Information on popular complementary and alternative medical topics

Hot flushes are the commonest symptom of the menopause, and may vary in severity from warm feelings to drenching sweats disturbing sleep. Some patients describe changing their clothes four to five times a night. They move out of double beds into single beds in separate rooms as they disturb their partners.

In a survey at the Prince Henry’s Hospital clinic, 91 per cent of women complained of hot flushes, and gave them as a reason for attending the clinic. Even women who do not experience these find themselves reacting more to heat than they did before. Women in all kinds of work describe the difficulty of coping with flushes during their working day. They are obvious to other people; the neck and face become red; and they are known to be aggravated by stressful situations. Others describe a more severe phenomenon of underlying weakness following the flush; they feel quite exhausted. Hot flushes may occur hourly, by day or night, or they may be occasional.

What causes them?

The actual mechanism that causes hot flushes is not known in detail, but they are known to be aggravated by heat, alcohol, obesity, caffeine and hot, spicy foods and stressful situations.

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Some women report an increase in libido at this time, others that it has declined. This is an area in which accurate details are hard to tabulate. So many factors are involved; compatibility with one’s partner; good health in both; depression, which affects libido the most; and medications such as some antidepressant drugs, antihypertensive drugs and alcohol.

On the positive side, with no fear of pregnancy, more time on their hands and lack of distraction from constantly present young, libido may increase and sexual experience may have a widening place in people’s lives.

As people grow older, with increased business cares and tiredness, there may be a decrease in sexual activity. On the other hand, some people, in a frantic attempt to relive their youth before it is entirely lost, look elsewhere and, in some cases, take off permanently with a younger partner. To be aware of this is an important factor in managing this time of your life.

However, in the vast majority of people that I see, both partners want the company of people of their own age group, who are alert and in good health.

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After middle life women, and men too, become anxious about cancer anywhere in their bodies, perhaps because old friends have died from it, and also perhaps because the menopause brings odd changes which make women preoccupied with their health. No one wants cancer, so it is no wonder that women and doctors too have reacted so strenuously to reports that oestrogen replacement may cause cancer of the uterus.

Before the menopause, oestrogen acts on the lining of the uterus (the endometrium), causing it to build up to form a bed for the fertilised egg. If fertilisation does not occur another hormone (progesterone) causes shedding of this lining and thus a monthly period is produced.

Later, if oestrogen is administered continuously without a break, or without added progestogen (which causes a shedding of the uterine lining) the endometrium builds up further and further and may give rise to endometrial hyperplasia. This in some women may go on to form cancer. However, if oestrogen is given with progestogen, shedding of the endometrium occurs regularly and it does not proceed on to hyperplasia.

Work has now been done which shows that if progestogen is given for 10-14 days each month with the oestrogen therapy then the incidence of hyperplasia and cancer of the lining of the uterus comes back to less than that in the normal community. That is if oestrogen is to be given safely then progestogen must be given with it.

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What are the periods like in the treatment?

They are usually lighter than in earlier years, particularly after the first period or clearing out. It varies very much from woman to woman, and the quantity of flow is related to age and the dose of oestrogen. The closer to your last periods, the heavier they usually are, but as you age the lining of your uterus reacts less to the oestrogen stimulation, and no period may occur at all. Progestogen must still be taken monthly.

Is there any premenstrual tension with progestogen?

This occurs in some patients but is not common and often settles with repeated doses. There are three progestogens used commonly, and one may suit one person better than the other in some instances. Simply try the other progestogens and fit whichever one suits you into your programme. You had to organize yourself with your hormones in your youth, and it is necessary to do so now if you want the benefits of oestrogen therapy. Progestogen is necessary in the programme of treatment.

Do these periods mean I can get pregnant?

The periods are purely a local effect due to a cleaning out of the lining of the uterus. They do not mean you are producing eggs and can become pregnant, provided you have had no periods for twelve months before starting treatment.

Is oestrogen replacement sometimes necessary before periods cease?

If true menopausal symptoms exist, then your oestrogen production may have decreased, particularly if your periods are more scanty and are longer spaced. Your symptoms may then be relieved by oestrogen therapy. This of course would never be given if bleeding was heavier or more frequent, as it would only aggravate this and might produce undesirable changes in the lining of the uterus.

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Polyps are small build-ups of mucous tissue in the lining of the uterus or cervix. They are easily removed and cause little trouble.

Fibroids are innocent tumours comprised of fibrous and muscular tissue; they are common, and cause heavy periods. They can produce pressure symptoms, if large enough, by pressing on adjacent organs such as the bladder. Bleeding and pressure symptoms are the reasons for their removal.

What is dilatation and curettage?

It is the usual method, in Australia, of examining the lining of the uterus. You will be in hospital, and the procedure will be carried out under a general anaesthetic. An instrument is introduced into the uterus and the lining scraped to remove any abnormal build-up. The build-up is then sent to a pathologist for diagnosis. Vabro curettage is another method used. This is done without an anaesthetic and without admission to hospital. An instrument is inserted into the uterus and cells from the lining are sucked out and examined.

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