SHE Malta is not qualified to dispense advice regarding hormone replacement therapy or prove the efficacy of HRT or alternative treatments such as supplements. This article should not be used to make any final decisions about whether HRT is right for you. Its sole purpose is to provide information as a starting point for a discussion with your doctor to help you decide whether to HRT or not to HRT.

If you read our article Menopause Matters – So Let’s Talk, Know and Do More About It, you’ll know we provided societal background on menopause, explained the biology of what actually happens in menopause and listed the many associated health implications for women at this stage of life. We also provided information on available options for reducing and relieving symptoms including a brief mention of HRT. (If you’ve not read it, we highly recommend you do so.)

Part 2 of our menopause series takes a closer look at HRT.

Now women are living longer and therefore one third of their life can be in post menopause, it’s never been more relevant to expect a full and active life into one’s advanced years. But opinions and feelings on whether to HRT or not to HRT can be very divided.

One camp sings HRT’s praises for ‘saving’ women’s lives and enabling them to continue business as usual. Another camp mistrusts HRT for going against the evolutionary process and feels that the end of menstrual life is a correct physiological adjustment rather than a mistake by Nature. A third camp suffers from symptoms but doesn’t know enough about HRT as a solution. Lastly, a fourth camp is living out menopause unaware of any troubling symptoms (lucky them!).

As Dr Oliva Anne Cassar – Obstetrician and Gynaecologist says, “I wasn’t always pro HRT but recently, I have noticed an increase in the number of patients whose life has changed for the worse during their perimenopause years. While I still consider every case individually, I do consider myself as pro HRT now.”

Depending on where you are in your menopause journey (and also geographically), you may feel knowledgeable and supported about HRT, confused by conflicting information and conversations or just blissfully in the dark altogether. This article aims to demystify HRT and explain its place in menopause management and female health. We’ll address the background, options, benefits and risks of this often misunderstood route of menopause symptom relief.

Background

HRT was developed in the 1960’s during the advent of feminism and the realisation that women should be able to continue a comfortable, active and healthy life in their mature years. (As Helen Swarbrick, a BBC interviewee says, “You just want to be the person who you were before. You’re not asking for something different or life-changing.”) First formulated in synthetic form, it was originally only intended to relieve hot flushes; it wasn’t until 1988 that the FDA approved it for the prevention of osteoporosis. Over the years, due to the publication of various papers, HRT developed a controversial reputation and wavering popularity. But it was in the late 90’s that two particular studies caused the greatest concern.

The Women’s Health Initiative (WHI) was an American study that found higher rates of heart disease, stroke and breast cancer among its HRT trial participants while a UK survey, Million Women Study (MWS), concluded breast cancer rates were higher among its respondents who took HRT. The results attracted huge publicity, creating alarm among women and confusion amongst doctors. However, a few years later, investigators revealed significant flaws and data inaccuracies in both studies, after discovering that participants had been asymptomatic, long past menopause, previous HRT users with pre-existing health issues. All the findings were withdrawn and the studies discredited.

The WHI carried out a second more rigorous study on a different data set from 2004-07, this time with the opposite conclusion highlighting the benefits of HRT! But the damage had been done. In the aftermath of the wide media exposure of the first studies, many women stopped HRT immediately, doctors were reluctant to prescribe it and HRT usage fell dramatically. Despite positive recently published research (including the WHI in 2020), this negative history has affected HRT uptake in many countries. Many doctors are inadequately informed about the place of HRT in menopause relief, some countries do not have enough stock of HRT meds or only offer limited HRT options and patients can feel daunted by the different options available.

In 2023, although HRT is still an underpublicised area of symptom relief (and usage varies by country), the tide is slowly turning. HRT is increasingly credited as the most effective way of relieving the most common perimenopausal and menopausal symptoms experienced by women in their 40’s and 50’s.

What is HRT?

HRT is the reintroduction of oestrogen and progesterone (and in some cases testosterone) into the body in order to restore and rebalance hormones lost during perimenopause and causing the onset of menopause.  It is used to relieve symptoms of perimenopause and menopause such as mood swings, anxiety, memory loss, brain fog, hot flushes, night sweats, vaginal dryness, diminished libido, sleeplessness, as well as reduce the risk of osteoporosis and later life dementia.

