فترة ما قبل انقطاع الطمث مرحلة انتقالية طبيعية وفصل جديد

Women worldwide experience menopausal symptoms during the menopause transition or in postmenopausal years. For clarity, here are the definitions.

Menopause Definitions:

Pre-menopause: the period of life where hormones of the ovary are gradually declining, quite often starting in the 40s

انقطاع الطمث: Cessation of the monthly menstruation (period) for successive 12 months

Post-menopause: the years of life after the menopause (the year of cessation of the period)

Perimenopause: includes all these years around the menopause.

PERIMENOPAUSE & Menopause as a Natural Transition

Let us not forget that cultures around the world (not so much in Western countries alas), view menopause as a passage to wisdom and respect. We suggest you see it as a time for personal pursuits, deeper self-knowledge, and perhaps a shift in your perspective. Be mindful of the fact that women sometimes report positive aspects of this life phase, albeit not so frequently. Menopausal women are prone to the odd complaint or two after all. Two things that could be a cause for celebration: The end of menstrual cycles and related symptoms and concerns about pregnancy. Sexual freedom and confidence await you.

You will find that the transition provides an opportunity to reassess your health priorities and some of your neglected self-love practices. Try some simple adjustments to diet, exercise, and sleep habits for the potential to significantly impact your experience of menopause symptoms.

Understanding the Changes in Your Body During Menopause

During menopause, your body will naturally decrease its production of hormones. This includes oestrogen and progesterone. This hormonal decrease is the underlying reason for the physical and emotional changes women report. Common experiences can include what are known as vasomotor symptoms – hot flushes and night sweats. Changes to sleep patterns, memory cloudiness and mood fluctuations may also occur. Noticing weight gain, body shape changes, and tissue sagginess. You may notice urogenital changes, like vaginal dryness, irritation and recurrent vaginal discharges, tissue shrinkage and sagginess resulting in exhibiting de novo troubling symptoms. There is a potential reduction in bone density, increased risk of heart disease and dementia are other health factors to be aware of, over the longer term. Getting to grips with potential changes is the first step toward managing your experience effectively.

Hormone Replacement Therapy (HRT)

For some menopausal women, lifestyle adjustments alone may not be enough to alleviate symptoms. If you are struggling, knowing all about your options can surely only be a good thing. Hormone Replacement Therapy (HRT) is one such option. It involves supplementing the hormones that your body produces less of during menopause. The main purpose of HRT is, usually, to help manage moderate-to-severe symptoms, particularly hot flushes and vaginal dryness.

Indications: Why women would seek HRT

•  Vasomotor symptoms (hot flushes/night sweats), and disrupted sleep, are most pronounced during the first four to seven years but can persist for more than a decade.
•  Other common symptoms and conditions are mood fluctuations, cognitive changes, low sexual desire, bouts of panic attacks and palpitations, bone density loss, loss of energy, and adverse changes in metabolic health.
•  Cosmetic changes like skin texture, appearance of wrinkles, scalp hair fall, excessive scalp sweating and increase in abdominal fat and saggy tissue.
•  Genitourinary symptoms tend to be progressive like vaginal dryness, irritation, urinary incontinence, recurrent UTI, SUI, recurrent vaginal discharge, pain during sex, mild prolapse, reduced sensation, التراخي المهبلي, faecal urgency etc.

Dr. Nadia believes strongly that women have the right to access full information on the Menopause health effects, so every woman needs to construct a comprehensive health plan to negate or limit the notorious caveats of such a transition period. Thus, women can approach menopause with empowerment, not apprehension. Support your own comfort and well-being with understanding of how your body is changing.

Counselling & calculating the Risk-Benefit Ratio:

Risks: The dose & the period of administration of certain elements of HRT might be associated with increased risk of Cancers, namely of the breast, endometrium (lining of the womb) or ovaries. Other possible side effects include  venous thromboembolism (clots), stroke, coronary heart disease, gallbladder disease, difficult control of diabetes, and weight loss.

Others like: Acne, bloating, weight gain, mood changes

Risk varies based on:

• Duration of use
• Dosage
• Type of hormone
• Delivery method
• Individual health profile

Hormones prescribed

The hormones considered in HRT include Oestrogen, often combined with Progesterone for women who have their uterus. Other hormones are also used, like Testosterone, DHEA (Prasterone) and Thyroxine etc., depending on individual circumstances. See it as a tool to raise in discussion as part of your menopause management.

Sources of HRT

Traditional vs bioidentical hormone replacement therapy (BHRT), each has its own merits and applications

What Are Bioidentical Hormones?

