being overweight or having obesity</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/25706184/">smoking</a>. MHT, previously known as hormone replacement therapy (HRT), usually includes oestrogen and is the <a href="https://pubmed.ncbi.nlm.nih.gov/26444994/">most effective treatment</a> for menopausal symptoms, such as hot flushes. But women may choose complementary and alternative medicines instead – either because they shouldn’t take hormone therapy, for example because they have breast cancer, or because of personal preference. Close <a href="https://pubmed.ncbi.nlm.nih.gov/26224187/">to 40%</a> of Australian women report using complementary and alternative medicines for menopausal symptoms, and up to 20% using them specifically to treat hot flushes and sweats. <h2>A long history</h2> Complementary and alternative medicines have a long history of use in many cultures. Today, their potential benefits for menopausal symptoms are promoted by the companies that make and sell them. The <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6419242/">complementary and alternative medicines</a> women often try for menopausal symptoms include phytoestrogens, wild yam, dong quai, ginseng and black cohosh. Black cohosh (plant name Cimicifuga racemosa) was <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6599854/">traditionally</a> used by Native Americans to treat a variety of health concerns such as sore throat, kidney trouble, musculoskeletal pain and menstrual problems. It is now a popular herbal choice for hot flushes and night sweats, as well as vaginal dryness and mood changes. There are <a href="https://pubmed.ncbi.nlm.nih.gov/37252752/">many theories</a> for how the active ingredients in black cohosh might work in the body, such as acting like oestrogen, or affecting chemical pathways in the brain. But despite extensive research, the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6599854/">evidence to support these theories remains inconclusive</a>. It is also not clear whether black cohosh is effective for hot flushes. Results from individual studies are mixed, with <a href="https://pubmed.ncbi.nlm.nih.gov/17565936/">some</a> finding black cohosh improves hot flushes, while <a href="https://pubmed.ncbi.nlm.nih.gov/18257142/">others</a> have found it doesn’t. A 2012 <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6599854/">review</a> combined all the results from studies of menopausal women using black cohosh to that date and found overall there was no proof black cohosh reduces hot flushes more effectively than an inactive treatment (placebo). <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6599854/">This review</a> also revealed that many studies did not use rigorous research methods, so the findings are hard to interpret. A more recent <a href="https://pubmed.ncbi.nlm.nih.gov/33021111/">review</a> of clinical trials claimed black cohosh may ease menopausal symptoms, but the included studies were mostly small, less than six months long, and included women with mild symptoms. There is also no meaningful evidence black cohosh helps other symptoms of menopause, such as vaginal symptoms, sexual problems, or poor general wellbeing, or that it protects against bone loss. Evidence for how black cohosh is absorbed and metabolised by the body is also lacking, and it is not known what dose or formulation is best to use. More good quality studies are needed to decide whether black cohosh works for hot flushes and other menopausal symptoms. <h2>Is it safe to try?</h2> A <a href="https://pubmed.ncbi.nlm.nih.gov/33021111/">review of studies</a> suggests black cohosh is safe to use, although many of the studies have not reported possible adverse reactions in detail. Side effects such as gastrointestinal upset and rashes may occur. While there have been <a href="https://www.mja.com.au/journal/2008/188/7/liver-failure-associated-use-black-cohosh-menopausal-symptoms#0_i1091948">rare reports of liver damage</a>, there is <a href="https://pubmed.ncbi.nlm.nih.gov/21228727/">no clear evidence</a> black cohosh was the cause. Even so, in Australia, black cohosh manufacturers and suppliers are required to put a warning label for the potential of harm to the liver on their products. It is recommended black cohosh is not used by women with menopausal symptoms <a href="https://www.canceraustralia.gov.au/cancer-types/breast-cancer/impacted-by-breast-cancer/physical-changes/menopause/treatments-menopausal-symptoms">after breast cancer</a>, as its safety after breast cancer is uncertain. All women should consult with their doctor before using black cohosh if they are taking other medications in case of possible drug interactions. Many women like to try herbal therapies for hot flushes and other menopausal symptoms. While black cohosh is generally considered safe and some women may find it helps them, at the moment there is not enough scientific evidence to show its effects are any better than placebo. Women experiencing troublesome menopausal symptoms, such as hot flushes, should talk to their doctor about the best treatment options for them.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/211272/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/sasha-taylor-1461085">Sasha Taylor</a>, Research fellow, Chronic Disease & Ageing, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> and <a href="https://theconversation.com/profiles/susan-davis-10376">Susan Davis</a>, Chair of Women's Health, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/lots-of-women-try-herbs-like-black-cohosh-for-menopausal-symptoms-like-hot-flushes-but-does-it-work-211272">original article</a>.

Body

Don’t believe the hype. Menopausal women don’t all need to check – or increase – their testosterone levels

<a href="https://theconversation.com/profiles/susan-davis-10376">Susan Davis</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> Ever heard “low testosterone” blamed for low mood, brain fog and loss of vitality? Despite all evidence to the contrary, social media influencers are increasingly promoting testosterone therapy as an elixir for women experiencing troubling symptoms of menopause. In a series of documentaries and <a href="https://www.dailymail.co.uk/health/article-11792553/Davina-McCall-effect-sparks-menopause-testosterone-treatment-rush-putting-women-risk.html">social media posts</a> about menopause in 2021 and 2022, British TV presenter Davina McCall promoted the use of testosterone therapy in addition to standard <a href="https://www.menopause.org.au/hp/information-sheets/combined-menopausal-hormone-therapy-mht">menopausal hormone therapy</a>. The “<a href="https://www.telegraph.co.uk/news/2023/02/17/davina-effect-fuels-surge-menopausal-women-using-testosterone/#:%7E:text=Chelsea%20Magazine%20Company-,'Davina%20effect'%20fuels%20surge%20in%20menopausal%20women%20using%20testosterone,NHS%20prescriptions%20for%20the%20hormone">Davina effect</a>” has helped fuel a <a href="https://pharmaceutical-journal.com/article/news/nhs-testosterone-prescribing-in-women-rises-ten-fold-in-seven-years#:%7E:text=The%20number%20of%20women%20in,The%20Pharmaceutical%20Journal%20has%20revealed">ten-fold increase</a> in prescribing of testosterone for women in the United Kingdom since 2015. Data isn’t available for Australia, but in my clinical practice, women are increasingly asking to have their testosterone level checked, and seeking testosterone to treat fatigue and brain fog. But while testosterone continues to be an important hormone before and after menopause, this doesn’t mean women should be having a blood test to get their testosterone levels checked – or taking testosterone therapy. <h2>What does testosterone do?</h2> Testosterone is an important hormone in women’s bodies, affecting the blood vessels, skin, muscle and bone, breast tissue and the brain. In both women and men, testosterone can act on its own or be converted into estrogen. Before menopause, testosterone is made in the ovaries, where it helps developing eggs grow and aids in estrogen production. The ovaries release both testosterone and estrogen into the bloodstream, and the levels of the two hormones in the blood peak around ovulation. Some of the testosterone measured in blood is also produced outside the ovaries, such as in fat, where it is made from “pre-hormones” secreted by the adrenal glands. This source of production of testosterone takes over after menopause. <h2>Do we have more testosterone before menopause?</h2> The claim is often made that pre-menopausal women have more testosterone in their bloodstream than estrogen, to justify the need for testosterone replacement after menopause. But, when sex hormones have been measured with precision, studies have shown this is not true. <a href="https://pubmed.ncbi.nlm.nih.gov/31390028/">Our research</a> found estrogen levels are higher than testosterone levels at all stages of the menstrual cycle. Blood testosterone levels <a href="https://pubmed.ncbi.nlm.nih.gov/31390028/">fall</a> by about 25% between the ages of 18 and 40 years in healthy women. The fall in testosterone coincides with the decline in eggs in the ovaries but whether this is a marker of the decline, a consequence, or a cause of the decline is not known. From around 40, the rate of decline slows and blood testosterone levels don’t change when <a href="https://www.menopause.org.au/hp/information-sheets/what-is-menopause">menopause</a> occurs naturally. Studies have not shown testosterone levels change meaningfully during the menopause transition. <h2>Can blood tests detect ‘low testosterone’?</h2> Some influencers claim to have a condition called “testosterone deficiency syndrome” or low levels of testosterone detected in blood tests. But there is no “normal” blood level below which a woman can be diagnosed as having “testosterone deficiency”. So there’s no such thing as having a testosterone deficiency or testosterone deficiency syndrome. This is also in part, because women have very low testosterone concentrations compared with men, and most commercial methods used to measure testosterone cannot separate normal from low levels in women with any certainty. Pre-menopausal women might also be told they have “low” testosterone if blood is drawn early in the menstrual cycle when it is normal for testosterone to be low. (However, it would only be clinically necessary to do this type of blood test to look for high testosterone, in someone with with excessive hair growth or severe acne, for example, not for low testosterone.) In post-menopausal women, much of the action of testosterone occurs in the tissues where it is made, after which testosterone is either converted to estrogen or broken down before it leaks back into the circulation. So blood testosterone concentrations are not a true reflection of tissue concentrations. Further complicating the picture is the enormous variability in the effects of testosterone. At a given blood level of testosterone, some women might have oily skin, acne, increased body hair growth or balding, while others will have no such effects. So, looking for a “low” blood testosterone in women is not helpful. <h2>Can testosterone improve sexual desire? What about other conditions?</h2> There is sound evidence that testosterone therapy may improve sexual desire in post-menopausal women who have developed low sexual desire that bothers them. This was <a href="https://www.tandfonline.com/doi/full/10.1080/13697137.2019.1637079">confirmed by</a> a <a href="https://pubmed.ncbi.nlm.nih.gov/31353194/">systematic review</a> of clinical trials comparing testosterone with a placebo or an alternative. These trials, all of which involved a treatment time of at least 12 weeks, showed testosterone therapy, overall, improved desire, arousal, orgasm and sexual satisfaction in post-menopausal women with low desire that caused them distress. Treatment is only indicated for women who want an improvement in sexual desire (after excluding other factors such as depression or medication side effects) and its success can only be determined by each woman’s personal self-reported response. But there is <a href="https://www.tandfonline.com/doi/full/10.1080/13697137.2019.1637079">not enough evidence</a> to show testosterone is beneficial for any other symptom or medical condition. The overall available data has shown no effect of testosterone on mood or cognition. As such, testosterone therapy <a href="https://www.tandfonline.com/doi/full/10.1080/13697137.2019.1637079">should not be used</a> to treat symptoms such as fatigue, low mood, muscle weakness and poor memory, or to prevent bone loss, dementia or breast cancer. However research continues to investigate these potential uses, including from my <a href="https://www.monash.edu/medicine/sphpm/units/womenshealth">research team</a>, which is investigating whether testosterone therapy can <a href="https://asbmr.onlinelibrary.wiley.com/doi/10.1002/jbmr.534">protect against bone density loss and muscle loss after menopause</a>. You can learn more about participating in one of our studies <a href="https://www.monash.edu/medicine/sphpm/units/womenshealth/join-a-study">here</a>. <img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/209516/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/susan-davis-10376">Susan Davis</a>, Chair of Women's Health, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/dont-believe-the-hype-menopausal-women-dont-all-need-to-check-or-increase-their-testosterone-levels-209516">original article</a>.