There are two main types of HRT:

Combined HRT: oestrogen and progesterone either taken in separate forms or both combined in one preparation. (Combined HRT is taken according to two different time variations: sequential (cyclical) HRT for women who still have their periods and combined continuous HRT for women post menopause.

Oestrogen-only HRT only, prescribed for women who no longer have their womb. 

These are available in synthetic, body identical and bioidentical form (depending on country).

How does HRT work?

Each of our body’s hormones has a specific chemical structure and shape that fits into a ‘docking site’ (known as a receptor site) which is present on the surface of all cells that interact with hormones. While sitting in the receptor site, the hormones can pass over the sets of instructions that instigate certain changes in cell activities. 

Synthetic hormones have higher levels of oestrogen and a slightly different chemical structure to the ones our bodies produce. Although these hormones are similar enough to fit into the docking sites, their subtle difference in shape and structure means that the instructions passed over to the cells are also a little different, creating a higher impact on the cells.

Body identical hormones, however, have exactly the same chemical structure and shape as the hormones that our bodies naturally produce (or used to produce before menopause). This means that your body can’t tell the difference between these types of  hormones and your own; they are identical in every way. 

Who can take HRT? 

Women in general good health (aside from menopause symptoms) with no history of heart disease, stroke, obesity, high blood pressure or certain cancers can take HRT. You don’t have to wait until the end of your periods to start HRT. Cultural factors or out of date medical information can cause unwillingness in some doctors to consider it for women under 50. However, HRT can be taken by women in their 40’s suffering from symptoms associated with perimenopause. Depending on symptoms, the most effective time to start HRT is generally advised as being during perimenopause or at least as close as possible to the end of one’s menstrual periods.  However, women in their mid 50’s can also start HRT. Official menopause organisations now say that up to the age of 60 or no longer than ten years after your last period is an acceptable timeframe to start HRT..

Who should not take HRT?

If you have had a hormone-related cancer, a history of strokes, cardiovascular disease, deep vein thrombosis, high blood pressure or obesity, HRT is not recommended.

How long can you stay on HRT?

The most common duration is two to five years during the most aggressive phase of symptoms. Many doctors advise a maximum of five years while some women stay on HRT for up to seven years. Increasingly, official menopause organisations advise it is safe (depending on individual medical history) to stay on HRT long term. However, the key point is individual medical circumstances and health. How long you can stay on HRT and the dose you should take should be assessed annually with your doctor.

How is HRT taken?

Some HRT meds are ‘local’ only treating the specific area to which they are applied. Others  are systemic, meaning they enter the bloodstream. HRT can be taken via numerous methods: skin patches, gels, oral tablets, intrauterine device, vaginal creams/pessaries or rings, implants (pellets inserted under the skin) and oral spray – depending on which form of HRT and product it is. Your doctor will help you choose the one most suited to your symptoms. 

There is also a synthetic steroid taken in tablet form, containing estrogenic, progestagenic, and androgenic properties called Tibolone, only suitable beyond a year in post menopause. Not regarded as ‘actual HRT’, Tibolone is not considered as effective as combined HRT and is only available in some countries. However, it is has far lower rates of bleeding and breast soreness.

Benefits

Apart from reducing intolerable symptoms of perimenopause and menopause, HRT has also been linked with a reduced risk of osteoporosis, heart disease, tooth loss, colon cancer, diabetes as well as improvement in joint pains. It is also being considered for its possible prevention of Alzheimers as long as HRT is started during midlife. HRT is credited with significantly improving the quality of women’s day to day life (performance at work, finding basic objects like keys, completing chores, ability to think straight, remembering words and names, sexual relationship). TV presenter Davina McCall covers this brilliantly in her documentary on menopause as well as her book Menopausing. In a survey I conducted amongst a cohort of my own friends, the mental health benefit was top of the list of every participant. 

Risks

Explaining the various findings and conclusions on potential HRT risks is complex because each risk factor is different based on type of HRT, age group, length of time on HRT etc.  In summary form, HRT could increase the risk of endometrial cancer, blood clots, stroke, dementia (if hormone therapy is started after the age of 60) and breast cancer with long-term use. 

