The Elixir Of Youth

At 54 I have for sometime had hot-flushes, probably since my mid to late 40’s. Women naturally go through menopause if we are lucky to stay alive & healthy not requiring treatment or removal of our uterus’ & ovaries before our 40’s or 50’s, so in some respect one is fortunate to experience this. But the given reality for some experiencing menopause can be unpleasant and quite disruptive.

When I was a young teenager I would hear my mum say to a friend about a women’s child up the street. ‘that child was a change of life baby’ like it was something not to be discussed. I used to think, what’s a change of life baby, it must be bad. Change of life baby’s always were some years younger than their siblings. Now I know it was a child conceived when a woman’s periods became irregular and the conception was a surprise. In other words she was peri menopausal and wasn’t planning a pregnancy.

Peri menopausal is when you are still having your period but are experiencing symptoms of menopause such as irregular periods ( I can’t tell you how many pregnancy tests I did at this time in a panic when my period was a few days late despite using contraception !) heavy or lighter than usual periods, hot flushes, night sweats, itchy skin like it’s crawling with ants, mood changes, tiredness, vaginal dryness, lower libido and weight gain especially around the waist. It sounds just awful doesn’t it. Yet women start suffering these symptoms generally sometime around their mid 40’s- mid 50’s and they can last for 10-12 years sometimes never ending. Menopause has been a ‘too hard’ topic after an American study that put fear into everyone. Post menopausal is when you haven’t had a period for 12 months but you can still be experiencing other menopausal symptoms. Basically it’s women’s body’s ceasing to produce adequate amounts oestrogen, progesterone and testosterone.

In my experience my older friends and work colleagues who experienced menopause before me never really talked about it to me and being younger and oblivious to the fact they may be peri menopausal I never asked. In fact I have found menopause seems like something women don’t talk about a lot. My experience is women suffer silently and wasn’t something openly discussed bar those I’d see around me in the community occasionally waving a piece of paper in front of them like a fan.

I would see this and think to myself I never want to be that person. It signified old age and women that had turned to seed. It was the woman who was always hot when I was freezing and wanted the cooling or fan on at work. Those annoying older women I say now shamefully as I had no understanding what they were going through.

It was the receptionist I remember at the doctors who looked overweight, sweaty, red faced and not happy. Yet in my 40’s I started feeling episodes of suddenly feeling hot. Was I turning into to that red faced hot sweaty receptionist I pondered!

Initially I would get 1 or 2 slight flushes weeks even months apart. I wasn’t really sure what it was. Was this a hot flush I’d think to myself. Like what do they feel like? No one talks about them and you never heard a lot about menopausal symptoms in the media or women’s magazines when I was in my early mid40’s . I now can say they were mild hot flushes, things were to get worse.

HRT in the 80’s gave menopausal women the promise of elixir of youth but was scuttled after a study published in the early 2000’s that the media reported headlines as ‘hormone replacement therapy (HRT) caused breast cancer’. HRT is also referred to as Menopause Hormone Treatment ( MHT). This study was the Women’s Health Initiative or WHI, a massive American based scientific study.

At that time I was in my thirties, married, having children and working as a midwife & general nurse in a tertiary women’s hospital emergency department. I remember rumbles about some research study, doctors discussing and asking each other is it true, have you heard. At the time my mum happened to be diagnosed with ovarian cancer and immediately taken off her HRT, my mother in law was opting for more natural treatments and my sister was diagnosed with breast cancer was told not to take HRT.

Women diagnosed with breast cancers after being commenced on HRT, started suing doctors for prescribing them HRT because of the of this research being published advising its dangers. Doctors soon started fearing legal action so ceased prescribing HRT and big pharma stopped financing further input into HET and production of, despite this research not being fully evaluated and properly interpreted amongst the medical fraternity. There was doubt about the safety of HRT and that was enough to scare everyone off it. Women had lost choice as a result.

Ginni Mansberg, author of the book The M Word – how to thrive in menopause explains,

….the WHI knew the conclusions were wrong and waited many years to set the record straight. 161,000 women between the age of 50 & 79 years old participated. It was a randomised prospective placebo controlled trial. The treatment of HRT is to treat menopausal symptoms such hot flushes, vaginal & bladder symptoms. The WHI study was to see if older women started on HRT after menopause would get the same heart health benefits as younger women who started HRT during their peak menopausal symptoms as other studies had indicated women who used HRT had the added benefit of better heart health. The WHI study didn’t intentionally include many recently menopausal women as we already knew about the benefits to them. The average age of women started on HRT in the WHI study was 63, but 25 percent of them were over 70 when they started their HRT and this is important. The women on HRT in this trial were older than the women on the placebo. With 66.6 percent of the women in the HRT group being between 60 & 79 years old. That is almost unheard of in clinical practice, but they were trying to determine whether the cardiovascular benefits of HRT meant your never to old to start. The researchers didn’t measure quality of life or reductions in hot flushes of the women in the study because HRT was being looked at as a cardiovascular disease preventor only. The women were chosen at random to take either prempro 0.625mg of conjugated equine oestrogen or CEE, & 2.5mg medroxyprogesterone acetate or CEE alone if the woman had a hysterectomy . This study was terminated prematurely in July 2002 due to some negative results of the women on HRT. Prempro was a form of HRT not commonly prescribed today. These days with access to transdermal oestrogen and micronised progesterone both of which have less side effects few women would be on these older formulations.