Body

“I was spiralling”: Naomi Watts’ candid menopause admission

Naomi Watts has spoken candidly about how her life drastically changed when she started going through early menopause at the age of 36. The Aussie actress, now 54, said going through such a big change at such a young age “wasn’t easy”, and found it difficult to access information about what she was going through, both physically and mentally. Speaking candidly to <a href="https://www.hellomagazine.com/healthandbeauty/health-and-fitness/498161/naomi-watts-marriage-menopause-hollywood-age-exclusive/">Hello magazine</a>, she said, “Going through menopause at such a young age was not easy, especially during a time when there was so little information available about it.” “Mood swings, night sweats, and migraines … I was feeling like I was spiralling out of control,” she added. According to the <a href="https://www.mayoclinic.org/diseases-conditions/menopause/symptoms-causes/syc-20353397">Mayo Clinic</a>, menopause typically occurs at the age of 50, when a woman experiences her last period. Despite the change coming on much earlier than anticipated, Watts said learning to cope with the hormonal changes helped her feel more liberated. “Going through this journey led me to a deeper understanding of myself, and I came out on the other side feeling more authentically me,” she told <a href="https://pagesix.com/2023/07/24/naomi-watts-i-was-spiraling-out-of-control-during-menopause/">Page Six</a>. “A lot of freedom came in the self-acknowledgment.” She continued, “I had those voices in the back of my mind reminding me how old women are let out to pasture, but there was a lure to this desire to be authentic, to crawl from behind the invisible wall and just acknowledge for myself something that everyone could have probably guessed.” Watts’ personal experience led her to partner with Menopause Mandate, a non-profit organisation that aims to revolutionise midlife support available for American women. “I truly believe that if menopause hadn’t been such an off-limits topic when I first started experiencing symptoms, I would’ve had an easier transition,” she said. “I was part of a cycle that desperately needed to be broken.” Image credits: Getty Images

Body

Hot flushes, night sweats, brain fog? Here’s what we know about phytoestrogens for menopausal symptoms

<a href="https://theconversation.com/profiles/caroline-gurvich-473295">Caroline Gurvich</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a>; <a href="https://theconversation.com/profiles/jane-varney-963066">Jane Varney</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a>, and <a href="https://theconversation.com/profiles/jayashri-kulkarni-185">Jayashri Kulkarni</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> While some women glide through menopause, <a href="https://pubmed.ncbi.nlm.nih.gov/26271251/">more than 85%</a> experience one or more unpleasant symptoms, which can impact their physical and mental health, daily activities and quality of life. Hot flushes and night sweats are the most common of these, affecting <a href="https://pubmed.ncbi.nlm.nih.gov/29393299/">75% of women</a> and the symptom for which most women seek treatment. Others include changes in weight and body composition, skin changes, poor sleep, headaches, joint pain, vaginal dryness, depression and brain fog. While menopause hormone therapy is the most effective treatment for menopausal symptoms, it is sometimes not recommended (such as following breast cancer, as there is conflicting evidence about the safety of menopause hormone therapy following breast cancer) or avoided by people, who may seek non-hormonal therapies to manage symptoms. In Australia it is estimated <a href="https://pubmed.ncbi.nlm.nih.gov/26224187/">more than one-third</a> of women seek complementary or alternative medicines to manage menopausal symptoms. But do they work? Or are they a waste of time and considerable amounts of money? <h2>What’s on the market?</h2> The <a href="https://pubmed.ncbi.nlm.nih.gov/30868921/">complementary or alternative interventions</a> for menopausal symptoms are almost as varied as the symptoms themselves. They include everything from mind-body practices (hypnosis, cognitive behavioural therapy and meditation) to alternative medicine approaches (traditional Chinese medicine and acupuncture) and natural products (herbal and dietary supplements). There is some evidence to support the use of <a href="https://pubmed.ncbi.nlm.nih.gov/23435026/">hypnosis</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/22336748/">cognitive behaviour therapy</a> for the treatment of hot flushes. Indeed these therapies are recommended in <a href="https://www1.racgp.org.au/getattachment/bfaa5918-ddc4-4bcb-93cc-d3d956c1bbfd/Making-choices-at-menopause.aspx">clinical treatment guidelines</a>. But there is less certainty around the benefit of other commonly used complementary and alternative medicines, particularly nutritional supplements. The most popular <a href="https://pubmed.ncbi.nlm.nih.gov/26224187/">nutritional supplements</a> for hot flushes are phytoestrogens (or plant estrogens). This trend has been driven in part by <a href="https://www.dailymail.co.uk/femail/article-11915645/HRT-not-supplement-created-experts-women-RAVING-effects.html">supplement companies</a> that promote such agents as a safer or more natural alternative to hormone therapy. <h2>What are phytoestrogens?</h2> Phytoestrogens are plant-derived substances that can show oestrogen-like activity when ingested. There are numerous types including isoflavones, coumestans and lignans. These can be consumed in the form of food (from whole soybeans, soy-based foods such as tofu and soy milk, legumes, wholegrains, flaxseeds, fruits and vegetables) and in commercially produced supplements. In the latter category, extracts from soy and red clover yield isoflavones and flaxseed gives us lignans. Because declining oestrogen levels drive menopausal symptoms, the theory is that consuming a “natural”, plant-based substance that acts like oestrogen will provide relief. <figure class="align-center zoomable"><a href="https://images.theconversation.com/files/528788/original/file-20230529-17-mh3zlk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img src="https://images.theconversation.com/files/528788/original/file-20230529-17-mh3zlk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/528788/original/file-20230529-17-mh3zlk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/528788/original/file-20230529-17-mh3zlk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/528788/original/file-20230529-17-mh3zlk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/528788/original/file-20230529-17-mh3zlk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/528788/original/file-20230529-17-mh3zlk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/528788/original/file-20230529-17-mh3zlk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" alt="Soy-rich foods on a table: edamame, soy milk, soy sauce" /></a><figcaption>Phytoestrogens can be consumed in foods like tofu or soy milk. <a class="source" href="https://www.shutterstock.com/image-photo/soy-bean-tofu-other-products-187030769">Shutterstock</a></figcaption></figure> <h2>What does the evidence say?</h2> In the case of isoflavones, initial support came from <a href="https://pubmed.ncbi.nlm.nih.gov/23562010/">epidemiological data</a> showing <a href="https://pubmed.ncbi.nlm.nih.gov/15919681/">women in Asian countries</a>, consuming a traditional, phytoestrogen-rich diet (that is, one including tofu, miso and fermented or boiled soybeans), experienced fewer menopausal symptoms than women in Western countries. However, several factors may influence the effect of dietary phytoestrogens on menopausal symptoms. This includes gut microbiota, with research showing only around <a href="https://pubmed.ncbi.nlm.nih.gov/15919681/">30% of women</a> from Western populations possess the gut microbiota needed to convert isoflavones to their active form, known as equol, compared to an estimated 50–60% of menopausal women from Japanese populations. Circulating oestrogen levels (which drop considerably during menopause) and the <a href="https://academic.oup.com/humupd/article/11/5/495/605995">duration of soy intake</a> (longer-term intake being more favourable) may also influence the effect of dietary phytoestrogens on menopausal symptoms. Overall, evidence regarding the benefit of phytoestrogens for hot flushes is fairly mixed. A <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001395.pub4/full">Cochrane review</a> synthesised study results and failed to find conclusive evidence phytoestrogens, in food or supplement form, reduced the frequency or severity of hot flushes or night sweats in perimenopausal or postmenopausal women. The review did note genistein extracts (an isoflavone found in soy and fava beans) may reduce the number of hot flushes experienced by symptomatic, postmenopausal women, though to a lesser extent than hormone therapy. Another <a href="https://pubmed.ncbi.nlm.nih.gov/36253903/">recent study</a> showed marked reductions in hot flushes in women following a low fat, vegan diet supplemented with daily soybeans. However, it was questioned whether concurrent weight loss contributed to this benefit. In Australia, <a href="https://ranzcog.edu.au/wp-content/uploads/2022/05/Managing-menopausal-symptoms.pdf">clinical guidelines</a> do not endorse the routine use of phytoestrogens. <a href="https://www.nice.org.uk/guidance/ng23/chapter/Recommendations#managing-short-term-menopausal-symptoms">Guidelines for the United Kingdom</a> note some support for the benefit of isoflavones, but highlight multiple preparations are available, their safety is uncertain and interactions with other medicines have been reported. <h2>Can phytoestrogens help the psychological symptoms of menopause?</h2> Less research has explored whether phytoestrogens improve psychological symptoms of menopause, such as depression, anxiety and <a href="https://theconversation.com/brain-fog-during-menopause-is-real-it-can-disrupt-womens-work-and-spark-dementia-fears-173150">brain fog</a>. A recent systematic review and <a href="https://pubmed.ncbi.nlm.nih.gov/33987926/">meta-analysis</a> found phytoestrogens reduce depression in post- but not perimenopausal women. Whereas a more <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9022873/">recent clinical trial</a> failed to find an improvement. Some research suggests phytoestrogens may reduce the <a href="https://www.sciencedirect.com/science/article/pii/S0960076015301254?via=ihub">risk of dementia</a>, but there are no conclusive findings regarding their effect on menopausal brain fog. <h2>The bottom line</h2> At present there is uncertainty about the benefit of phytoestrogens for menopause symptoms. If you do wish to see if they might work for you, start by including more phytoestrogen-rich foods in your diet. Examples include tempeh, soybeans, tofu, miso, soy milk (from whole soybeans), oats, barley, quinoa, flaxseeds, sesame seeds, sunflower seeds, almonds, chickpeas, lentils, red kidney beans and alfalfa. Try including one to two serves per day for around three months and monitor symptoms. These are nutritious and good for overall health, irrespective of the effects on menopausal symptoms. Before you trial any supplements, discuss them first with your doctor (especially if you have a history of breast cancer), monitor your symptoms for around three months, and if there’s no improvement, stop taking them.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/204801/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/caroline-gurvich-473295">Caroline Gurvich</a>, Associate Professor and Clinical Neuropsychologist, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a>; <a href="https://theconversation.com/profiles/jane-varney-963066">Jane Varney</a>, Senior Research Dietitian in the Department of Gastroenterology, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a>, and <a href="https://theconversation.com/profiles/jayashri-kulkarni-185">Jayashri Kulkarni</a>, Professor of Psychiatry, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/hot-flushes-night-sweats-brain-fog-heres-what-we-know-about-phytoestrogens-for-menopausal-symptoms-204801">original article</a>. Images: Getty