Synthetic oestrogen is more linked to side effects and risk factors than body identical HRT due to its higher level of oestrogen than the body’s own natural levels. It is therefore considered safer to take oestrogen alongside progesterone (i.e. combined HRT) to mitigate risks of heart disease, endometrial cancer and breast cancer rather than a synthetic oestrogen-only HRT. Synthetic progesterone (known as progestogen) could increase risk of blood clots, heart disease, high blood pressure, high cholesterol, and breast cancer. 

However, it is important to look at actual statistics and decide if these would impact one’s personal decision about HRT. It is also important to note that body identical HRT is far less likely to cause side effects and risk than synthetic HRT making HRT and obvious choice for many women now.

What is the difference between synthesised, synthetic, bioidentical and body identical hormones?

Understanding HRT options and choosing what’s right for you can feel like an impossible to navigate minefield full of unclear conflicting information. The many HRT terms – synthetic, bioidentical, body identical, synthetic identical, compounded identical, biocompounded – do not help the situation! Firstly, all HRT methods are synthesised as this simply means they are made in a laboratory.

Synthetic HRT known as traditional HRT is still the most commonly prescribed form in many countries. A version of the body’s oestrogen and progesterone, it is manufactured by pharmaceutical brands using hormones extracted from the urine of pregnant horses in standard set doses. The appropriate dose is prescribed based on the patient’s individual symptoms and needs.  This HRT is regulated.

Body Identical HRT is derived from yams and is increasingly available in some countries as it is considered the most natural way of taking HRT as it mimics the body’s own hormones. It has lower levels of oestrogen than synthetic HRT and is less associated with risk factors such as breast cancer. This is also manufactured in set doses by pharmaceutical brands and the prescribed dose based on the patient’s individual symptoms and needs.  This HRT is regulated.

Bioidentical HRT is formulated using soy and yam-derivatives. It is made by compounding pharmacies in individual tailored doses according to the patient’s unique hormonal profile, as determined by the doctor using saliva results. This bespoke service is usually available via specialist private clinics. It is not regulated and attracts wildly differing opinions from the medical profession and health journals.

What’s the alternative…?

Article 1 in our series provided a list of lifestyle options that can all help reduce the number and intensity of menopausal symptoms. While HRT is considered the most effective solution for many women, products like Femarelle® could be seen as an ideal ‘menopause partner’ for those preferring the non-hormonal route.

Available in 33 countries, the Femarelle® range targets all three stages – perimenopause, menopause and post menopause.

Femarelle® Rejuvenate focuses on the perimenopausal stage, supporting women in their 40s suffering from the first confusing and uncomfortable signs of hormonal imbalance and its impact on skin elasticity, hair, sleep, fatigue and mood. The “unique formulation” includes the proprietary fermented soy derivative (DT56a), flaxseed, vitamin B2 and vitamin B7 which work together to help metabolism, release energy, reduce tiredness, maintain skin health and improve hair quality as well as ease the nervous system.

Femarelle® Recharge addresses common problematic symptoms caused by the end of menstruation, i.e. when a woman officially reaches menopause. Hot flushes, night sweats, reduced sex drive, anxiety, depression and aggression are particularly distressing consequences of the significant drop in oestrogen and can present a real threat to quality of life at this point. Recharge contains proprietary fermented soy derivative (DT56a), flaxseed and vitamin B6.

Femarelle® Unstoppable is designed for the future wellbeing of women whose menopause transition is over and now face the rest of their lives in a state of post menopause. Two of the realities of post menopausal hormone deficit are weakened bones and extreme vaginal dryness. Containing soy derivative (DT56a), vitamins B2, B7 and D3 and calcium, Unstoppable assists with increased energy levels, bone health and vaginal health (as well as normal hair and psychological function). 

Other such brands that produce supplements to tackle midlife belly fat, hair loss, fatigue and bone condition are Happy Mammoth, Better Body, Biocare and Vitabiotics, to name a handful.

Meanwhile, Vanessa Coleiro, Brand Consultant and Natural Health Enthusiast, offers some valuable insight on the natural alternative to HRT.“Our body is an exquisitely engineered machine with an incredible ability to heal itself and the right kind of diet is a strong factor in cleansing our bodies from years of toxins, obstruction and inflammation.”

Which Doctor, Where do You Start?

