DR QURATULAIN ZAIDI of Mind N Life says you shouldn’t have to let menopause symptoms interfere with your way of living. She shares her view on perimenopause, menopause and Hormone Replacement Therapy.
What is menopause?
It’s quite common for me to hear from women in their late 30s or early 40s that they are just not feeling right or not feeling themselves for any number of reasons. Difficulty with sleep, lack of energy, forgetting words mid-sentence, feeling low, increased anxiety and loss of libido. These symptoms, whether alone or combined, can have a detrimental impact on quality of life, self-confidence and relationships. Hormone levels are not often where their minds immediately turn, and they can be quite surprised when I bring up the topic because the age-old tale is that menopause happens in women’s 50s.
Menopause is defined as when your period has stopped for a year and you’re no longer able to release an egg. At this time, you experience a shift in three important hormones: oestrogen, progesterone and testosterone. Endocrinologists say that it’s the fall in oestrogen that brings on most common symptoms experienced by the women.
What is perimenopause?
Perimenopause, also known as menopause transition, is the stage of a woman’s reproductive life that begins several years before menopause, as their ovaries gradually begin to produce less oestrogen. For some women it can start as early as their late 30s and last over a decade. This stage of life doesn’t arrive at the best time, often happening when women are at the peak of their careers with busy home lives and young families.
Don’t grin and bear it!
Perimenopause can mark the start of a complicated relationship with your body. Although every woman experiences menopause, research shows that medical care all over the world often fails to provide them with treatment that could alleviate their symptoms. Research also suggests that 70 to 80 percent of women experience menopause symptoms. And more than 25 percent of the time they are debilitating.
On average, these symptoms can last for seven and a half years. And yet doctors often encourage women to “grin and bear it”. I was certainly told as much in Hong Kong — I was told nothing helps and I would just have to live with it. I didn’t give up hope, though. And I was lucky enough to have access to medical professionals in the UK and I went on HRT. That changed my life. It was like I’d been walking around in a black-and white movie and then saw things in colour again.
Some doctors may prescribe antidepressants to help with depression symptoms. However, it’s nowhere near enough as it’s not treating the cause of the problem.
Common perimenopause symptoms
- Loss of libido
- Migraines
- Mood changes
- Depression or anxiety
- Transient memory loss
- “Brain fog”
- Weight gain
- Hot flushes and night sweats
- Insomnia
- Breast tenderness
- Itchy, crawly or dry skin
- Exhaustion
- Irregular periods
- Vaginal dryness
About Hormone Replacement Therapy (HRT)
In reality, there are options and women don’t have to suffer in misery for 10 years. Hormone Replacement Therapy (HRT) – the medical replacement of oestrogen, progesterone, and sometimes testosterone – can elevate life-impeding menopause symptoms.
For example, in the longer term this treatment can reduce the risk of osteoporosis (which rises after menopause) and therefore the risk of bone fractures, because oestrogen is vital for maintaining muscle mass and bone density. In addition, emerging research has reinforced the link between menopause and cardiovascular health. These studies show the risk of heart disease increases significantly post-menopause due to hormonal changes, as oestrogen’s protective effects on the cardiovascular system are diminished.
HRT may also provide neuroprotective benefits and improve cognitive function in women. Fluctuating oestrogen levels during menopause can lead to cognitive difficulties, including memory lapses and concentration issues. Oestrogen promotes brain health by enhancing synaptic plasticity and reducing inflammation, and HRT therefore has the potential to preserve cognitive function. The effectiveness depends on the timing of HRT and the type used.
So why are doctors reluctant to discuss or prescribe Hormone Replacement Therapy?
In 2002, the results of a large randomised trial conducted by America’s National Institutes of Health, known as the Women’s Health Initiative, showed that taking oestrogen with synthetic progesterone increased women’s risk of breast cancer, heart attacks, strokes and blood clots.
However, since 2002, we’ve learnt that the first conclusions of that trial, on which so much reluctance to HRT is still based, were almost entirely wrong. For one thing, the median age of the sample was 63 years. Also, most of the women were unhealthy 50 percent were obese. Nearly 50 percent were current or past smokers, and more than a third had been treated for high blood pressure.
What the study actually showed, therefore, is that HRT is not suitable for older, unhealthy women. Re-analysis of the results show that the long-term benefits of HRT for women who are given it as they enter menopause — during their perimenopausalstage – are significant.
Of course, HRT may not be a suitable solution for everyone. The suitability of this option must be discussed with a doctor.
Take the extra step
It’s also essential to remember that, while there are medical options for women suffering through perimenopause and menopause, there are other key things you can do to enhance your quality of life at this time.
#1 Be informed and educate yourself
Being aware of what’s going on for you biologically is important. Reaching out for help and knowing that you are not alone is helpful.
#2 Practice self-care
Self-care is important during this period. This can include changing your diet, looking after your emotional and physical wellbeing, exercising, and managing your sleep routine well.
#3 Look at the options for psychological support
Cognitive Behavioural Therapy (CBT) is known to be an effective therapeutic treatment, and seeking help for any mental health challenges can be useful.
#4 Seek social support
It can be helpful to have an open and honest discussion with family members and create a support network by reaching out to groups of women who may be going through similar challenges. It’s important to know you have options and that your quality of life can be improved significantly. However, you have to educate yourself about this stage of life and you have to know the risks and benefits of the treatments that are available so you can make informed decisions. It’s imperative to find trusted, experienced and competent professionals who will listen and guide you safely through this challenging life stage and make it easier, understanding that an accepting, holistic approach combining HRT (where appropriate) and a healthy lifestyle will mitigate the health risks associated with menopause.
It’s a life stage that doesn’t have to be so hard for women – trust me, as with so much else that comes with being a woman, you don’t have to grin and bear it.
Dr Zaidi is a British-registered clinical psychologist who works with individuals, couples and families in her private practice in Central, and as a mental health consultant for a number of NGOs and international corporations.
9700 2786 | info@mindnlife.com | mindnlife.com
This article explaining menopause, symptoms and HRT first appeared in the Autumn 2024 issue of Expat Living magazine. Subscribe now so you never miss an issue.
See more advice and insights in our Health & Fitness section.