Body

Why weightlifting is beneficial before and after the menopause

<a href="https://theconversation.com/profiles/athalie-redwood-brown-1298061">Athalie Redwood-Brown</a>, <a href="https://theconversation.com/institutions/nottingham-trent-university-1338">Nottingham Trent University</a> and <a href="https://theconversation.com/profiles/jennifer-wilson-1436440">Jennifer Wilson</a>, <a href="https://theconversation.com/institutions/university-of-derby-758">University of Derby</a> Many women begin experiencing symptoms of the menopause around age 50. As hormones begin to fluctuate and change, women might start experiencing a range of symptoms, such as hot flushes, joint pain, low mood and vaginal dryness. The menopause can also be accompanied by a range of physical changes too – including loss of muscle mass, loss of bone density and a slowed metabolism. Fortunately, regular exercise – specifically <a href="https://bjsm.bmj.com/content/43/12/898.short?casa_token=HOnkvcc7R6QAAAAA:u1D2xvhIRLNsaA_STgiJiGRY-z1tXnuQqw6Sc4uRn0B5b-vMeXxjcn17m457MdY0Q9ffSpGAUPSl">weightlifting</a> – can help <a href="https://www.sciencedirect.com/science/article/abs/pii/S8756328206009495?casa_token=kx_1iDoGr28AAAAA:apeExle4xzT-csJD2kqhdVq4Y5bq7hNIUYBvuhyJIEXAT9iyOvPR6LBtOW2h5A6SDli4Gr0zgqg">mitigate these changes</a> somewhat and improve overall health and wellbeing. Here are just some of the ways weightlifting can be beneficial to women going through the menopause. <h2>1. Increases bone density</h2> Not only does weightlifting challenge your muscles, it also challenges your bones. In fact, resistance exercises (such as weightlifting) are shown to stimulate the formation of <a href="https://www.sciencedirect.com/science/article/abs/pii/S8756328206009495?casa_token=kx_1iDoGr28AAAAA:apeExle4xzT-csJD2kqhdVq4Y5bq7hNIUYBvuhyJIEXAT9iyOvPR6LBtOW2h5A6SDli4Gr0zgqg">new bone tissue</a>, which can increase bone density. This may be particularly beneficial to women who are postmenopausal and at risk of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5643776/">osteoporosis</a> (brittle bones). Research has shown women who <a href="https://www.sciencedirect.com/science/article/abs/pii/S8756328206009495?casa_token=kx_1iDoGr28AAAAA:apeExle4xzT-csJD2kqhdVq4Y5bq7hNIUYBvuhyJIEXAT9iyOvPR6LBtOW2h5A6SDli4Gr0zgqg">regularly resistance train</a> had significant increases in <a href="https://link.springer.com/article/10.1007/s00198-003-1436-x">bone mineral density</a>, including in the <a href="https://bjsm.bmj.com/content/43/12/898.short?casa_token=Hgh5Huim8ocAAAAA:TGeAWPEh-sEHmBw40iJmP_X1lehvFEZ0QhQvY6ag4lcZ_zTkZv1jLbA6Apzopb85PU4EaqC4XoGl">hip and spine</a>. Greater bone density may also reduce the risk of osteoporosis. <h2>2. Maintains muscle mass</h2> As women age, they tend to lose muscle mass and strength, which can increase the risk of <a href="https://agsjournals.onlinelibrary.wiley.com/doi/full/10.1111/j.1532-5415.2004.52014.x?casa_token=jhMt3SVQFCIAAAAA%3AsfVYMh2ExMyyw1cu4BGLhwiDkuIdMvABMv5imzHqSamdfb0OoFpWcIVbJ9c111K4_pCWwRmgC_On_P_-">falls, fractures and injury</a>. The menopause may contribute to this <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7956097/#:%7E:text=Sarcopenia%2C%20the%20age%2Drelated%20decline,%2Daged%20adults%20(2).">loss of muscle mass</a>. But research shows that weightlifting is an effective way for older adults – including women – to maintain and even increase their <a href="https://europepmc.org/article/med/19949277">muscle mass</a> and strength. For postmenopausal women, research has shown that those who participate in regular resistance training are less likely to experience losses in <a href="https://pubmed.ncbi.nlm.nih.gov/34167695/">muscle mass and strength</a> compared to those who participate other forms of exercise, such as <a href="https://link.springer.com/article/10.1007/s11357-013-9586-z">stretching and mobility</a>. Other research has also found that weight training may be beneficial for women in the perimenopause period, too. The study found that perimenopausal women who <a href="https://academic.oup.com/ajcn/article/86/3/566/4754063">regularly weight trained</a> – as opposed to doing standard aerobic exercise (such as running or walking) – over a two-year period gained around three times less stomach fat on average. <h2>3. Boosts metabolism</h2> Weightlifting can increase lean muscle mass, which in turn can help boost metabolism and <a href="https://pubmed.ncbi.nlm.nih.gov/17823418/">burn more calories at rest</a>. This can be especially important for women just before and after the menopause, as hormonal changes can lead to a decrease in metabolism and an <a href="https://pubmed.ncbi.nlm.nih.gov/14567150/">increase in body fat</a>. In one study published in the Journal of Strength and Conditioning Research, postmenopausal women who participated in a 12-week resistance training programme had significant increases in <a href="https://pubmed.ncbi.nlm.nih.gov/31343601/">resting metabolic rate</a> which can help to manage excess weight gain. <h2>4. Improves mood</h2> Women going through the menopause may experience <a href="https://www.nhsinform.scot/healthy-living/womens-health/later-years-around-50-years-and-over/menopause-and-post-menopause-health/menopause-and-your-mental-wellbeing#:%7E:text=Changes%20in%20your%20hormones%20during,anger%20and%20irritability">mental health issues</a>, including depression and anxiety. But exercise – including weightlifting – may have numerous benefits for mental health, including reducing symptoms of depression and anxiety. One study found women who participated in a 16-week combined resistance training programme reported improved mood and <a href="https://pubmed.ncbi.nlm.nih.gov/33739319/">emotional wellbeing</a> when compared to a programme which only included guidance on a healthy lifestyle. Furthermore, self-esteem, mood and fatigue have also been shown to improve following <a href="https://journals.lww.com/acsm-csmr/fulltext/2012/07000/resistancetrainingismedicineeffectsof.13.aspx">prescribed resistance training</a> in older adults – suggesting weightlifting can have a positive effect on quality of life. Although this particular study wasn’t conducted on menopausal women specifically, it’s likely exercise may have a similar effect. Women who experience disturbed sleep and hot flushes may also experience reduced <a href="https://pubmed.ncbi.nlm.nih.gov/22809134/">quality of life</a> and mood. But resistance training is shown to be an effective tool in <a href="https://www.sciencedirect.com/science/article/pii/S0378512218307618">regulating body temperature</a>, which may improve emotional wellbeing. The effects of weightlifting on mood may be due to the <a href="https://ijogi.mums.ac.ir/article_11631_en.html">release of endorphins</a>, which are natural painkillers and mood-boosting chemicals in the brain. <h2>Getting started</h2> Given how many benefits weightlifting can have for women going through this period of their lives, you may be eager to get started. But if you’ve never tried resistance training or weightlifting before, here are a few things to bear in mind: <ol> <li>Start with a qualified trainer: Working with a qualified personal trainer or strength and conditioning coach can be beneficial especially right at the start of your fitness journey. They can help you learn proper lifting techniques, establish a safe and effective exercise programme and progress at a pace that’s appropriate for your fitness level and goals.</li> <li>Focus on form: Proper form is crucial when lifting weights, especially as you age. Poor form can increase your <a href="https://www.tandfonline.com/doi/abs/10.3810/psm.2009.06.1716">risk of injury</a> and prevent you from seeing the benefits of weightlifting. Take the time to learn proper technique and start with lighter weights until you feel comfortable and confident. Using a mirror or videoing yourself during workouts can help ensure your form is good.</li> <li>Start with compound exercises: Compound exercises are exercises that work multiple muscle groups at once. These exercises are great for building overall strength. Some examples include squats, deadlifts and bench presses. Try doing these around 2-3 times a week. Once you have a good foundation of these compound exercises, start to include exercises which focus on one specific muscle or work to help stability – such as shoulder press or lunges.</li> <li>Progress gradually: As you become more comfortable with weightlifting and feel the weights you’re lifting aren’t as challenging as they used to be, you can gradually increase the weight or intensity of your workouts for <a href="https://paulogentil.com/pdf/Fundamentals%20of%20Resistance%20Training%20Progression%20and%20Exercise%20Prescription.pdf">progression</a>. Just be sure not to progress too quickly, as this may increase your risk of injury.</li> </ol> Weightlifting can have many benefits – and doing it consistently may help you maintain good physical and mental health not only before and after the menopause, but as you get older too. Just be sure to consult your healthcare provider before starting any new exercise programme, especially if you have pre-existing health conditions or concerns.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/204846/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/athalie-redwood-brown-1298061">Athalie Redwood-Brown</a>, Senior Lecturer in Performance Analysis of Sport, <a href="https://theconversation.com/institutions/nottingham-trent-university-1338">Nottingham Trent University</a> and <a href="https://theconversation.com/profiles/jennifer-wilson-1436440">Jennifer Wilson</a>, Programme Leader for BSc (H) Sport Therapy and Rehabilitation, <a href="https://theconversation.com/institutions/university-of-derby-758">University of Derby</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/why-weightlifting-is-beneficial-before-and-after-the-menopause-204846">original article</a>.

Body

Is menopause making me put on weight? No, but it’s complicated

It’s a question people ask often: does menopause cause weight gain? Women commonly put on weight as they enter menopause. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8569454/">Research</a> shows women aged 46-57 gain an average of <a href="https://pubmed.ncbi.nlm.nih.gov/11910598/">2.1kg over five years</a>. But like many things related to weight, all is not what it seems, and the relationship between menopause and weight gain is not straightforward. Here’s everything you need to know about menopausal weight gain and what you can do about it. <h2>What typically happens to women’s bodies during menopause?</h2> Menopause marks the natural end of the reproductive stage of a woman’s life. It officially starts when a woman has not menstruated for <a href="https://www.sciencedirect.com/science/article/abs/pii/S0140673698053525">12 months</a>, and most women reach menopause between the ages of <a href="https://academic.oup.com/ije/article/43/5/1542/695928?login=false">45 and 55</a>, but it can happen much earlier or later. The transition to menopause, however, typically starts four years prior, with perimenopause marking the time when a woman’s ovaries start slowing down, producing less oestrogen and progesterone. Eventually, these hormone levels fall to a point at which the ovaries stop releasing eggs and menstruation stops. The symptoms associated with the menopausal transition are many and varied, and can include irregular periods, breast pain, vaginal dryness, hot flashes, night sweats, fatigue, difficulty sleeping, and changes in mood and libido. <h2>So does menopause cause weight gain?</h2> The short answer is no. But it’s complicated. When it comes to menopause and weight, it’s weight redistribution – not weight gain – that is actually a symptom. <a href="https://www.ajog.org/article/S0002-9378(19)30588-5/fulltext">Research</a> has confirmed menopause is linked to an increase in belly fat but not an increase in overall weight. This is because the hormonal changes experienced during menopause only prompt a change in <a href="https://www.sciencedirect.com/science/article/abs/pii/S0002937896701114">where the body stores fat</a>, making women’s stomachs and <a href="https://www.ajog.org/article/S0002-9378(19)30588-5/fulltext">waists</a> more prone to weight gain. <a href="https://pubmed.ncbi.nlm.nih.gov/10702775/">Research</a> shows visceral fat (deep belly fat) increases by nearly 50% in postmenopausal women, compared with premenopausal women. It’s also important to recognise some menopause symptoms may indirectly contribute to weight gain: <ul> <li> sleep issues can lead to sleep deprivation, disturbing the body’s <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/oby.23616">appetite hormones</a>, increasing feelings of hunger and triggering food cravings </li> <li> some mood changes can activate the body’s stress responses, increasing the production of the hormone cortisol, promoting fat storage and triggering unhealthy food cravings. Mood can also impact the motivation to exercise </li> <li> fatigue, breast pain and hot flushes can make physical activity challenging or uncomfortable, also impacting the ability to exercise. </li> </ul> <h2>The truth? Ageing is the real cause of menopausal weight gain</h2> You read that right – the weight gain often associated with menopause is a <a href="https://www.sciencedirect.com/science/article/pii/S1568163709000415">byproduct of ageing</a>. As the body ages, it stops working as efficiently. It experiences an involuntary loss of muscle mass – referred to as <a href="https://www.sciencedirect.com/science/article/abs/pii/S0070215305680052">sarcopenia</a> – and fat levels begin to increase. Because muscle mass helps determine the body’s metabolic rate (how much energy the body burns at rest), when we lose muscle, the body starts to burn fewer calories at rest. Ageing also means dealing with other health issues that can make weight management more complex. For example, <a href="https://www.ncbi.nlm.nih.gov/books/NBK537590/">medications</a> can impact how the body functions, and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3529154/">arthritis</a> and general aches and pains can impact mobility and the ability to exercise. In short – the body’s ageing process and changing physicality is the real reason women experience menopause weight gain. <h2>It’s not just weight gain</h2> While menopause doesn’t make you put on weight, it can increase a woman’s risk of other serious health conditions. The redistributed weight that leads to more fat being carried in the belly can have long-term effects. Belly fat that lies deep within the abdominal cavity (visceral fat) is an especially unhealthy fat because it’s stored close to the organs. People with a high amount of visceral fat have a <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/j.1464-5491.2011.03503.x">higher risk</a> of stroke, type 2 diabetes and heart disease than people who hold body fat around their hips. The reduction in the amount of oestrogen produced by the ovaries during menopause also increases a woman’s risk of heart disease and stroke. This is because oestrogen helps keep <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2637768/">blood vessels dilated</a> – relaxed and open – to help keep cholesterol down. Without it, bad cholesterol can start to build up in the arteries. Lower oestrogen can also result in a loss of bone mass, putting women at <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1297264/">greater risk of osteoporosis</a> and more prone to bone fractures and breaks. <h2>The bottom line: can we prevent weight gain during menopause?</h2> Menopause itself does not cause weight gain; it unfortunately just occurs during a stage of life when other factors are likely to. The good news is weight gain associated with ageing is not inevitable, and there are many things women can do to avoid weight gain and health risks as they age and experience menopause. Start with these six steps: <ol> <li> incorporate daily exercise into your routine, with a mixture of intensities and variety of exercises, <a href="https://www.health.gov.au/topics/physical-activity-and-exercise/physical-activity-and-exercise-guidelines-for-all-australians">including body-strengthening exercises</a> twice a week </li> <li> stop dieting. Dieting drives up the weight your body will strive to return to (your “<a href="https://theconversation.com/whats-the-weight-set-point-and-why-does-it-make-it-so-hard-to-keep-weight-off-195724">set point</a>”), so you’ll end up heavier than before you began. You’ll also slow down your metabolism with each diet you follow </li> <li> curb your sugar cravings naturally. Every time you feel an urge to eat something sugary or fatty, reach for nature first – fruits, honey, nuts, seeds and avocado are a few suitable examples. These foods release the same feelgood chemicals in the brain as processed and fast food do, and leave us feeling full </li> <li> create positive habits to minimise comfort-eating. Instead of unwinding in the afternoon or evening on the couch, go for a walk, work on a hobby or try something new </li> <li> eat slowly and away from distractions to reduce the quantity of food consumed mindlessly. Use an oyster fork, a child’s fork or chopsticks to slow down your eating </li> <li> switch off your technology for a minimum of one hour before bed to improve sleep quality. </li> </ol> This article originally appeared on <a href="https://theconversation.com/is-menopause-making-me-put-on-weight-no-but-its-complicated-198308" target="_blank" rel="noopener">The Conversation</a>. Images: Getty

