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Most women probably know about hot flushes, unpredictable moods and loss of sex drive, but what else might there be?
The consequences of low or falling oestrogen are grouped in three categories: (a) early symptoms that, for most women, last between about six months and two years, (b) rather later symptoms that tend to become more noticeable as the years go by, and (c) conditions that may not start for many years and then get steadily worse.
These symptoms occur during the early months (or years) of the menopause when periods are erratic and unpredictable, but haven’t yet stopped. Typical symptoms at this time are:
• hot flushes
• night sweats
• mood changes
• loss of self-esteem
• loss of confidence
• difficulty in making decisions
• feelings of unworthiness
• loss of interest in sex
• genital itching
Most of these symptoms will last for a comparatively short time, but they can go on for many years and can greatly reduce a woman’s quality of life.
DO WE KNOW ENOUGH ABOUT THE LONG-TERM EFFECTS OF HRT TO BE SURE IT’S SAFE AND WILL LIVE UP TO THE CLAIMS MADE FOR IT?
One area of concern is a possible increased risk of breast cancer in women on HRT for more than ten years. This is an issue that many research teams are investigating.
Another area of uncertainty is the effect on heart disease risk of including progestogens in HRT formats. It seems that while progestogens protect the endometrium, they may also reduce the protective effects of oestrogen on blood fats when used in large doses. The 19-nortestosterone progestogens seem to have a more adverse effect than the more commonly prescribed Provera in this regard.
It is also unclear what effects long-term use of progestogens (high or low dose) have on women. Studies are under way in many medical and research centres worldwide, including several in Australia, but we won’t know the answer to this question until the end of this decade.
Sex is not a precondition for a happy and satisfying life. If sex is not part of a relationship, lack of interest in it is a matter of concern only if it becomes personally troubling or causes problems in relating to others. It cannot be said too strongly that those who have neither a desire for nor interest in sex, or who have deliberately chosen a lifestyle in which sexual activities play little or no part, have every right to their decision. On the other hand, those older people who enjoy sex or want to enjoy it should be given the information and treatment they need if problems arise.
There are other couples who have put intimacy on hold, pending treatment for a disability or serious illness. The partner who is in good health sometimes admits to mixed feelings: anger or irritation that his or her sexual needs cannot be satisfied within the relationship, and guilt for lacking compassion over a partner’s ill health. Ailing partners may also feel distressed about their inability to participate in an active sex life.
There is evidence that low oestrogen levels over a period of years affect the collagen component of skin, causing it to become thinner, drier, more prone to damage, bruising and itching, and somewhat transparent in appearance. Loss of collagen also occurs in ligaments and other soft tissues, and this may explain joint aches and pains. An estimated 15 to 30 per cent of collagen is lost from the skin within five years of menopause. Another problem experienced by some women around this time is a crawling sensation on the skin (known as formication).
HRT appears to prevent the thinning effect or, if it has already occurred, to restore skin thickness and improve its texture by increasing the collagen content. It may also provide relief from crawling skin sensations, and muscle and joint aches and pains. All the hormone therapy in the world will not remove wrinkles, but they may become less noticeable while you are on HRT because the skin looks fuller. Hair texture may also improve, although there is not necessarily an increase in the number of hairs.
The experience of menopause is a roller coaster ride for some women, and the history of menopause-related sex hormone therapy has also had its ups and downs. Early this century medical practitioners and alternative therapists used powdered and desiccated concoctions prepared from animal ovaries as remedies for many physical and mental disorders in women. All sorts of problems were blamed on ovarian malfunction, and it seemed logical to look to healthy ovaries for a solution. The preparations given to women were full of impurities, however, and the results were unpredictable and discouraging.
Hormone replacement therapy as we know it today had its beginnings in the late 1920s, when the form of oestrogen now known as oestrone (see page 171) was first isolated from the urine of pregnant women. A later (1943) development was the extraction of an oestrogen from the urine of pregnant mares. This preparation, called conjugated equine oestrogen, was, and continues to be, prescribed widely under the brand name Premarin.
The next big development had nothing to do with science and everything to do with marketing. In 1963 the Wilson Foundation was established in New York by the Brooklyn gynaecologist Dr Robert A. Wilson, and backed by $USi.3 million in grants from the pharmaceutical industry. The foundation’s mission was to promote the use of oestrogens and Wilson succeeded in this, particularly through his widely read book Feminine Forever. In an article summarising his book, Wilson described menopausal women as ‘living decay’, and said that oestrogen therapy could save them from being ‘condemned to witness the death of their womanhood’. He listed twenty-six symptoms that the ‘youth pill’ could avert -including hot flushes, osteoporosis, thinning of the vaginal walls, sagging and shrinking breasts, wrinkles, absent-minded episodes, irritability, frigidity (a condition rarely referred to these days!), depression, alcoholism and even suicide.