Bioidentical hormones are man-made hormones derived from plant oestrogens (commonly soy or yam) that are chemically identical to those the human body produces.

BHRT vs Traditional Hormone Replacement Therapy (HRT)

Routes/methods of delivering the HRT

Systemic (tablets, injections) that go through the body circulation and reach the liver for metabolism

Subcutaneous/Topical (creams, gels, implants, patches), these routes avoid systemic circulation and liver metabolism, and help to deliver the HRT directly to the affected tissue (e.g. vaginal wall)

Benefits of HRT

Short-term includes management of general symptoms like hot flushes, night sweats, mood changes, memory loss, reduced libido and sexual cycle dysfunctions etc., or topical application to treat urogenital atrophy (tissue shrinkage of structures of the external female genital area namely the vaginal wall, vulval structures, trigon of the bladder, blood flow to pelvis and pelvic floor muscles that lead to vaginal dryness, irritation, changes in pH, recurrent vaginal discharges, dyspareunia (pain during sex), reduced sensation, urgency incontinence, recurrent UTI, vaginal laxity, SUI, faecal incontinence etc.)

Long-term: Oestrogen hormone is known to sustain bone density, reducing the risk of cardiovascular disease, and the risk of mental dementia (Alzheimer’s disease)

Considering Potential Benefits/Side Effects Analysis of HRT

HRT can be effective in reducing the frequency and severity of hot flushes and improving vaginal comfort. Some evidence suggests it can help maintain bone density. As with most medical treatments, HRT can cause side effects. There are also certain health risks associated with HRT that need careful consideration. This is always based on your personal medical history and the specific type and duration of therapy. The benefits and risk profile are different for every woman. Individual assessment is always necessary.

HRT Alone Cannot Improve all Symptoms

Hormone Replacement Therapy (HRT), especially when applied topically, offers significant relief for many oestrogen-linked urogenital symptoms like vaginal dryness and irritation, Patients should understand its limitations. HRT alone may not fully address the complete range of urogenital concerns women can face during menopause.

Complex urogenital issues can include urine leakage, persistent vaginal dryness despite HRT, pain, significant tissue shrinkage, reduced sensation, vaginal laxity, pelvic floor muscle weakness, and faecal urgency. A multifaceted approach beyond HRT is often necessary for the following reasons:

1. Pelvic Floor Muscle Integrity – Conditions such as stress urinary incontinence, vaginal laxity, and faecal urgency often stem from weakened pelvic floor muscles. While HRT improves tissue quality, it doesn’t directly strengthen these muscles; targeted physiotherapy is usually required. Energy based therapies can help.

2. Established Anatomical Changes – For more advanced tissue shrinkage or prolapse, HRT can enhance tissue health, making other treatments more effective, but it may not single-handedly reverse significant structural alterations.

3. Specific Dermatological Conditions – Genital Lichen Sclerosus is a chronic inflammatory skin condition, not primarily caused by oestrogen deficiency. HRT has no direct treatment value for Lichen Sclerosus, which requires specific  management.

4. Neurological Factors & Sensation – Reduced sensation can arise from various causes. HRT might improve tissue health but may not fully restore sensation if other nerve-related factors are involved.

5. Severity and Multifactorial Causes – The intensity of symptoms and the interplay of hormonal, muscular, and lifestyle factors often mean a single therapy like HRT isn’t enough. For instance, pain during intercourse could have multiple components beyond dryness.

6. Varied Individual Response – Women’s responses to HRT differ. Some experience excellent relief, while others find improvement is partial, necessitating additional or alternative therapies for urogenital concerns.

Therefore, Dr. Nadia advocates for a holistic, individualised approach. For comprehensive management of urogenital issues, HRT may need to be combined with interventions such as pelvic floor rehabilitation, lifestyle adjustments, or regenerative therapies. A thorough assessment is the recommended course to creating the most effective, personalised plan for your specific case.

Why consult with Dr Nadia for HRT prescribing and for a Management Plan for Perimenopause and Menopause?

Dr Nadia is a highly experienced Gynaecologist who is a lead expert in prescribing individual HRT equation based on a matrix of elements and being part of a rather comprehensive plan that includes:

• Addressing hormonal deficiencies as early as the premenopausal years can help maintain tissue quality and function, as well as support psychological well-being and self-confidence.
• Calculating the Risk Assessment Analysis of any individual risks based on medical and family history.
• Establishing preventive health measures, including regular health screenings and monitoring existing medical conditions (diabetes, blood pressure, fibroids, etc.).
• Early management of any troubles e.g. managing postmenopausal bleed etc.
• Promoting general health and longevity.