Body

“I didn’t know how to ask for help”: Naomi Watts shares important message on ageing

Naomi Watts got candid about the topic of menopause and how the word used to “freak her out” in a bid to normalise conversations about this aspect of every woman’s life. The 53-year-old took to Instagram to tackle the topic, which she describes as “a natural phase in life”, sharing her own experience and revealing that it began earlier than she expected. “When I was in my late 30s, I was finally ready to start thinking about creating a family. Then the M word swiftly blew my doors down, it felt like a head-on collision with a Mack truck.🚚💥,” she began. “How could I figure this out when no one was talking? I was earlier to it than my peers. My mentors and mum didn’t seem up for discussing it, I didn’t know how to ask for help and they didn’t know how to provide… even doctors had little to say. “It’s oddly like an unwritten code of silence: women should suck it up and cope, because that’s how generations past have done it.” <blockquote class="instagram-media" style="background: #FFF; border: 0; border-radius: 3px; box-shadow: 0 0 1px 0 rgba(0,0,0,0.5),0 1px 10px 0 rgba(0,0,0,0.15); margin: 1px; max-width: 540px; min-width: 326px; padding: 0; width: calc(100% - 2px);" data-instgrm-captioned="" data-instgrm-permalink="https://www.instagram.com/p/CejRzoprP0H/?utm_source=ig_embed&utm_campaign=loading" data-instgrm-version="14"> <div style="padding: 16px;"> <div style="display: flex; flex-direction: row; align-items: center;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 40px; margin-right: 14px; width: 40px;"> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 100px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 60px;"> </div> </div> </div> <div style="padding: 19% 0;"> </div> <div style="display: block; height: 50px; margin: 0 auto 12px; width: 50px;"> </div> <div style="padding-top: 8px;"> <div style="color: #3897f0; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: 550; line-height: 18px;">View this post on Instagram</div> </div> <div style="padding: 12.5% 0;"> </div> <div style="display: flex; flex-direction: row; margin-bottom: 14px; align-items: center;"> <div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(0px) translateY(7px);"> </div> <div style="background-color: #f4f4f4; height: 12.5px; transform: rotate(-45deg) translateX(3px) translateY(1px); width: 12.5px; flex-grow: 0; margin-right: 14px; margin-left: 2px;"> </div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(9px) translateY(-18px);"> </div> </div> <div style="margin-left: 8px;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 20px; width: 20px;"> </div> <div style="width: 0; height: 0; border-top: 2px solid transparent; border-left: 6px solid #f4f4f4; border-bottom: 2px solid transparent; transform: translateX(16px) translateY(-4px) rotate(30deg);"> </div> </div> <div style="margin-left: auto;"> <div style="width: 0px; border-top: 8px solid #F4F4F4; border-right: 8px solid transparent; transform: translateY(16px);"> </div> <div style="background-color: #f4f4f4; flex-grow: 0; height: 12px; width: 16px; transform: translateY(-4px);"> </div> <div style="width: 0; height: 0; border-top: 8px solid #F4F4F4; border-left: 8px solid transparent; transform: translateY(-4px) translateX(8px);"> </div> </div> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center; margin-bottom: 24px;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 224px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 144px;"> </div> </div> <p style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; line-height: 17px; margin-bottom: 0; margin-top: 8px; overflow: hidden; padding: 8px 0 7px; text-align: center; text-overflow: ellipsis; white-space: nowrap;"><a style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: normal; line-height: 17px; text-decoration: none;" href="https://www.instagram.com/p/CejRzoprP0H/?utm_source=ig_embed&utm_campaign=loading" target="_blank" rel="noopener">A post shared by Naomi Watts (@naomiwatts)</a> </div> </blockquote> Watts then called for more representation of women “in this phase of life” and age group in the media. “We’ve been under-served in media, stories and marketing for far too long”, she continued. “Particularly since 1 billion people worldwide will be menopausal by 2025… “When you spotlight uncomfortable conversations, they get easier. Progress is made. Why has this particular one taken so long?” She concluded the post by urging everyone to “conquer the stigma” and “address the secrecy and shame” for the sake of generations to come. “Getting older is a privilege and a time for us to feel proud of our cumulative experiences - to feel empowered, unapologetically so,” she wrote. “I think being part of a change-maker generation is exciting. No more walking through this alone.” Watts, who became a mother at the age of 38, hinted that she is “working on something” she is “super proud of”, with more details to come soon. Image: @naomiwatts (Instagram)

Caring

Misdiagnosis of menopause is more common than you think

Menopause is a life-stage that affects half of the population at a certain point in life, but a lack of attention and awareness of it can result in misdiagnosis and improper care for women. While hot flushes and vaginal dryness are symptoms frequently associated with menopause, others such as mood fluctuations, disturbed sleep, and poorer daily function are less well-known and can be misdiagnosed as symptoms of a mental health condition instead. To address this issue, insurance company AIA Australia has partnered with the Australasian Menopause Society (AMS) to raise awarness and increase the discourse around menopause. “AIA and AMS want to drive awareness and better understanding about the commonly overlooked life stage of menopause,” Stephanie Phillips, the Chief Shared Value and Marketing Officer at AIA Australia, tells OverSixty. “AIA has a strong belief in the importance of early intervention and considers it crucial that Australian women can access the right treatment in a timely fashion. “Partnering with AMS is an opportunity for us to empower women experiencing menopause so they know that they are not alone, and that there is a wide range of support available if they need it.” Menopause can still affect women over the age of 55 Women first begin experiencing menopause, the term referring to a woman’s final menstrual period, between the ages of 45 and 60, though some symptoms can begin before then, during a period called perimenopause. “The average age of menopause is 50-51, but some women can continue to have periods up to the age of 55,” gynaecologist Dr Peter Ganter and endocrinologist Dr Christina Jang, of Queensland Health, tell OverSixty. “It is less common for women to be having periods after the age of 55,” they add. Though every woman goes through menopause, the symptoms they experience can differ from person to person and can even be experienced for years. “Many women experience symptoms of menopause such as hot flushes, sweats, poor sleep while others are fortunate to have no symptoms at all,” Dr Ganter and Dr Jang say. “Women troubled by menopause may continue to experience symptoms into their 60s and sometimes 70s.” Women in the perimenopause and menopause periods are more likely to experience feelings of anxiety and depression due to changes in hormone levels, as reported by <a href="https://health.clevelandclinic.org/is-menopause-causing-your-mood-swings-depression-or-anxiety/" target="_blank" rel="noopener">Cleveland Clinic</a>. According to AIA, the highest rate of suicide in 2020 was among women in the 45-49 age bracket, while those in the 45-55 bracket are 50 percent more likely to experience depression or anxiety than men, which the insurer argues could be to do with menopause. “While deterioration in mood can be diagnosed by a medical practitioner, often it is not considered that a contributing factor could be menopause, meaning that symptoms may be treated pharmacologically with antidepressant medications in the first instance,” AIA said in a statement. Dr Karen Magraith, the President of AMS, says healthcare providers should help women manage their symptoms in a “multi-faceted” way. “For women experiencing symptoms of menopause, a comprehensive assessment and multi-faceted management plan is recommended,” Dr Magraith says. “For women with symptoms of depression and anxiety, this may involve psychological therapies, and attention to healthy lifestyle changes. “Some women may need medication as part of their treatment plan. Whether this should involve menopausal hormone therapy, antidepressant medication, or other treatment is an individual clinical decision depending on the particular circumstances of the woman, and should be a shared decision with her doctor. “Women having treatment need follow up and tailoring of treatment to meet their needs, and generally need several consultations to enable this to occur.” What should you do if you’re concerned? Dr Magraith recommends women reach out to their GP if they are experiencing any symptoms during perimenopause or menopause. “In some cases, women may need to seek help from a doctor with a special interest in menopause,” she says. For those women who do need to find a doctor, the AMS website’s <a href="https://www.menopause.org.au/health-info/find-an-ams-doctor" target="_blank" rel="noopener">search function</a> can help them find a doctor in their area. As for women looking for more information about menopause, Dr Magraith says there are several resources women can access, including: <ul> <li dir="ltr" aria-level="1"> The <a href="https://www.menopause.org.au/" target="_blank" rel="noopener">Australasian Menopause Society</a> website </li> <li dir="ltr" aria-level="1"> <a href="https://www.jeanhailes.org.au/resources" target="_blank" rel="noopener">Jean Hailes for Women’s Health </a> </li> </ul> Image: Getty Images

Body

‘Brain fog’ during menopause is real – it can disrupt women’s work and spark dementia fears