Depending on where you live, whether you have insurance or have a good public service, the system will obviously differ. In many countries, a General Practitioner is the first point of contact. In others, women see a gynaecologist either directly or after referral. As described in our first article, many GP’s do not know enough about menopause treatment and may not offer up to date reliable advice. However, not all gynaes are equal! Many of the women I questioned for our series recommended doing some independent research to seek out a doctor who specialises in menopause treatment or is at least known for an open mind on the topic.

To increase the likelihood of a constructive talk with your doctor, it’s a good idea to note down your questions and even ‘rank’ your symptoms. Perhaps ask for data on how effective a particular HRT form is as well as potential impact on future health. You will need to detail your own medical history so that your doctor can guide you and hopefully help you decide how you want to move forward.

Conclusions

As a postmenopausal woman, you have to live with a long term hormone deficiency for the rest of your life.  Whether you decide to replace lost vital hormones via HRT or seek alternative ways to boost your levels, the ultimate goal is to alleviate current life-impacting symptoms and safeguard your future health. 

HRT is not a one size fits all strategy with a standard/identical type or dose of HRT prescribed for every patient. Every woman’s case is judged separately based on several factors and the most suitable form and dose of HRT individually assessed.

Depending on attitudes and culture of the country you live in, there may be a stronger emphasis on and wider availability of traditional body identical HRT rather than bioidentical.

If choosing HRT, you will need to consider your specific health history, know which symptoms you hope to resolve, discuss the risk to benefit ratio with your doctor and expect a possible period of trial and error to find the right combination (rather than an instant quick fix).

It is important to note that HRT cannot and does not replace a healthy lifestyle. As Dr Olivia Anne says, “Lifestyle changes go hand in hand with whatever treatment is decided and I do emphasise the importance of this to my patients. No hormone I prescribe can ever replace the beneficial effects of weight loss, exercise and a healthy diet.” So if choosing this particular menopause management route, the key thing is to find the right dose and method that promises the most benefit for your particular symptoms with the lowest level of perceived risk. 

Don’t miss Part 3. We’ll be addressing some common misconceptions about menopause and answering many of your questions (including the ones you don’t know you have!).

Written by Prabjit Chohan-Patel & Supported by Femarelle

SHE Malta is not qualified to offer medical advice nor proof of the efficacy of conventional or alternative treatments. This article should not be used to make any final decisions about perimenopause or menopause management or treatment. Its sole aim is to provide clarifications and information as a starting point for a consultation with your doctor to discuss the best route for you individually. 

Today’s increased life expectancy means more women are living a third – even half – of their lives in a post menopausal state. As the SHE Malta community is made up of women who will either hit this life stage in the future or already have done so, we’re departing from our usual business-focused content and looking at this significant and inevitable health and life issue. An issue that the SHE Word host Trudy Kerr tellingly describes as “affect[ing] every single woman on the planet but the most un-talked about topic I think I have ever come across”.  This is no exaggeration. Menopause and everything surrounding it seems to be the elephant in the room.

While we can’t cover this topic entirely, we will be addressing the main aspects in a three part series, starting with this article.  Part 1 presents an overview of menopause, historically and sociologically and explains the biology of what happens to the female body and the consequent health implications. We’ll list the available options for symptom reduction and relief. Part 2 will look at HRT, the background, options, benefits and risks. Part 3 will address some common misconceptions about menopause and hopefully answer many of your own questions (including the ones you didn’t know you had!) in the hope of forging a path through the confusion.

Society…a brief history of menopause

Often referred to as “The Change”, menopause is a stage of life that all women – fortunate enough to reach a certain age – inevitably experience. While many things in life are a woman’s choice, menopause is not. It is unavoidable. The chain reaction it sets off is complex and goes way beyond the simplicity of its name (Greek: ‘meno’ = month, ‘pausis’ = cessation) and its impact on female health and quality of life is far-reaching and profound.

Yet for some reason, this significant health issue has often been misunderstood, misdiagnosed, overlooked or incorrectly treated. The hush hush taboo status that has been – and continues to be – attached to this part of a woman’s life has compounded the situation, resulting in generations of women feeling that menopause is an automatic life sentence of decay and deterioration to be simply endured in silence.  In fact, some of us may recall it affecting our mothers/grandmothers/older sisters but not understanding what was ‘wrong’ with them.

