What Next?

The diagnosis of Early Menopause can be an overwhelming, emotional and anxious time. Knowing what to do next can be a challenge. Below is a checklist of things you might like to consider post diagnosis:

• Have a blood test to gather a baseline for your hormone levels including oestrogen, progesterone, testosterone, DHEA, FSH and any others recommended by your doctor.

• Have your thyroid function checked – it’s another simple blood test.

• Explore and decide if HRT is an option for you (more on HRT below). Be patient, as it may take some time to find the best type and dosage of HRT for you and may also change over time. I learnt that a gel or patch (transdermal) form of HRT is better than a tablet as the liver doesn’t have to work so hard to absorb it.

• Organise through your GP or specialist to have a bone scan. It is a simple and painless process in which scans are taken to measure your bone density. Having a bone scan annually is recommended to monitor any changes in bone density over time in particular Osteoporosis. Ensuring that your initial scan is done ASAP means that you’ll have a baseline to compare future scans with. The expense of these scans is less for women in Early Menopause – make sure doctor codes the referral appropriately.

• Breast Check: ensure that you are self checking and following the advice of doctors regarding regular examinations and mammograms (if appropriate). Regular Pap Smears are essential for many women in Early Menopause too. Check with your medical professional for advice.

• Consult an Endocrinologist if appropriate. An Endocrinologist is a doctor specialising in the endocrine and hormonal systems of our body.

• Seek the help of a Psychologist/Counsellor to support you through this difficult time. A Medicare rebate is available for these services as long as you have a referral from your GP.

• Talk to other women experiencing Early Menopause and/or Fertility issues through online forums etc. Feeling like there are other people that understand and know what you’re going through makes a HUGE difference.

• Ensure your calcium intake is adequate and that your Vitamin D levels are functioning normally (another simple blood test) as Vitamin D levels affect the absorption of calcium.

• Get a second opinion about your diagnosis, condition, HRT options. Remember it’s your body and you’re the boss of it!

• Exercise regularly – especially weight bearing activities to keep your bones strong and healthy.

• Take additional supplements as directed by your medical professionals. Fish oil is effective in helping to minimise joint pain associated with Early Menopause.

• Be gentle with yourself. The grief, challenges, body changes, fertility issues and relationship implications to do with Early Menopause can be overwhelming, ongoing and tiring. Take one step at a time and know that it won’t always feel like this.

HRT Options

Thursday, June 24th, 2010

Kindly contributed by the New Zealand Early Menopause Support Group

Disclaimer: HRT is not for everyone. There are medical and personal reasons why HRT may not be right for you. The following is written to help you understand your options when considering HRT but is not meant to replace the advice of your medical practitioner.

Choosing whether or not to take HRT is a big decision and I hope this information helps you in some small way.

Women going through an early menopause are prescribed HRT to alleviate complications of oestrogen deficiency. As well as the typical menopausal symptoms, this includes negative effects on your bones and possibly your heart.

In finding the right formulation of HRT, it’s been my experience that doctors work on the ‘trial and error’ principle. Basically, they start you on a low dose to avoid putting in too much oestrogen as that can cause symptoms like breast tenderness and nausea. Then, if you still have menopausal symptoms (flushes, sweats etc.), they raise the dose and try to just get that balance right between too little oestrogen (which causes the menopausal symptoms) and too much oestrogen in your system. OK, still with me?!

The main goal in symptom control is to increase your oestrogen levels to where they should be for a woman your age. Women with a uterus are prescribed combined HRT (oestrogen with a progestin) to protect the endometrium (womb lining) from overstimulation by the oestrogen. Getting the progestin component right can also be tricky as you may get symptoms like bloating and headaches.

There are other choices to make also:

  1. You have a few methods of delivery available – tablets, patches, gels, implants – depending on which suits you better. There is a school of thought that the liver may be damaged when it processes tablets. (NB. There is, to date, no evidence that progesterone creams protect the endometrium the way progestin’s do.)
  2. You have a choice of plant-derived or animal-derived oestrogens. You might feel bad for the animals (like me), but those preparations have been studied for longer.
  3. You can choose between continuous (no bleed) or cyclical (monthly bleed) treatment.
  4. You need to weigh up the pros and cons for your personal medical history. If there is a history of hormone-sensitive cancers in your family, or blood clots, these are things that might steer you away from using HRT.

Your doctor should discuss all these issues with you along with alternatives for symptom control.

There is much debate on the pros and cons of HRT. Unfortunately, there have been no long-term studies done on young women, but the current thinking is that it’s ok for us as long as we’re otherwise fit and healthy. So keep that diet varied and healthy, and incorporate some regular exercise into your lifestyle; the positive influence of these two factors cannot be overstated.

It’s a big decision and one only you can make for yourself. So get informed and get confident. And remember, you can always change your treatment regime if you feel it’s not right for you anymore – it’s your body after all!

From the Australian Early Menopause Network:

There is much talk and hype in the media regarding biodentical hormone replacement. It is our understanding that the research and evidence of the implications, long term risks and effectiveness of these hormones on women in Early Menopause is limited.

Please note: For women who are in Early Menopause and have or had Cancer please consult your doctor for specific information about HRT as certain oestrogen replacements are not recommended.

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