For nearly two-thirds of women, menopause comes with an undesirable <a href="https://www.liebertpub.com/doi/10.1089/152460901750269670">change in memory</a>. Despite great progress in understanding the medical aspects of <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/menopause#what-is-menopause">menopause</a> – a natural part of life that occurs when a woman has not had a menstrual period for 12 months – we are only beginning to recognise the experience and impact of <a href="https://www.frontiersin.org/research-topics/17042/the-psychology-of-menopause#overview">cognitive changes during menopause</a>. In most cases, it appears cognitive changes – that is, problems with thinking, reasoning or remembering – during menopause are subtle and possibly temporary. But for some women, these difficulties can negatively impact work productivity. And for others, they can raise concerns about developing dementia. <h2>The Big M</h2> Menopause marks the end of reproductive years. It can happen naturally, at an average age of 49 years, when the hairlike follicles in the ovaries are exhausted. Menopause can also happen surgically, with the removal of both ovaries (for example to reduce the risk of ovarian cancer). The change from reproductive to postmenopausal years, referred to as “perimenopause” usually lasts four to ten years. The symptoms of menopause, which can include vasomotor symptoms (hot flashes and night sweats), vaginal dryness, sleep disturbance, depression, anxiety and “brain fog” can span perimenopause and last for up to ten years. <h2>What kind of foggy thinking?</h2> Just over 60% of women <a href="https://www.liebertpub.com/doi/10.1089/152460901750269670">report cognitive difficulties</a> during their menopause transition. Women describe difficulties remembering people’s names or finding the right word in conversation. Some describe difficulties with concentrating or making decisions. As discussed in our <a href="https://www.sciencedirect.com/science/article/abs/pii/S0083672920300686?via%3Dihub">recent review</a>, these “subjective cognitive difficulties” appear to be linked to performance on tests of memory, recall and processing. Difficulties on tests of verbal memory (learning and remembering information new words you have heard), verbal fluency (quickly retrieving words from your memory) and attention are seen in perimenopausal women. <h2>Women at work</h2> While the degree of cognitive decline is subtle and performance generally remains within the normal limits of functioning, the symptoms can be bothersome for the individual. For many women, menopause coincides with the prime of their productive lives, when the load of caring for young children has eased and they’ve garnered experience and seniority in the workplace. <a href="https://images.theconversation.com/files/436857/original/file-20211210-141979-g7ejsn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img src="https://images.theconversation.com/files/436857/original/file-20211210-141979-g7ejsn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" alt="Woman in glasses" /></a> Women might be hitting their professional peak just as menopause affects their cognition. <a href="https://images.unsplash.com/photo-1559856553-823ca11d1518?ixlib=rb-1.2.1&ixid=MnwxMjA3fDB8MHxwaG90by1wYWdlfHx8fGVufDB8fHx8&auto=format&fit=crop&w=2108&q=80" class="source">Unsplash/Maria Lupan</a>, <a href="http://creativecommons.org/licenses/by/4.0/" class="license">CC BY</a> There is growing interest in the impact of <a href="https://www.sciencedirect.com/science/article/pii/S2214911221000242?via%3Dihub">menopausal symptoms in the workplace</a>. Research suggests menopause symptoms can <a href="https://pubmed.ncbi.nlm.nih.gov/25830628/">adversely affect</a> work productivity and work satisfaction. Contributing factors include poor concentration and poor memory. The retention of menopausal female workers is important, for women themselves, but also to ensure we continue to strive for workforce diversity within our modern workforce. <h2>What causes menopausal brain fog?</h2> “Brain fog” is not a medical or psychological term, but a lay term that aptly describes the fogginess in thought experienced by many women during menopause. Menopause related cognitive changes are not just age-related cognitive decline. Rather, fluctuating and eventual decline of ovarian hormone production associated with menopause is likely to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3763981/">play a key role</a>. Hormones produced by the ovaries, estradiol (a type of estrogen) and progesterone, are potent brain chemicals that are thought to protect the brain and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6162653/">enhance thinking and memory</a>. The fluctuations and eventual loss of estradiol has been <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6162653/">suggested</a> to contribute to cognitive difficulties. Cognitive symptoms can occur in the <a href="https://academic.oup.com/aje/article/171/11/1214/102233">absence of other menopausal symptoms</a>. This means other menopausal symptoms are not responsible for cognitive symptoms. However, menopause related depressive and anxiety symptoms, sleep disturbance and vasomotor symptoms <a href="https://academic.oup.com/aje/article/171/11/1214/102233">may make cognitive symptoms worse</a>. <a href="https://images.theconversation.com/files/436861/original/file-20211210-17-qacocb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img src="https://images.theconversation.com/files/436861/original/file-20211210-17-qacocb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" alt="Working women share coffee" /></a> More research is needed to determine if lifestyle changes could buffer cognitive problems related to menopause. <a href="https://images.unsplash.com/photo-1590650046871-92c887180603?ixlib=rb-1.2.1&ixid=MnwxMjA3fDB8MHxwaG90by1wYWdlfHx8fGVufDB8fHx8&auto=format&fit=crop&w=1770&q=80" class="source">Unsplash</a>, <a href="http://creativecommons.org/licenses/by/4.0/" class="license">CC BY</a> <h2>Is there a link with Alzheimer’s disease?</h2> Alzheimer’s disease is the <a href="https://www.alz.org/alzheimers-dementia/what-is-dementia/types-of-dementia">most common form of dementia</a> and <a href="https://www.alz.org/blog/alz/february_2016/why_does_alzheimer_s_disease_affect_more_women_tha#:%7E:text=Women%20are%20disproportionately%20affected%20by,with%20Alzheimer's%20disease%20are%20women.">being female is a risk factor</a>. The greater longevity of women does not explain this increased risk. Instead, the loss of estradiol associated with menopause has been suggested to play a role. Early menopause, such as surgical menopause before the age of 45 years, <a href="https://www.sciencedirect.com/science/article/pii/S0306453018311478?casa_token=v6m5g8k3kCcAAAAA:cW3RhpbLs2tAD7o2hcIXTR_e-LCQAv77WMpnciHZ8Rgp2cLJhwW74evz28z0Uf47JjZeF9V16c-U">has been associated</a> with an increased risk of dementia later in life as well as a faster rate of cognitive decline. Because similar symptoms may present during menopause and the early stages of Alzheimer’s disease (forgetfulness and word-finding difficulties) perimenopausal women can become concerned about dementia. Women should be reassured that dementia that begins before age 65 – called young onset dementia – is not common (unless there is a family history of early-onset dementia). Forgetfulness and other cognitive difficulties during the menopausal transition are common and a normal part of menopause. <h2>What can help?</h2> Although fluctuations and an eventual decline in estrogen play a role in cognitive difficulties, the use of hormone therapy <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8394691/">does not appear to have a clear benefit</a> on cognitive function (but evidence remains limited). More research is needed to determine whether lifestyle factors can help menopausal brain fog. We do know exercise can improve cognition during <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7907999/">midlife</a>, mindfulness and meditation may be <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4125424/">helpful</a>. At Monash University, we are currently conducting an <a href="https://redcap.link/menopause">online survey</a> for women aged 45 to 60 to better understand cognitive symptoms during menopause. Avoiding illicit drugs, prescription medication overuse, smoking and excessive alcohol may be <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8293659/">protective</a>. A diet that includes plant-based unprocessed foods (such as a Mediterranean diet), close social bonds and engagement, and a higher level of education have been <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8624903/">broadly linked</a> to better cognitive functioning during later life.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important; text-shadow: none !important;" src="https://counter.theconversation.com/content/173150/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/caroline-gurvich-473295">Caroline Gurvich</a>, Associate professor and Clinical Neuropsychologist, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a>; <a href="https://theconversation.com/profiles/chen-zhu-1298027">Chen Zhu</a>, , <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a>, and <a href="https://theconversation.com/profiles/shalini-arunogiri-385503">Shalini Arunogiri</a>, Addiction Psychiatrist, Senior Lecturer, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/brain-fog-during-menopause-is-real-it-can-disrupt-womens-work-and-spark-dementia-fears-173150">original article</a>. Image: Unsplash/Gantas Vaiciulenas

Mind

EXCLUSIVE: Claudine Ryan talks hormones, PMS and the brain

If you have ever had your feelings of anger dismissed because you are dealing with fluctuations in hormones - whether that’s around your period, pregnancy-related or due to menopause - you’re not the only one. While the vast majority of women experience these dips and peaks in hormones without many severe symptoms, the dismissal of symptoms as a side effect of hormones can have severe consequences. Between 2009 and 2018, suicide was the <a rel="noopener" href="https://www.theguardian.com/society/2021/may/09/the-chemical-question-does-focusing-on-hormones-undermine-mental-healthcare" target="_blank">third-highest cause</a> of mortality among women who had recently given birth. For women entering menopause, the incidence of depression <a rel="noopener" href="https://www.health.harvard.edu/womens-health/menopause-and-mental-health" target="_blank">doubles</a>, and those who have experienced mental illness in the past may see their symptoms return. Claudine Ryan is one half of the duo behind the popular podcast Ladies, We Need To Talk, alongside host and co-creator Yumi Stynes. Claudine spoke to OverSixty about the pair’s latest book - named after their podcast - which tackles the thorniest of issues relating to women’s health, biology, and sex lives. In particular, she shared her thoughts on the overlap between hormones, PMS. and mental health, as well as advice for those navigating these issues with friends and family. O60: Throughout Ladies, We Need to Talk there’s a core message of opening up conversations on ‘taboo’ topics to improve awareness and help women feel less alone. Do you have particular hopes about how the awareness of and conversations around mental health and hormones will change? When it comes to our hormones and mental health, every woman is different. For reasons that aren't totally understood, some of us can really feel the impact of changing levels of certain hormones at certain times during our cycles or at certain times in our lives. So some of us experience really severe hormonal symptoms (severe insomnia, trouble concentrating, depression and even suicidal thoughts), while others find their hormones have no noticeable impact on their mood. [My] version of PMS looks different to Yumi's. But when we share our stories with each other we can start to see that there is a range of different women's experiences and this can help us to place our own somewhere on this spectrum. One hope is that these conversations foster a rich and diverse community of people who understand each other so that fewer of us feel alone or isolated, and also so we have a better understanding of what this spectrum of normal is. Another hope is that these conversations give women courage to speak out and ask for help when something does seem right for them. We have heard so many stories of women's symptoms being dismissed, or them being what they are living with is in their head. Understanding how your experience fits in with others can help you to know that what is happening for you is real and that if someone isn't listening to you, then you need to find someone who will. O60: In chapter six you both talked about anger and how it surfaces around the same time as other PMS symptoms, how do you feel about the association between anger and other ‘uglier’ emotions with being hormonal? It is very infuriating to have your feelings or frustrations dismissed as being purely hormonal. But it is also very helpful to understand that there might be certain times when your mood might be really low or you might be more inclined to feel frustrated by pee on the toilet seat or a sink full of dishes. For some women, just understanding how their hormones may affect their mood is all they need. But for others, knowing their hormones are making them miserable is the first step in figuring out what their options are to get some relief. It's important to acknowledge, as is the case with many many women's health issues, there needs to be more research for us to better understand the relationship between our hormones and our moods. O60: Do you have any advice for other women struggling with family/friends/partners/colleagues/strangers commenting on their mental health and being hormonal or dealing with PMS? You could swear at the person, and that is a legitimate response. You could explain to them these conditions are recognised by leading women's health experts and that for those who experience symptoms on the more severe end there are treatment options available. You could take the approach of women's health psychologist Professor Jane Ussher, who's spent decades researching PMS. Over the years many women have told her that when they are on holidays or away from the usual stress and pressures of their lives that they are much less likely to have PMS. But when life is as normal, all the crap they normally put up with just becomes too much. Women tell her that it's their real feelings that are coming out when they get PMS. So for three weeks of a month they can play nice and bottle it all up, but then at that point in their cycle they don't have the energy to keep up this front. These women often then ask those around them to help out a bit more so they don't get so worn out and frustrated. <a rel="noopener" href="https://www.hardiegrant.com/au/publishing/bookfinder/book/ladies_-we-need-to-talk-by-yumi-stynes/9781743797518" target="_blank">Ladies, We Need To Talk</a>, published by Hardie Grant, is now available to purchase. Image: Supplied