Many societies have commonly viewed women going through this change as permanently depressed, crazy and written off as no longer useful (as if the physical and mental realities of menopause are not punishing enough). Vanessa Coleiro – brand consultant and natural health enthusiast – mentions that American women in the 1950’s were routinely told their menopausal symptoms were “in their head’ and that they were simply bored, attention-seeking housewives who should join the PTA!

Moira Delia, speaking on Trudy Kerr’s podcast admits people tended to react in shock when she mentioned she was in early menopause and also feels denial is a big issue.

It is also not inconceivable to suggest women (more so in certain parts of the world than others) are more likely to address the visible signs of midlife by going to a med-aesthetic practitioner for Botox, dermal fillers etc than they are to address the physical and mental aspect by going to a gynaecologist for HRT.

Menopause and Geography

The Western view of menopause as being something to be dreaded is vastly different from the one held by certain other cultures.  The Japanese for instance appreciate this as a welcome transition towards renewal and regeneration. In New Zealand, traditional Maori culture respects middle aged women for the wisdom they can offer. And the Mayans value older women so greatly they place them at the very centre of their culture and community for the life experience they can teach future generations.

It’s worth noting that women’s symptoms vary according to country (lifestyle including diet could play a part in this). In her article “An Overview of Menopausal Disorders”, Dr Heidi Grech mentions that Japanese and Chinese women tend to suffer fewer symptoms than North American women.

Although we are beyond the decades-ago thinking mentioned earlier, menopause education and treatment has still not advanced to the level one might expect. And it seems to be a case of geographical lottery as the BBC also recently revealed. Depending on where one lives, the level of attention and support given to peri menopause management can vary greatly, either resulting in a woman feeling supported, well informed and able to make the right decisions for her health and quality of life. Or instead unaware, in physical discomfort, abandoned and helpless to take charge of her current and future medical safety.

A 2021 study conducted in the USA found 73% of women were not treating their menopausal symptoms and 45% of women didn’t know the difference between perimenopause and menopause.

On a positive note, many women themselves can feel liberated by no longer having to endure pain, weakness from blood loss, expenditure on sanitary products or limited activity due to monthly periods.

Awareness

The fact there is an entire month dedicated to menopause awareness each year perhaps bears proof of the incredibly common scenario that is emerging: many women themselves often fail to recognise what is happening to them or know what to do even when they have realised their body and health is changing negatively. The commentary I see on menopause forums, the interviews and research I’ve done (and indeed my personal experience) all confirm this.

As Yvonne Midolo, Podiatrist, says “Health literacy is not automatically connected to one’s intelligence”. Below are just a few of the discoveries I’ve made the last few years from talking to several friends across the UK, France, Germany and Malta:

-Many women revealed their difficulty in obtaining clear advice – some women ‘laughed out of’ their appointment by a dismissive doctor (in most cases male) unwilling to offer relief options to any woman under the age of 50.

-Conversely, three people in Malta said any ailment they mentioned to their GP was automatically associated with perimenopause with no discussion of other possible causes.

-Only two people – including myself – in their mid 50’s had done a bone density scan.

-Several of my friends have never seen a consultant or done independent research for HRT

-Hardly anyone had heard of perimenopause until their early 50’s (i.e. after it had finished)!

-Almost everyone was initially uncertain over which medical professional to see: general practitioner, gynaecologist, endocrinologist?

-Absolutely everyone said they no longer recognised themselves but couldn’t pinpoint when they started feeling this way.

On her podcast, Trudy admits she only discovered she was well into menopause after visiting a doctor regarding unexpected symptoms she was experiencing: “I had not prepared for it but of course, I’m 48 and you would expect that this might happen!,” she says, adding “I had never heard of perimenopause”. 

Maybe it’s not so surprising then that Dr Olivia Anne Cassar, Malta-based gynaecologist, revealed that out of all her annual patients, only two visit her to discuss menopause (interestingly, these are usually expat, not Maltese patients).

What are the possible contributing factors?

-The inadequate infrastructure within many healthcare systems resulting in a lack of obvious, accessible and robust information on menopause – in stark contrast to the amount of information (depending on country) on other female health areas such as breast cancer screening, pregnancy and fertility, contraception, STD’s, cervical cancer screening etc.

