Every woman will be affected by menopause in some way. Dr Pip Shirley explains how some of the more troublesome symptoms can be managed.

Perimenopause is often referred to as ‘puberty in reverse’ due to the turbulence that some women experience. The ovaries gradually stop working and oestrogen levels fluctuate, causing a myriad of unwelcome physical and emotional symptoms.

Women often become aware of entering this phase when their menstrual cycle becomes erratic and they start to experience hot flushes and night sweats. This might be followed by sleep problems, joint pain, tiredness, anxiety, mood changes as well as vaginal dryness and bladder issues.

The good news is a gynaecologist can help. We’re intimately familiar with this stage and can recommend evidence-based treatments and lifestyle modifications to ease symptoms. We can also dispel myths of which there are plenty out there. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) has excellent guidelines and the Australasian Menopause Society has a user-friendly website.

So what happens at your first appointment? First, we listen. There’s no specific test to determine if someone has entered perimenopause, so learning a comprehensive history of your health and taking stock of your symptoms is the best place to begin. The more you tell us, the better, as it all contributes to formulating a holistic management plan.

For many, MHT (menopausal hormonal therapy) is an effective treatment for the disruptive vasomotor symptoms of hot flushes and night sweats, and genitourinary issues like vaginal dryness. It can also help with mood changes, depressive symptoms and ‘brain fog’ and can have a positive effect on bone density.

The type of MHT prescribed is entirely individual but the general approach is to aim for the lowest dose, for the shortest time, to get the greatest effect.

Two medications are required if a woman has a uterus. A Mirena intrauterine system (hormonal IUD) together with an oestrogen patch is the gold standard and suits many women. For those who prefer not to have an IUD, an alternative is Utrogestan tablets. Estrogel is now funded in New Zealand, so women may opt to apply this topical gel instead of using a patch.

Decreasing levels of oestrogen affect the vulva, vagina and urinary system and can lead to genitourinary syndrome (GSM). GSM manifests with vulvovaginal dryness, irritation, itching, recurrent infections and pain during intercourse. Vaginal oestrogen cream (Ovestin), soothes and hydrates the vaginal tissue. This is considered safe even for some women who are not able to use other forms of MHT. Another option (or in addition) is a hormone-free vulvovaginal lubricant such as Nu Balm – a New Zealand product designed for vaginal dryness, painful sexual intercourse, vulval and perineal massage.

Lifestyle modifications, such as regular weight-bearing exercise and adequate calcium intake, can also help. Gynaecologists and endocrinologists frequently work together to provide appropriate advice.

Open discussion of perimenopause is important. Each woman will go through their own unique experience. While your sister, mother, friends, workmates may have different symptoms, your gynaecologist will be able to determine the best management options for you.

 

Dr Pip Shirley is a gynaecologist who provides women-centred care. Management of perimenopause is a key aspect of her practice. She is also an advanced gynaecological and laparoscopic surgeon. coga.org.nz