Mind

15 body signs no one tells you will come before menopause

Unexpected symptoms Changes like bruises and extra hair are just a few of the unexpected symptoms of premenopause and perimenopause, the latter being the last four or so years before a woman enters menopause. Breast pain Pesky menopause changes and hormonal fluctuations can cause cyclical breast tenderness (ranging from bothersome to unbearable) even when Aunt Flo isn’t due for a visit. What’s more, since perimenopause causes irregular cycles, it’s nearly impossible to know when your breasts are going to begin throbbing, according to the National Cancer Institute. Your breasts may also feel “more lumpy” than they did before, notes Ellen Dolgen, Menopause Mondays blogger and author of the free eBook, The Girlfriend’s Guide to Surviving and Thriving During Perimenopause and Menopause. Unexpected bruises Perimenopause causes some women to become a bit clumsy – and those minor bumps can quickly turn into big bruises. This is because fluctuating hormones can make skin thinner, making you bruise easier. Dry eyes Strangely, excessive tearing is a sign that your eyes are desperately trying to make up for a lack of moisture. And you can thank menopause changes and plummeting hormones for those “Cheech and Chong”-style eyes, Dolgen says. Hormones affect the ocular tissues and the composition of tears your eyes produce, resulting in excessively dry eyes and changes in vision (going from near-sighted to far-sighted, for example). Chin hair Don’t be surprised if your tweezers become your new best friend, Dolgen says. For a lucky 15 percent of women, “super human” hair on your chin, upper lip, or cheeks is an all-too-common symptom of perimenopause. And, perhaps what’s worse, the hair on your head may become thin, dry, or brittle. Heart palpitations The sudden speeding-up or irregularity of your heart rate is a common yet not often talked about symptom of perimenopause. Studies show that epinephrine and norepinephrine, the neurotransmitters that regulate heart rate and blood pressure, tend to fluctuate in menopausal women, David Portman, MD, a gynaecologist and Women’s Health expert told everydayhealth.com. Urinary urgency or leakage Pee a little when you do jumping jacks or leak when you cough or sneeze? Gotta hurry up and go right now? It’s likely due to stress urinary incontinence (SUI) or urge urinary incontinence (UUI) – both common menopause changes. Lower oestrogen levels cause the lining of the urethra to thin, says JoAnn V. Pinkerton, MD, executive director of the North American Menopause Society (NAMS). And weakened pelvic floor muscles, often a result of a vaginal childbirth, are also to blame. Dry skin Less oestrogen equals acne and dry and thinning skin for many women in entering menopause, which Dr Pinkerton likens to “reverse puberty.” It’s also common to experience flare-ups or new cases of allergies and eczema during this time, adds Dolgen, whose swears by coconut oil for softer skin and smaller pores. Body odour Of course, the excessive sweating that accompanies night sweats and hot flashes can create an unpleasant odour. But there’s another explanation, too: A drop in oestrogen levels tricks your hypothalamus gland into thinking you’re overheated, signalling your body to sweat more. Migraines Migraines may start for the first time, or worsen, when you start going through menopause because of new hormonal fluctuations, says Dr Pinkerton. The good news, however, is that hormonal migraines usually stop or vastly improve after menopause, when levels are consistently low. In fact, only 5 percent of women suffer migraines after age 60, according to the Migraine Research Foundation. Vaginal dryness Sex-stifling vaginal dryness was one of the most difficult symptoms for Dolgen. “Your vagina takes a trip to the desert and takes your eyes and skin along with it,” she says. Menopause changes, such as lower oestrogen levels, cause thinner, drier and less-elastic vaginal tissue and decrease blood flow to the area. The result: vaginal dryness, itching and painful sex. Hot flashes Sure you’ve heard about hot flashes, but you may not know that they can be different for every woman. Some even experience them for decades, starting in perimenopause. Caused by a drop in oestrogen levels, which affects the gland that regulates body temperature, hot flashes can happen during the day or at night – or both. They can be mild, lasting seconds, or severe and stick around for a half hour or longer. Weight shifts Whether you call it meno-pot, meno-pudge, or middle-age spread, extra fat in the abdominal region is a reality for many women in perimenopause. “A woman’s weight throughout her menopausal journey is impacted by five factors: hormones, diet, exercise, stress and genetics,” Dolgen explains. And you can also lose muscle mass – 0.6 percent per year or more if you’re not physically active and don’t get enough protein, Dr Pinkerton adds. Irregular periods Is your period shorter and lighter one month and heavy with cramping the next? This is part of perimenopause, explains Pinkerton. In addition to being a nuisance, irregular periods also up your pregnancy risk. “The second highest unintended pregnancy time for women is during your 40s,” Dr Pinkerton says. “And pregnancy remains a risk until you haven’t had a period for a year.” Bone loss The less oestrogen your ovaries produce, the more bone loss may accelerate. This can put you at a greater risk for osteoporosis, or bone thinning, which increases your risk of fracture. “You can lose up to 20 percent of your bones during the first five years of menopause,” Dr Pinkerton says. Fuzzy thinking Hormonal changes – along with premenopausal symptoms like mood swings and sleep problems – may make you more forgetful and less focused. Stress also plays a role. “It’s hard to relax, especially when you’re going through the trials of perimenopause,” Dolgen says, “but it’s important for your mind and body to decompress.” Written by Susan Jara. This article first appeared on <a href="https://www.readersdigest.com.au/healthsmart/conditions/15-body-signs-no-one-tells-you-will-come-before-menopause?pages=1">Reader’s Digest</a>. For more of what you love from the world’s best-loved magazine, <a href="http://readersdigest.com.au/subscribe">here’s our best subscription offer</a>.

Body

Make sure you’re not accidentally ageing your hair

<ol> <li> You don’t give much thought to your scalp</li> </ol> There’s only so much you can do with hair products. “All of us are more about instant gratification,” says celebrity stylist Nunzio Saviano. “You do all the things you’re supposed to do on the outside, but you’re not taking care of the root of the problem – and the root of the problem is taking care of the scalp and hair follicles.” The older you get, the more you lose the small veins in your scalp, meaning your hair follicles aren’t getting the nutrients they need, he says. One easy way to get the blood flowing – and make your hair lush again – is by giving your hair that classic 100 strokes a day. Sure, it might smooth your hair, but best of all, it stimulates your scalp. <ol start="2"> <li> You have the wrong hairbrush</li> </ol> Those plastic-knobbed brushes might be cheap, but they’re not doing your hair any favours. The plastic can easily snag hair, damaging tresses. Instead, buy a boar bristle brush, which will stimulate the scalp without harming your hair, recommends TV hair stylist Laura Burns. “They kind of glide through the hair and don’t pull it,” she says. <ol start="3"> <li> You wash your hair every day</li> </ol> The texture of your hair might change as you get older for the same reason that you’ve been noticing your skin is losing its glow: your skin stops secreting as much oil, says dermatologist Dr Tsippora Shainhouse. She recommends cutting back on how often you wash your hair – stick to about two or three times a week – and using a gentler shampoo when you do suds up. A sulphate-free shampoo and conditioner will keep your scalp and hair from drying out too much in the shower, she says. <ol start="4"> <li> You’re always pulling your hair back</li> </ol> A ponytail is a lifesaver on a bad hair day, but making it your daily style could contribute to the thinning that already happens naturally with age. “When a ponytail is really tight, it’s a lot of pressure on the follicle,” says Saviano. “Day after day, the follicle just gives in, and you lose that hair.” Resist pulling your hair back unless you really need to, and during activities like a workout, try to keep the ponytail loose so you aren’t putting so much stress on your roots. <ol start="5"> <li> You rely on dry shampoo</li> </ol> “Dry shampoo is probably one of the worst products you can use because it just clogs the pores,” says Saviano. Using it once or twice a week is fine, he adds, but using it day after day will interfere with healthy oils your hair needs to retain its youthful lustre. For a better anti-ageing hair care routine, make sure you’re washing your hair a couple of times a week; shampooing your roots helps stimulate the scalp, says Saviano. <ol start="6"> <li> You use heavy, sticky products</li> </ol> Pomades and mousses may have worked wonders when your hair was younger and thicker, but if it’s thinning now, those heavy products are no longer the right choice. “Be gentle: don’t use a product that is too sticky – nothing you put in and then have to really pull to work the brush through your hair,” says Burns. Using products that stiffen your hair is just one of the hairstyle mistakes that age your face – and you should avoid them. Swap out mousse and root boost for lighter products, like a gentle volumiser or a hair tonic, she suggests. <ol start="7"> <li> You load up on product</li> </ol> It’s not just about what you use; it’s how much. “Less is better,” says Saviano. The more creams, serums, and sprays you layer onto your hair, the heavier and duller it will look – which is just the opposite of what you need from anti-ageing hair care. Give your hair bounce and shine by cutting back on the amount of product you use. <ol start="8"> <li> You spend a ton of time in the sun</li> </ol> You wouldn’t go out in the sun without protecting your skin – right? – so the same should go for your hair. UV damage from the sun can dry out strands and make hair colour fade faster, says Dr Shainhouse. She recommends wearing a wide-brimmed hat to block those harmful rays. “It will keep the sun off of your face, ears, and scalp, which are susceptible to age spots, premature wrinkling, sunburn, and developing skin cancer,” she says. <ol start="9"> <li> You don’t give pollution a second thought</li> </ol> Sunlight isn’t the only danger to your hair in the great outdoors. Wind and changes in humidity can make your hair frizzy, compelling you to try and tame it with products and heat. And toxins in air pollution can do a number on your tresses. “They produce free radicals reactive oxygen species that damage hair cells and disrupt the normal biochemistry of hair, thus making hair age faster and damage prone,” says cosmetic surgeon Dr Sonam Yadav. <ol start="10"> <li> You straighten or curl your hair every day</li> </ol> Curling irons and flat irons may give your hair the style you want, but all that heat is very hard on your hair. Your hair already loses moisture and softness as you age; using hot tools makes your tresses even drier and more brittle, says Saviano. “In general, the less you use them, the better it is,” he says. <ol start="11"> <li> Your diet is lacking key nutrients</li> </ol> “Menopause causes thinning and fall of hair in almost all women due to the decrease in oestrogen levels that are a normal part of menopause,” says Dr Yadav. Some cases are more extreme, with women noticing the patchy balding called female pattern hair loss. Eating iron- and calcium-rich foods like spinach, dairy, and eggs can help. If hair loss is extreme and noticeable work with your doctor to rule out underlying medical issues that could be throwing your hormones out of whack. <ol start="12"> <li> You’ve been skipping your workouts</li> </ol> Exercise is great for your heart, brain, and pretty much every other part of your body – hair included. If you’ve been getting less physical activity as you age, your body isn’t the only part of you that’s missing out. Anti-ageing hair is dependent on the blood-pumping benefits of a healthy circulatory system. “Get as much circulation as you can get,” says Burns. “Blood flow to the scalp is great.” <ol start="13"> <li> Your shampoo is too intense</li> </ol> As your hair gets drier through the years, a clarifying shampoo might be too strong. “Using a heavier shampoo like detoxifying shampoos might strip natural oils from the hair,” says Saviano. “You feel squeaky clean, which is good, but if you’re not using conditioner, your hair will look dull.” <ol start="14"> <li> You ignore self-care</li> </ol> Emotional and physical stress take a toll on your body, and your body might respond by putting the brakes on some of your hair follicles, says Dr Shainhouse. To keep stress from making age-related hair loss more pronounced, make sure you’re addressing sources of chronic stress in your life. Talk to a mental health provider about coping strategies, or pick up stress-busting activities like meditation and exercise. Written by Marissa Laliberte. This article first appeared on <a rel="noopener" href="https://www.readersdigest.com.au/culture/14-everyday-mistakes-that-are-aging-your-hair" target="_blank">Reader’s Digest</a>. For more of what you love from the world’s best-loved magazine, <a rel="noopener" href="http://readersdigest.com.au/subscribe" target="_blank">here’s our best subscription</a>.

Beauty & Style

New study places postmenopausal women at higher risk of COVID-19

<div class="post_body_wrapper"> <div class="post_body"> <div class="body_text "> A groundbreaking study has found that post-menopausal women with lower levels of estrogen appear to be at higher risk of developing severe coronavirus. The study, which was led by researchers at King's College in London found that higher levels of estrogen may have a protective effect against coronavirus. Estrogen interacts with the immune system in various ways, including how many immune cells are produced and how they respond to infection. Using data from the COVID Symptom Study App, researchers examined the rate of predicted COVID-19 among post-menopausal women, pre-menopausal women taking the combined oral contraceptive pill and post-menopausal women taking hormone replacement therapy. Results were taken from more than 500,000 women in the UK between May 7th and June 15th in 2020. Researchers hypothesised that estrogen could serve as a protectant against COVID-19. The study quickly found postmenopausal women had a higher rate of predicted COVID-19 than other studied women. Women in the 45-50 age group were most likely to be at risk, with reported symptoms of anosmia (inability to smell), fever and a persistent cough. Women who were using the combined oral contraceptive pill between 18-45 had a lower rate of predicted COVID-19 and corresponding reduced frequency of symptoms. The rate of hospitalisation was also significantly lower in this group. Hormone replacement theory in post menopausal women between 50-65 years was associated with an increased rate of predicted COVID-19 but not with hospitalisation. The researchers advised that hormone replacement therapy should be considered with caution due to the lack of information, route of administration as well as duration of treatment. Joint lead author Dr Karla Lee, from King’s College London, said: “We hypothesised that pre-menopausal women with higher estrogen levels would have less severe COVID-19 when compared to women of the same age and BMI who had been through the menopause, and our findings supported this. “Additionally, when we compared a younger group of women on the combined oral contraceptive pill (COCP) with a similar group not taking the COCP, we saw less severe COVID amongst those taking the COCP - suggesting hormones in the COCP may offer some protection against COVID-19. “More research is certainly needed to further our knowledge.” </div> </div> </div>

Body

Why do women gain weight during menopause?