The M word by Ginni Mansberg

What were the WHI results ? It was appropriate to cease the trial at the time but the conclusions were incorrect. It showed more heart attacks, an increase of 29 percent in the HRT group compared with the placebo group. This means that for every 10,000 person years or 10,000 women taking it for 1 year there would be 37 women who had a heart attack while on HRT compared to 30 women having heart attacks on placebo. That means 7 more women out if 10,000 in a year. If you are one of the 7 it’s not good but it must be remembered that the women in the HRT group were older than the placebo group so you would expect a higher risk. Furthermore this was a group of women who started a form of HRT most doctors no longer use and often at an age most women would be off HRT already.

The M Word by Ginni Mansberg

However the rise in females in the workforce and females continuing to suffer menopausal symptoms looking for remedies, the growing demand of women for better quality of life in general scientists and medics started to question what were the available treatments for menopause. The 2002 research study that damned HRT was revisited and found to have many flaws therefore questions being raised around the validity of this research.

In 2008 the data from the WHI study was re evaluated and it actually showed that the younger women in the study, the women who started HRT around the time of menopause had a reduced heart attack risk. Re strokes. Initially it was reported the HRT group had more strokes compared to the women in placebo 29 cases in HRT versus 21 on placebo per 10,000 person years. That meant 8 more women per 10,000 as mentioned above. This headline in the media was also a distortion of the study findings. There were more women with cardiovascular events in women within the first 2 years of starting HRT but flipped around after 2 years when the women on HRT had fewer adverse cardiovascular endpoints than the women taking placebo. This meant that overall there were no differences in cardiovascular endpoints in both groups by the end of the study. Re breast cancer – the study found a 26 percent increase in the risk of breast cancer among women on HRT compared to placebo. That translated to 38 women per 10,000 per year in women in HRT compared to 30 women per 10,000 per year on placebo. When the data was re looked at to show women taking HRT during menopause showed no increase risk in breast cancer. To put this data in perspective, for this group of older women the risk of breast cancer from using HRT is slight higher risk from the same study of drinking 1 glass of wine a night but less than the risk than drinking 2 glasses of wine a night. The risk of breast cancer from taking HRT in this group of older women is similar to the risk reported with obesity and low physical activity.

The M Word by Ginni Mansberg

So you have more chance of getting cancer if you are overweight, smoke or enjoy 1-2 glasses of wine a night than if you start HRT in the first few years of getting menopausal symptoms.

As I went through my thirties and early forties I didn’t think to much about women not having HRT, however women were still going through menopause and symptomatic but no one was game enough to touch HRT. HRT became such a dirty word for so many years that a generation of medical students received very little training on treatments for menopause. Lack of knowledge amongst up and coming medics put treatment for HRT into the background.

Still many women fear HRT but happy to enjoy wine o’clock and to be well over their healthy weight range. No- one is terrified of that second glass of wine like they are when it comes to HRT.

The M word by Ginni Mansberg

Over time and overdue this research study of the early 2000’s has now been discredited and HRT has been reviewed. The current advice now stating it does show a slight increase in breast cancer for women. To put it in perspective albeit HRT can increase your risk of cancer, most people put themselves at more risk of cancer by other lifestyle choices.

I feel many young general practitioners (GP) have very little knowledge on HRT due to their limited training during medical school as menopause is still glossed over amongst the many other topics to be taught and learnt about. So women have been left to suffer symptoms unnecessarily due to a poorly done research paper in the early 2000’s on HRT that scared the crap out of everyone unnecessarily. Like a recent autism and immunisation study which has also been completely de credited by peer review. The need for adequate peer review on research studies cannot be underestimated when we can see how impact on society and its individuals incorrectly concluded research can have

There’s a few doctors taking a keen interest in HRT and I sort out one of them because I wanted to see someone who specialises in menopause and has current well informed knowledge on the topic given my family history of breast and ovarian cancer which is believed to have a familial link. She discussed this comprehensively with me and I had a pelvic ultrasound, mammogram and breast ultrasound along with an array of blood tests to gain a baseline of my current health status.

I have a friend who is of similar age and also experiencing some menopausal symptoms. It’s been nice to chat with someone who is enduring this time of life at the same time as me. We discuss where we seek information on the topic and general what it feels like being a women who works and having poor sleep due to symptoms and how it’s impacting our everyday lives.

