Judging by all the white-hot noise on social media at present, you can be forgiven for thinking that a revolutionary new discovery about a hitherto unrecognised transition in a woman’s life had just been made.
Hype, influencers and misinformation aside, the time of peri and actual menopause in women is experiencing a moment as we enjoy a rapid increase in our understanding of what’s happening to women’s bodies at this time, and it goes far beyond the cessation of periods.
This is evidence by the number of publications on sex differences between men and women which have doubled over the last 10 years and there’s still so much more to discover. While it may have seemed obvious these differences existed, it’s good to now have the data.
Medical education on menopause has lagged for years. My memory from medical school was being taught that menopause was simply the time when a woman’s reproductive capacity ended.
Which is why I, along with thousands of medical and allied health practitioners around the world, have been upskilling in menopause management.
I’m deeply grateful to Dr. Wendy Sweet, who opened my eyes to the transformation process of menopause. Undertaking her practitioner course was a fantastic introduction and deep dive into current knowledge to help women seeking answers to all those curly questions around fatigue, aching joints, sleep issues, weight gain, brain fog and hot flushes.
It’s been a journey of discovery that has made me even more curious to what we can do to ensure women can remain healthy and avoid the multitude of chronic diseases that can occur at this time of our lives.
Hot off the menopause press
Last weekend, I had the pleasure of attending the Australian Menopause Society’s Annual Congress in Fremantle, a 3-day veritable smorgasbord of delight delivered by an international and local cohort of specialists.
With so many highlights and takeaways, it’s been tricky to know which to share.
Here are a few I thought especially relevant.
1. Women have more chronic disease and disability than age-matched men.
Why? Because menopause is a time of massive transition.
Women are more likely to develop depression, heart disease, stroke, dementia, arthritis, autoimmune disease and asthma.
You might think how unfair, but that’s how it is.
And it’s the result of changes in hormone levels and inflammation where overlapping pathologies affect our blood vessels, heart and immune system.
Knowledge is power. Yes, we age differently and have different symptoms from men, but being aware of how chronic disease can manifest gives you a head start to keep chronic disease in check. This is where lifestyle factors are so important.
2. 50% of menopausal women experience some level of urinary incontinence.
It’s not talked about, but it is a very common and embarrassing issue.
Not only that, but leaky bladders are often accompanied by more frequent urinary tract infections. Incontinence can be urge-related, as in “I need to go right now, or else I’ll wet my pants”, or stress-related, where coughing, sneezing or dancing can cause a leak.
The good news being that there are many ways this can be helped, so don’t think you’re doomed to carrying 15 extra pairs of knickers in your handbag or having to wear adult diapers. Pelvic floor physiotherapists and local vaginal hormone treatment can work a treat.
Doctors can be guilty of forgetting to ask – so be brave, speak up and say if you need help with waterworks control.
3. We need to talk about sex.
Many clinicians believe that asking their patients if they are having problems with sex is important, but studies suggest only 5-39% remember to ask.
Loss of libido, lack of arousal or desire can put an enormous strain on relationships especially if there is a mismatch between partners where one partner’s libido is unchanged but the other partner’s has packed its bags and gone on a cruise.
It’s estimated that low desire, arousal and orgasm with distress doubles in prevalence between early pre-menopause and early perimenopause.
Painful sex or dyspareunia is another issue. Plummeting levels of oestrogen lead to thinner vaginal tissue, meaning penetration can become impossible. Gritting your teeth to have sex is no one’s idea of a good sex life, and research suggests up to 30% of women experience some sexual pain at some point.
Again, there are a variety of treatments available, and there are a number of gynaecologists, sexologists and counsellors who specialise in this area.
Sexuality is an important part of our well-being, so if this is an area of your life you’d like help with, reach out and ask.
4. Testosterone. Flavour of the month, but should it be used by everyone?
Professor Susan Davis, endocrinologist from Monash University, believes the only current evidence-based indication for testosterone therapy for women is for the treatment of post-menopausal women with low sexual desire with associated distress.
Period.
5. Brain fog is real, temporary and not dementia.
It’s bad enough having to deal with pregnancy brain, then women are thrown a huge curve ball in perimenopause when they can experience memory and attention difficulties, distractibility and difficulty switching between tasks. This often happens at a time when the woman may also be conscious of her parents’ increasing cognitive decline, so it’s not surprising that you might be worried that you’re on a slippery slope to dementia yourself.
Remember, 65% of women experience this phenomenon. We are not all going crazy!
What we do know is that oestrogen and progesterone play an important role in synapse density and remodelling. Rat studies have shown how declining hormone levels lead to a reduction of synapse density, that can be reversed with oestrogen therapy.
Not everyone wants hormone therapy, and we all benefit from implementing lifestyle factors like getting enough good quality sleep, following a healthy diet, exercise and activities that promote relaxation.
Monash University has also produced a helpful fact sheet if you’d like more information.
Whether you’re one of the 51% of the population or one of the 49ers, we all benefit from a great understanding of the processes that occur in our bodies as we age.
Healthy aging is something we can all aim to enjoy more of.
Have you learnt anything about the menopause transition that has surprised you?