For most women, perimenopause – the transition to menopause – begins in their 40s. The entire menopause process typically lasts around four years and begins with the ovaries making less estrogen. A woman is considered to be post-menopausal when she <a href="https://www.sciencedirect.com/science/article/pii/S0140673698053525">hasn’t experienced a menstrual period</a> for 12 months. This <a href="https://academic.oup.com/ije/article/43/5/1542/695928">usually occurs</a> between the ages of 46 to 52 years. Symptoms of menopause can include irregular periods, hot flushes, fatigue, tender breasts, night sweats, vaginal dryness, difficulty sleeping, changes in mood and lower libido. During menopause, hormonal changes can affect the way fat is distributed in the body, but ageing is more likely to be the cause of any weight gain associated with menopause. Gaining weight isn’t inevitable, though. There’s plenty you can do to combat weight gain as you age. Hormonal changes alter where the body deposits fat Certain areas such as your stomach are more prone to weight gain during menopause. This is because the change in hormones, which lead to a higher testosterone-to-estrogen ratio, <a href="https://www.ajog.org/article/S0002-9378(19)30588-5/abstract">alters where the body deposits fat</a>. Fat comes off the hips and is <a href="https://www.sciencedirect.com/science/article/abs/pii/S0002937896701114">deposited around the middle</a>. But the hormonal changes involved in menopause aren’t the reason you gain weight. Ageing is the real cause The weight gain that comes with menopause is a <a href="https://www.sciencedirect.com/science/article/pii/S1568163709000415">by-product of ageing</a>. As we age, our body stops working as efficiently as it did before. Muscle mass starts to decrease – a <a href="https://www.sciencedirect.com/science/article/abs/pii/S0070215305680052">process known as “sarcopenia”</a> – and fat begins to increase. And because muscle mass is one of the determining factors of how fast your metabolism will run, when your muscle mass decreases, your body starts to burn fewer calories at rest. This might make it more challenging to maintain your weight. As we age, we tend to continue with our same food habits but <a href="https://www.ncbi.nlm.nih.gov/pubmed/15496544">don’t increase our activity</a>. In fact, aches and pains can make some people actively decrease theirs. Not compensating for the ageing process and the change in body composition can lead to weight gain. And this <a href="https://www.hindawi.com/journals/jobe/2019/8031705/">applies to men too</a> – they are just as likely to gain weight due to this process known as sarcopenia. Menopause and weight gain take their toll Due to a change in body fat distribution and <a href="https://academic.oup.com/eurheartj/article/28/7/850/2887789">increase in waist circumference</a>, menopause can also increase your risk of other health conditions. Following menopause, your ovaries make very little of the hormones estrogen and progesterone. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2637768/">Estrogen helps to keep your blood vessels dilated</a> – relaxed and open – which helps keep your cholesterol levels down. Without estrogen, or with lower quantities, your bad cholesterol (known as low-density lipoprotein or LDL-cholesterol) starts to build up in your arteries. This can increase your risk of heart disease and stroke. Having less estrogen also results in a loss of bone mass, putting you <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1297264/">at risk of the disease osteoporosis</a>, which makes your bones more prone to fractures. What can you do? Weight gain associated with ageing is not inevitable. There are a number of things you can do to maintain your weight as you age. <ol> <li> Exercise</li> </ol> Incorporate <a href="https://www1.health.gov.au/internet/main/publishing.nsf/Content/health-pubhlth-strateg-phys-act-guidelines#npa%2065">regular daily exercise</a>, with a mixture of intensities and variety of activities. Try to include body-strengthening exercises two days per week. <ol start="2"> <li> Weigh yourself – but not too much</li> </ol> <a href="https://journals.lww.com/acsm-healthfitness/fulltext/2011/03000/the_national_weight_control_registry__a_study_of.7.aspx">Weigh yourself once a week</a> at the same time and day to monitor the trend over time. Any more than this will only create a fixation with weight. Day-to-day fluctuations in weight are to be expected. <ol start="3"> <li> Create positive habits</li> </ol> Create positive habits by replacing negative behaviours. For example, instead of mindlessly scrolling through social media of an evening or turning on the TV and comfort-eating, replace it with a positive behaviour, such as learning a new hobby, reading a book or going for a walk. <ol start="4"> <li> Eat more slowly</li> </ol> Eat food away from technological distractions and slow down your food consumption. Try using a teaspoon or chopsticks and chew your food thoroughly as slowing down your food consumption <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/oby.20715">reduces the quantity consumed</a>. <ol start="5"> <li> Switch off from technology:</li> </ol> Turn off technology after dusk to improve your sleep. Blue light emission from phones, tablets and other devices tell your brain it’s day, instead of night, which will keep you awake. Lack of sleep (less than six hours per night) <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3763921/">can compromise your decision-making abilities</a> which might lead you to make unhealthy choices that contribute to weight gain. <ol start="6"> <li> Curb sugar cravings naturally</li> </ol> If you’re craving sugar you’re better off reaching for foods naturally high in sugar and fat first. Some great options are fruits, nuts, avocado and 100% nut butters. These foods release the same feel-good chemicals in the brain as processed and fast food and leave us feeling full. Allow yourself your favourite treats, but keep them to once per week. Written by Nicholas Fuller. Republished with permission of <a href="https://theconversation.com/why-do-women-gain-weight-during-menopause-131564">The Conversation. </a>

Beauty & Style

How to beat weight gain at menopause

For many women, the journey through menopause is a roller coaster of <a href="https://www.jeanhailes.org.au/health-a-z/menopause/menopause-symptoms">symptoms including hot flushes</a>, night sweats, sleep disturbance, dry and itchy skin, mood changes, anxiety, depression and weight gain. For some, it can be relatively uneventful. Menopause <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/menopause">is medically defined</a> as not having any menstrual bleeding for 12 months. Most women reach this milestone <a href="https://www.jeanhailes.org.au/health-a-z/menopause/about-menopause">between the ages of 45 to 55</a>. Even though weight gain is common, you can beat it by using menopause as an opportunity to reset your eating and exercise habits. Do women gain weight at menopause? Australian women <a href="https://www.ncbi.nlm.nih.gov/pubmed/26626467">tend to gain weight as they age</a>. During menopause, women also experience a shift in <a href="https://www.ncbi.nlm.nih.gov/pubmed/28982486">how fat stores are distributed</a> around the body. Fat tends to move from the thigh region up to the waist and abdomen. A review of studies that quantified changes in body fat stores before and after menopause found <a href="https://www.ncbi.nlm.nih.gov/pubmed/31034807">total body fat mass also increased significantly</a>. While the average weight increase was only about one kilogram, the increase in percentage total body fat was almost 3%, with fat on the trunk increasing by 5.5% and total leg fat decreasing around 3%. Average waist circumference increased by about 4.6 centimetres and hips by 2.0 centimetres. Other bad news is that once postmenopausal, <a href="https://www.ncbi.nlm.nih.gov/pubmed/25191611">women have lower total daily energy needs</a>. This is partly because body fat requires less energy to maintain it compared to muscle. So even if your weight doesn’t change, the increase in body fat means your body needs fewer kilojoules each day. In addition to this, <a href="https://www.ncbi.nlm.nih.gov/pubmed/1522233">the menstrual cycle had a small energy cost</a> to maintain ovarian function. This amounted to about 200 kilojoules a day, which is now “saved”. The bottom line is that unless your transition to menopause is accompanied by a reduction in your total energy intake or an increase in your physical activity, you’re at high risk of weight gain. But there is some good news Around <a href="https://www.ncbi.nlm.nih.gov/pubmed/16491110">60% of women manage to avoid weight gain</a> at menopause. They <a href="https://www.ncbi.nlm.nih.gov/pubmed/17264847">manage this by</a> either decreasing the total amount of food they eat, cutting down on fat and sugar, using commercial weight loss programs, doing more exercise, or a combination of all these. They key thing is that they change some aspects of their lifestyle. So what works best? Until recently, only <a href="https://www.ncbi.nlm.nih.gov/pubmed/24971172">three major studies</a> had tested interventions. The <a href="https://www.ncbi.nlm.nih.gov/pubmed/14644697">Women’s Healthy Lifestyle Project</a> compared the impact of receiving support to improve diet and exercise habits over four years covering menopause, to making no changes at all. Women who changed their lifestyle had lower body weights, less abdominal fat and better blood sugar levels compared to those in the control group. The second study, of 168 women, enrolled <a href="https://www.ncbi.nlm.nih.gov/pubmed/19339904">them into a 90 minute Nordic walking program</a>, three times a week. This was associated with a reduction in weight, body fat and waist circumference, as well as blood levels of <a href="https://en.wikipedia.org/wiki/Low-density_lipoprotein">bad cholesterol</a> and fats, highlighting the benefits of endurance walking. The third study divided 175 Nigerian women into two groups: one group undertook a <a href="https://www.ncbi.nlm.nih.gov/pubmed/22547191">12-week circuit training exercise program</a>, the other was a control group. Women in the exercise group reduced their waist circumference relative to their hips, indicating a reduction in abdominal fat, even though their total body weight did not change. The 40-something trial More recently, we studied 54 women aged 45-50 years in the <a href="https://www.ncbi.nlm.nih.gov/pubmed/24156558">“40-Something” trial</a>. We randomly assigned half the participants to receive healthy eating and physical activity support from health professionals, using motivational interviewing to encourage behaviour change. The other half received information only and were asked to self-direct their lifestyle changes. Our aim was to prevent weight gain in women who were in either the overweight or healthy weight range as they entered early menopause. We encouraged women who were overweight to reduce their body weight to achieve a body mass index (<a href="https://www.heartfoundation.org.au/your-heart/know-your-risks/healthy-weight/bmi-calculator">BMI</a>) in the healthy weight range (BMI 18 to 25). We encouraged women already in the healthy weight range to maintain their weight within one kilogram. We gave all women the same healthy lifestyle advice, including to eat: <ul> <li>2 serves of fruit and at least 5 serves of vegetables every day</li> <li>1-1.5 serves of meat or meat alternatives</li> <li>2-3 serves of dairy</li> <li>wholegrain breads and cereals.</li> </ul> And to: <ul> <li>limit foods high in fat and sugar</li> <li>cut down on meals eaten outside the home</li> <li>engage in moderate to vigorous physical activity for 150-250 minutes per week</li> <li>sit for less than three hours per day</li> <li>take at least 10,000 steps per day.</li> </ul> Women in the intervention group had five consultations with a dietitian and exercise physiologist over one year to provide support and motivation to change their eating habits and physical activity. After two years, women in the intervention group had <a href="https://www.ncbi.nlm.nih.gov/pubmed/31108930">lower body weights, less body fat and smaller waist circumferences</a> compared to the control group who received information pamphlets only. When we evaluated changes based on their starting BMI, the intervention was more effective for preventing weight gain in women initially of a healthy weight. Of all the health advice, <a href="https://www.ncbi.nlm.nih.gov/pubmed/25062965">eating five serves of vegetables and taking 10,000 steps per day</a> were the most effective strategies for long-term weight control during menopause. Although weight gain, and especially body fat gain, is usual during the menopausal transition, you can beat it. Rather than menopause being a time to put your feet up, it’s a time to step up your physical activity and boost your efforts to eat a healthy, balanced diet, especially when it comes to the frequency and variety of vegetables you eat.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important; text-shadow: none !important;" src="https://counter.theconversation.com/content/123368/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/clare-collins-7316">Clare Collins</a>, Professor in Nutrition and Dietetics, <a href="https://theconversation.com/institutions/university-of-newcastle-1060">University of Newcastle</a>; <a href="https://theconversation.com/profiles/jenna-hollis-171991">Jenna Hollis</a>, Conjoint Lecturer, <a href="https://theconversation.com/institutions/university-of-newcastle-1060">University of Newcastle</a>, and <a href="https://theconversation.com/profiles/lauren-williams-14548">Lauren Williams</a>, Professor of Nutrition and Dietetics, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a> This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/how-to-beat-weight-gain-at-menopause-123368">original article</a>.