-A tendency in many Western medical cultures to only deal with the mental aspect of menopause via antidepressants instead of adressing the other symptoms via HRT or supplements etc.

The frequent inability – and in many cases unwillingness – of partners or family to understand or provide support for their female partner’s/relative’s mental and physical state in midlife.

-The absence of guidelines or policies within the workplace to support female employees, a valuable and vital part of the economy – in menopause. (400k women resign annually in the UK due to the grave mental and physical impact of menopause – a huge amount of the workforce and skills force lost.)

Doctor, doctor.

In light of this, it is not that surprising that many general practitioners or family doctors are not well equipped to help patients in this area. Edinburgh GP Dr Maria, admits “Menopause is barely covered at medical school: the onus is really on individual general practitioners to ensure that they are up-to-date and knowledgable about current menopause management guidance, by paying to attend or study specific courses on the subject.”

In fact, a doctor I spoke to at a leading clinic in Malta admitted to feeling embarrassed at her lack of menopause knowledge. It also transpires that doctors only recommend synthetic HRT in Malta, despite there being a clinic offering customised bioidentical hormones.

So you could be forgiven for thinking menopause matters don’t…well…matter. But menopause is a hot (flush) issue…

So WHAT exactly are perimenopause, menopause and postmenopause?

In the bloom of life, the female body’s ovaries produce the key reproductive hormones oestrogen, progesterone and testosterone. Around ages 40-44 (on average), oestrogen levels decrease, throwing off the balance with progesterone.  (Testosterone decrease is more a symptom of natural ageing rather than menopause.) This is perimenopause. As oestrogen and progesterone are both responsible for ovulation and menstruation, their decrease inevitably leads to unpredictable menstrual cycles. Perimenopausal hormone levels can resemble a rollercoaster, causing numerous symptoms including anxiety, mood swings, brain fog, hot flushes and increased sweating, all marking the transition towards the next stage.

Menopause (between ages 45-55, but most commonly 51 years) is defined as the point at which 12 months have passed since your last period. This is the stage where your body is making so little oestrogen that your ovaries stop releasing eggs altogether, causing the end of menstrual periods.

Once more than a year has passed after the last period, the body enters postmenopause. This stage defines  the rest of a woman’s biological life, from which there is no return or further stage.

What does the female body experience?

The list of symptoms is long and the number and intensity of symptoms experienced varies between individuals. Some symptoms are short term and more prevalent in an individual stage eg perimenopause and other symptoms are connected to long term postmenopause health.

Physical: 

Joint aches and stiffness (unrelated to previous illness or injury)

Weight gain

Increased sweatiness

Tension headaches due to hormonal changes

Low libido and pain from intercourse

Palpitations

Hot and cold flashes (most often together)

Night sweats

Osteopenia

Vaginal dryness (atrophy)/itching

Frequent urination

Incontinence

Increased fatigue

Hair loss: widening parting, receding hair line, thinning hair texture

Nail breakage and dry skin

Formication prickly skin sensation

Bleeding gums

Height shrinkage

Mental

Poor concentration (causing slower learning time) and brain fog

Confusion and less ability to think logically, plan simple tasks and make decisions

Memory loss (difficulty recalling everyday words, placement of items, names of people and places)

Clumsiness from impaired judgement of space and distance.

Emotional

Anxiety, overwhelm and nervousness

Feeling low and/or easily weepy.

Apathy, feeling directionless or uninterested in life, reclusiveness and withdrawing socially

Feeling invisible, loss of identity, self confidence, feminine self (also connected to physical sexual dysfunction above)

My menopause, your menopause.

No two women’s experiences are the same.  Some women are lucky enough to pass through the various stages with mild symptoms and little physical discomfort while others suffer greatly, to the point where they can barely function. Chances are if you chat to a handful of friends, you’ll all have different stories and symptoms about the same natural physiological event!

Dr Olivia Anne confirms: “I have seen women who sail through these years without any problems and I have encountered patients who burst into tears in clinic as they cannot put on a spot of make up without it melting off their faces within the hour.” 

A few things are certain: it is important to be aware of your symptoms in order to know what to do about them.  And it is essential to be kind to yourself. Self care is not a nice-to-do but a must at this stage of life.