She understands what a hot flush feels like and that offers support. It’s like this overwhelming sensation of heat from within. Prior to seeking medical advise from a menopause specialist I would get hot flushes throughout the day and night with them more intense at night. I would feel so hot, so uncomfortable I couldn’t stand clothing on my upper body or feet & when in bed I would have to remove completely the bedding covering me. At their worst I had multiple hot flushes a day sometimes in clusters and if I couldn’t remove my cardigan or jumper I would break out in a sweat! Sometimes removing layers of clothing or bedding wasn’t enough. I would go and stand outside in the middle of winter in the crisp coldness of the air whilst the minutes passed until the flush subsided, my only relief.

In bed I would have a desk fan set up on my bedside table going all night for relief as a stuffy room with no breeze felt stifling, almost smothering like I couldn’t breath.

Continual waking night after night feeling hot and needing to remove the bed covers, falling back asleep to wake soon after feeling cold and needing to put the covers back over me made it hard to get up for work and function during the day due to lack of good sleep.

My lower legs would feel itchy and once I started scratching I could keep going until blood was drawn. To get relief from the itch I would get a cold flannel and lay in the reddened itchy area or sable my legs in our cold pool.

Women who suffer an array of menopause symptoms may be less likely to work or continue to work and be competitive against their male counterparts in their field because the symptoms and lack of sleep make demanding careers to hard.

I was finding the constant uncomfortableness of overwhelming heat within and lack of sleep awful. Having to front up to work tired day after day was hard. I never said much to anyone bar my friend at work because I didn’t want to be seen as the receptionist at the doctors practice or various other fan waving women drawing attention to themselves for reasons other than flattering. I just wanted to be me, the person people always knew, not this person who was viewed as some old menopausal lady, paradoxically in some way becoming invisible to people because I was that women who is menopausal. The women who looked angry and unpleasant. A person that was seen as had her day, that was now no longer interesting.

I finally took the step of making an appointment and going to see a menopause specialist. Three months in and using HRT and my symptoms have gone. I can’t tell you how much better it feels to not be suffering through every single day silently.

Blood tests also showed I had crucially low levels of vitamin D which is a hormone so I also started high doses of vitamin D with K to get my blood levels up. Low vitamin D and cause fatigue, muscle and joint aches, low mood and affect bone density.

After living through the early 2000 practical cessation of HRT being prescribed and living with the knowledge my mum died from ovarian cancer and my sister is a survivor of breast cancer I did my own information gathering. I listened to various menopause experts on podcasts and engaged with social media platforms, read books and articles gaining a better understanding of the WHI study and cancer risks and other advantages and disadvantages of HRT.

Once starting my HRT regime it took about 3 weeks for the hot flushes to stop. As has the muscle and joint aches. I’m sleeping better because I’m not being woken multiply times a night. After tweaking my doses to personalise the treatment to my symptoms, overall on a day to day basis I feel so incredibly better. The thought of hot flushes returning causes me a feeling of dread. I know I’ve made the right decision to seek a better quality of life for myself .

The vital years between 45 & 55 is a window of opportunity to addressing the gamut of symptoms for best results. It’s been reassuring that the feelings I have had are normal. Talking with my menopause specialist I’ve learnt so are other symptoms that affect our sex lives as a result of changing hormonal levels, as is bone health, and other issues such as cardiovascular and brain health. If women healthily address these symptoms in the years when their elasticity in their skin is changing and the lining of their vaginal wall is changing and other physical symptoms, I believe we can enter the next phase of our life in better mental and physical condition.

If you are suffering from menopausal symptoms you don’t need to, but do your own homework. Seek out a menopause specialist to discuss your options and regain your symptom free self back. Best results for long term health effects are gained when HRT is started mid symptoms between the ages of 45-54. The argument that menopause is a natural occurrence fir women so shouldn’t we just go with it, endure it is flawed. Female life expectancy is into the eighties. In the past women died in their mid forties so menopause wasn’t a problem, as science improved and our life expectancy has increased over the years women are living much longer with menopausal symptoms. Women now also work and want or have careers so we want to feel the best we can. Our lives and lifestyles are changing and science is helping that change. The information I was given for me is that I can take it for as long as I want, that this 5 year only information isn’t correct for someone with my circumstances.

Don’t leave seeking help for menopause if you are having uncomfortable symptoms. Ginni said in her book lowered libido and dry vaginal mucosal walls causes women to avoid sex with their partners, their partners feel rejected and eventually couples just stop having sex. If couples were brave enough to discuss this and women informed enough that it isn’t them it’s their hormones affecting their desire for sex then there would be so much less guilt and relationship strain. Testosterone is another medication women along with oestrogen that can be taken to address lower libido caused by menopause.

There’s so many reasons to address menopausal symptoms, your general health such as bone density, brain acuity, cardiovascular benefits and weight, to help your ability to function at a level you can remain competitive to your male counterparts in the workplace, for your relationships and ongoing enjoyment of sex, your skin integrity and vibrancy and to help you to feel the best you can internally going into your fifties and beyond. As said HRT can be seen as the elixir of youth for some women.

Love Lucy x

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