Body

What you can expect from menopausal hormone therapy consultation

We have seen increasingly dramatic headlines over the years on the risks of menopausal hormone therapy (MHT), also known as hormone replacement therapy. An alarming <a href="https://www.ncbi.nlm.nih.gov/pubmed/12117397">study in 2002</a>, which found an apparent increased risk of breast cancer in women who took MHT, prompted the first of these headlines. But newer evidence has been reassuring. It’s also a reminder that when considering your options, any risk associated with taking MHT needs to be balanced with the benefits. This balance is the main thing your GP will consider when discussing whether MHT is right for you. Remind me, what’s all this about breast cancer? In 2002, the <a href="https://www.ncbi.nlm.nih.gov/pubmed/12117397">Women’s Health Initiative study</a> found women who took MHT had a 26% increased risk of breast cancer. This finding, which was later disputed, led to a <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0146494">55% drop</a> in MHT use in the next three years. A reanalysis of the data showed <a href="https://jamanetwork.com/journals/jama/fullarticle/1745676">a lower risk</a> of breast cancer in some women. And in 2016, a statement from the world’s leading menopause specialists <a href="https://www.tandfonline.com/doi/full/10.3109/13697137.2013.771520">said</a> the benefits of MHT are more likely to outweigh the risks if women with symptoms start taking it before they turn 60 or within ten years after menopause. Then <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31709-X/fulltext">a study</a> published in The Lancet in recent months suggested the risks might be greater than once thought. However, this study combined the results of previous ones, including observational studies, which have limitations. Observational studies show associations between one factor and another, rather than one causes the other. So factors other than MHT might be at play in increasing a woman’s risk of breast cancer. As a result, these studies tend to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3818421/">overestimate the risks</a>. Other risks linked with MHT include <a href="https://www.ncbi.nlm.nih.gov/pubmed/30626577">thromboembolism</a> (a type of blood clot). And in older women, there’s an increased risk of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3675220/">stroke</a>. So, if you are one of approximately <a href="https://www.ncbi.nlm.nih.gov/pubmed/25706184">one-third of women</a> aged 40-65 suffering moderate to severe menopausal symptoms, what do you need to know? What type of symptoms are we talking about? Most women experience menopause (the date of her last period) at around <a href="https://www.nature.com/articles/nrdp20154">45-55 years of age</a>. Some women’s periods stop before then, either spontaneously or due to some medical treatment, with varying symptoms and health risks. However, menopausal symptoms may start before periods stop, and last on average seven to ten years. <a href="https://www.ncbi.nlm.nih.gov/pubmed/25706184">For a minority of women</a>, symptoms can last for longer. Physical symptoms include hot flushes, night sweats and vaginal dryness, with <a href="https://www.ncbi.nlm.nih.gov/pubmed/25706184">severe symptoms</a> <a href="https://www.ncbi.nlm.nih.gov/pubmed/26115590">profoundly reducing</a> women’s quality of life. What are the benefits of MHT? MHT is available in different forms such as a tablet, skin patch, gel, and vaginal pessary or cream. These have <a href="https://jeanhailes.org.au/contents/documents/Resources/Tools/Menopause_tool.pdf">advantages and disadvantages</a>. For example, some act on the whole body such as tablets, gels, and patches while others such as vaginal creams and pessaries act on the local area only. Those that act locally have <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31709-X/fulltext">no increased risk</a> of breast cancer or thromboembolism. MHT is an <a href="https://www.ncbi.nlm.nih.gov/pubmed/26444994">effective treatment</a> for hot flushes, night sweats and vaginal dryness. Other treatments, such as bioidentical or natural hormones, have <a href="https://theconversation.com/natural-hormone-therapy-no-panacea-for-menopause-symptoms-25869">safety concerns</a>. Others, such as <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001395.pub4/full">phytoestrogens</a> and many <a href="https://www.menopause.org.au/health-info/fact-sheets/complementary-medicine-options">other herbal preparations</a>, <a href="https://canceraustralia.gov.au/publications-and-resources/clinical-practice-guidelines/menopausal-guidelines">don’t work</a>. MHT also helps <a href="https://www.ncbi.nlm.nih.gov/pubmed/29234813">prevent</a> osteoporosis, and may help prevent colon cancer, type 2 diabetes and coronary heart disease. Different risks and benefits for each woman The balance of risks versus benefits of MHT varies from woman to woman, depending on a number of factors. Here are some hypothetical examples. 1. Gina is a healthy 52 year old with menopausal symptoms, a family history of breast cancer (her mother was diagnosed at 65), and low bone density If Gina’s menopausal symptoms are troubling her, then MHT is a reasonable option. Not only is it the <a href="https://www.ncbi.nlm.nih.gov/pubmed/15495039">most effective treatment</a> for her symptoms, it has the <a href="https://www.ncbi.nlm.nih.gov/pubmed/30907953">added benefit</a> for bone health. Gina will need a comprehensive assessment to decide the best type of MHT. Breast cancer is the most feared risk of MHT. The risk depends on the type of MHT and how long it’s used. But that risk declines after Gina stops using it. <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31709-X/fulltext">The Lancet paper</a> showed that for women with a family history of breast cancer like Gina, MHT use does not further increase her breast cancer risk. But it also showed that longer use of MHT is associated with a slower decline in risk after stopping using it. 2. Sarah has menopausal symptoms, has had both ovaries removed and a hysterectomy, is obese and drinks moderately Sarah’s going through what’s called a “surgical menopause” and has the physical symptoms that go with it, including hot flushes. Her obesity and moderate drinking already increases her risk of breast cancer. <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31709-X/fulltext">The Lancet paper</a> showed that the use of oestrogen only-MHT (the type of MHT she’d take because of her hysterectomy) does not further add to this risk. However, her obesity is associated with an increased risk of blood clots. As the risk of blood clots increases if she takes oestrogen in tablet form, MHT as a <a href="https://www.tandfonline.com/doi/abs/10.1080/13697137.2018.1439915">skin patch or gel</a> would be the best choice. Losing weight <a href="https://www.ncbi.nlm.nih.gov/pubmed/23084519">may also improve</a> Sarah’s hot flushes. 3. Sam went through menopause before she turned 45 <a href="https://www.thelancet.com/action/showPdf?pii=S1470-2045%2812%2970425-4">One in 10 women</a> experience menopause before the age of 45, like Sam. This puts her at a <a href="https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(12)70425-4">30% lower risk</a> <a href="https://www.menopause.org.au/about-ams/media-info/1468-mht-and-breast-cancer-risk-lancet-29-august-2019">of breast cancer</a> compared with women who experience menopause later in life. However, early menopause is associated with a <a href="https://www.ncbi.nlm.nih.gov/pubmed/21993082">greater risk</a> of premature death, including from <a href="https://www.ncbi.nlm.nih.gov/pubmed/27627190">heart disease</a> as well as substantially greater risk of <a href="https://www.ncbi.nlm.nih.gov/pubmed/17476146">osteoporosis and fragility fracture</a> in later life. So her GP will likely advise her to take MHT until the average age of menopause. This <a href="https://www.ncbi.nlm.nih.gov/pubmed/19733988">restores</a> her breast cancer, heart, and mortality risk to approximately what it would have been if she had not gone through an early menopause. It also reduces her risk of bone thinning (osteoporosis). 4. Lee is 65, has vaginal dryness but no more hot flushes Vaginal symptoms, including discomfort from vaginal dryness, <a href="https://www.tandfonline.com/doi/full/10.1080/13697137.2017.1421923?scroll=top&needAccess=true">are common</a> in postmenopausal women like Lee. And vaginal oestrogen preparations as a pessary are <a href="https://www.ncbi.nlm.nih.gov/pubmed/27577677">an effective and safe option</a>. Vaginal oestrogen acts locally so <a href="https://www.ncbi.nlm.nih.gov/pubmed/27577677">does not</a> improve bone health and does not increase blood clots or breast cancer risk. So how best to act on this? The decision about whether to use MHT, which form, or to consider an alternative to MHT to manage your symptoms can be a complex one. So, it’s important to form a partnership with your doctor who can guide you to make an informed decision. You may need several discussions over a period of time to fully consider what is right for you.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important; text-shadow: none !important;" src="https://counter.theconversation.com/content/124174/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/rhonda-garad-783705">Rhonda Garad</a>, Senior Lecturer and Research Fellow in Knowledge Translation, <a href="http://theconversation.com/institutions/monash-university-1065">Monash University</a> and <a href="https://theconversation.com/profiles/amanda-vincent-842862">Amanda Vincent</a>, Adjunct Clinical Associate Professor and Endocrinologist, <a href="http://theconversation.com/institutions/monash-university-1065">Monash University</a> This article is republished from <a href="http://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/thinking-of-menopausal-hormone-therapy-heres-what-you-can-expect-from-your-gp-124174">original article</a>.

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Keeping intimacy alive after menopause

How tracking menopause symptoms can give women more control over their health

What are the most common symptoms of menopause? And which can hormone therapy treat?

How long does menopause last? 5 tips for navigating uncertain times

Lots of women try herbs like black cohosh for menopausal symptoms like hot flushes – but does it work?

Don’t believe the hype. Menopausal women don’t all need to check – or increase – their testosterone levels

“I was spiralling”: Naomi Watts’ candid menopause admission

Hot flushes, night sweats, brain fog? Here’s what we know about phytoestrogens for menopausal symptoms

Why weightlifting is beneficial before and after the menopause

Is menopause making me put on weight? No, but it’s complicated

“I didn’t know how to ask for help”: Naomi Watts shares important message on ageing

Misdiagnosis of menopause is more common than you think

‘Brain fog’ during menopause is real – it can disrupt women’s work and spark dementia fears

EXCLUSIVE: Claudine Ryan talks hormones, PMS and the brain

15 body signs no one tells you will come before menopause

Make sure you’re not accidentally ageing your hair

New study places postmenopausal women at higher risk of COVID-19

Why do women gain weight during menopause?

How to beat weight gain at menopause

What you can expect from menopausal hormone therapy consultation

Our Partners

News

Shop

Catalogues

Newspaper

Contests

Entertainment

Travel

Health

Lifestyle

Finance

Property

Compare

Games

Information

Keep up to date

Search

Keeping intimacy alive after menopause

How tracking menopause symptoms can give women more control over their health

What are the most common symptoms of menopause? And which can hormone therapy treat?

How long does menopause last? 5 tips for navigating uncertain times

Lots of women try herbs like black cohosh for menopausal symptoms like hot flushes – but does it work?

Don’t believe the hype. Menopausal women don’t all need to check – or increase – their testosterone levels

“I was spiralling”: Naomi Watts’ candid menopause admission

Hot flushes, night sweats, brain fog? Here’s what we know about phytoestrogens for menopausal symptoms

Why weightlifting is beneficial before and after the menopause

Is menopause making me put on weight? No, but it’s complicated

“I didn’t know how to ask for help”: Naomi Watts shares important message on ageing

Misdiagnosis of menopause is more common than you think

‘Brain fog’ during menopause is real – it can disrupt women’s work and spark dementia fears

EXCLUSIVE: Claudine Ryan talks hormones, PMS and the brain

15 body signs no one tells you will come before menopause

Make sure you’re not accidentally ageing your hair

New study places postmenopausal women at higher risk of COVID-19

Why do women gain weight during menopause?

How to beat weight gain at menopause

What you can expect from menopausal hormone therapy consultation

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