What options are available to relieve or minimise symptoms? 

The adage prevention is better than cure couldn’t apply more and it is a good idea to take steps during the perimenopause years to increase your chances of a more comfortable menopause. Nevertheless, whatever stage of menopause you are at (peri, menopause transition or post menopause), it is not too late to tackle your symptoms as long as you do not leave it til many years after your last period. (Post menopause, if left unsupported, can have serious ramifications for long term health including osteoporosis, heart disease, osteoarthritis and dementia.)

Many women wish to address this stage in life as naturally as possible, without pharmaceutical intervention. This requires a ‘whole life style’ approach including the aid of:

– exercise – cardiovascular, weight-bearing, yoga, pilates

– consistent sleep schedule and sufficient rest

– diet high in proteins, vegetables and food groups that are low on the glycaemic index

– low to moderate alcohol consumption

– mindfulness – meditation

– acupuncture

– massage – abhyangha (Aryuvedic), aromatherapy and Swedish

– supplements

Interestingly, Vanessa Coleiro, Brand Consultant and Natural Health Enthusiast, has spent time studying the connection between liver and colon health and the endocrine system, discovering that menopausal hormonal imbalance is potentially worsened by a clogged up liver and colon. A big believer in the new generation of plant-based detox and power nutrition programmes, Coleiro is convinced that cleansing the liver and colon – thereby supporting the endocrine system – greatly reduces and even eliminates many significant symptoms including weight gain, hot flushes and poor sleep.

Supplement Me 

The potential use of supplements for menopause is worthy of an article in itself (or even its own three part series!). Evening primrose oil, curcumin, moringa, turmeric, collagen, Vitamin D, calcium, red clover, black cohosh, Flaxseeds, Ginseng, Valerian have been shown to deliver benefit (to different degrees) when used with an understanding of dosage and potential side effects.

In addition, an increasing number of menopause-specific supplements are hitting the market, designed for those women not wishing to go down the ‘pharmaceutical HRT’ route. Companies such as Happy Mammoth and Better Body are tackling some of the most common symptoms such as the midlife tyre, hair loss and fatigue with a range of different products including Bloat Banisher and Provitalise. Biocare and Vitabiotics have been offering their own ‘complete menopause’ supplements for years.

Meanwhile, Femarelle® is another leading provider of menopause-focused supplements. Available in several territories worldwide, the Femarelle®  range consists of three different lines designed to support different stages of the menopausal journey: Rejuvenate, Recharge and Unstoppable. We’ll be taking a closer look at how the Femarelle® products work in Part 2 of our Menopause Matters series.

HRT

Today, HRT is credited as being the most effective way of relieving the most common menopause symptoms and reducing the risk of osteoporosis and dementia. Combined HRT – oestrogen and progesterone – can either be taken in separate forms or both hormones are combined in one preparation called progestogen. Different factors influence what is prescribed for the patient. Oestrogen-only HRT is only for women who have had a hysterectomy.

HRT is available in three forms: 

– traditional ‘classic’ synthetic (chemically produced and not identical to human hormones, sometimes the only form available in a country)

– body identical HRT (increasingly preferred, considered by medical professional as safest and available in many countries)

– bio identical (less commonly available depending on where you live and currently not FDA approved).

HRT can be taken in numerous ways such as oral tablets, sprays, dermal patches, creams, gels, vaginal pessaries and intrauterine coil, depending on the symptoms, medical history and needs of the patient. Not all methods are available in all countries or available in bioidentical HRT form. We’ll be delving into HRT more in Part 2 of our Menopause Matters series.

Let’s turn the tide.

Awareness campaigns are being seen in certain countries. Known media personalities such as Davina McCall are publishing books on menopause and raising an immense amount of publicity about the daily struggle of women in menopause. Conversations are happening aimed at destigmatising menopause. Gynaecologists are also more willing to prescribe HRT as treatment. It’s a step in the right direction.

As Dr Oliva Anne puts it: “Patients are also more aware that menopause is not something they have to endure but rather something they have to live through with a positive attitude. I feel this shift in mentality is a healthy one and I look forward to seeing it improve further in the coming years as I approach my own!”

DON’T MISS PART 2: “To HRT or not to HRT?”