Menopause Treatments in Australia: HRT, Natural Options, and What the Evidence Says
Enter any chemist, search social media, or even ask a group of friends what they are doing to their menopause symptoms, and you will soon realise that there are an infinite number of alternatives, and the views, to these alternatives. Hormone therapy. Black cohosh. Soy supplements. Meditation. Specialty pharmacy based compounded creams. Antidepressants. Acupuncture.
It can be also very overwhelming. And, unhelpily, much of what flows through the Internet is either dumbed down, or dated, or has some kind of hidden agenda of a person who is moving to sell the product.
This guide breaks the radio noise. It discusses the primary treatment choices women have in Australia, what each option actually does and is also frank what is supported and what is not supported by evidence. No agenda, no more than a clear picture to allow you to have a more informed conversation with your doctor.
The menopause has a wide range of treatment options. The categories help you think more easily about what could be applied to your situation.
The combination of all of them is the one that most women find themselves using, and it is indeed a matter of personal preference which one works best. The picture is customized by your medical history, the severity of your symptoms, your personal likes and dislikes, and the fact of any condition that would eliminate some choices.
MHT is the best therapy that has been used in the most prevalent and bothersome symptoms of menopause: A hot flush, night sweats, and vaginal drying. It is not a marketing statement. It is the active advocacy of the decades of research of the Australian and international menopause organisations.
The simple explanation is that your body is not producing as much oestrogen and progesterone as it did, and that lower levels are making you feel that way. MHT replenishes back a minor portion of those hormones to alleviate the interference.
One aspect that amazes most women is that there are a number of options available in MHT. MHT is available in various forms in Australia, and the form of MHT is both important to its effectiveness and risk:
Unless you have already been hysterected, i.e. have had your uterus removed, you must use both oestrogen and a progestogen. This is because it is protective: when oestrogen is used without the corresponding progestogen, the risk of cancer of the uterine lining is increased with time. The women having undergone a hysterectomy can safely use oestrogen alone.
The most widespread excuse women have against MHT is the fear of breast cancer which should have a clear and honest answer to it as opposed to a particular convincing statement.
Combined MHT (oestrogen combined with progestogen) has a slight higher risk of breast cancer. The true figure, as far as can be established, is between one and nine additional cases per 10,000 women taking MHT during a specified time. In context, the Australasian Menopause Society observes that such degree of risk is comparable to the higher chances of developing breast cancer due to either being overweight or consuming two or more alcoholic beverages daily.
MHT that contains oestrogen alone with women who have gone through hysterectomy has not been identified to be a risk factor towards breast cancer. Certain researches indicate that it might make it a little lower.
The progestogen type applied also counts. Modern and more natural versions of progesterone, such as micronised progesterone which is similar to the naturally produced progesterone, seem to have a decreased risk of breast cancer over those that were produced many years ago.
Notably, the risk image can also be reliant on the time of starting. The risks of MHT in most women offset the benefits in healthy women younger than 60 years or younger than age 10 years of menopause. The initiation of MHT over ten years old among older women is another discussion, and the risk profile is different.
There is more than just short-term symptom alleviation of MHT; the MHT has reported the following benefits:
They may be called compounded or bioidentical hormones, and they are hormones that are combined by special pharmacies to an individualized formula instead of utilizing standard regulated product.
Australia Expert organisations against custom compounded hormone preparations include the Australasian Menopause Society. This is due to the fact that such products do not undergo similar quality testing and control to regular MHT. You have no control over what dose you are taking and the product may not be regularly prepared. The words bioidentical create a sweet sound, yet, this is more of a marketing brand. Body identical progesterone is already available in standard, regulated MHT in the form of micronised progesterone so the argument of the lack of appeal in the regulated system to do so cannot pass.
Others cannot ingest MHT; those who have a past of some cancers which are sensitive to hormones, or whose cardiovascular or clotting immobilisation is known. Some just do not want to use it. These women should be given non-hormonal prescription drugs as an option that has a moderate level of evidence.
Some antidepressants do decrease the hot flushes experienced and their intensity even in non-depressed women, at low doses, in particular, SSRIs and SNRI antidepressants (venlafaxine, escitaloprom, and paroxetine). They act by influencing the temperature control system of the brain and not by hormonal means.
They are not as useful as MHT in treating hot flushes and they have their own side effects; one being the possible effects on sexual activity and blood pressure. Nevertheless, to women who are unable to use hormones, they constitute a real, evidence-based choice.
Initially created as a treatment of nerve pain and epilepsy, some women have reported their reduction in hot flushes by using gabapentin. Its greatest weakness is the fact that it causes sedation which may work with women who are having issues with their sleep at the night, but not at the daytime.
Studies are developing rapidly in this field. There is the emergence of a new group of medications that prevent certain nerve receptors that cause hot flushes. They are non-hormonal, they specifically act on the hot flush mechanism and they are a genuinely new direction in the treatment of menopause. In Australia newer therapies are still undergoing changes and it is therefore worthwhile to discuss with your GP what is being well offered at the moment.
CBT refers to a kind of talking therapy, whereby it assists you to discover and alter how you think and react to things. It has a high and substantial evidence base in anxiety, depression and insomnia and has also been seen in specific research on menopause symptoms with truly encouraging outcomes.
Studies have indicated that CBT can significantly lessen the level of bothering the women with hot flushes even in cases where the frequency of the flushes may not serve a significant reduction. It is not about not pretending that symptoms are non-existent. It involves altering the distress reaction to them that would lessen their influence on the quality of life, sleep, and overall functionality.
CBT has proved to be of use in sleeping, mood swings, and anxiety conditions during the transition of the menopause. As an intervention that women might like to avoid medication, or to use in addition to others, it is worth considering by referring to a psychologist through GP.
Approximately 4 out of 10 women in Australia resort to the use of complementary or natural medicines in order to control the effects of menopause. That is a great percentage, and it indicates the real need of non-pharmaceutical methods, and in certain situations, the lack of access to good medical treatment or knowledge.
The candid stand on the natural treatments is subtle. Others have little and actual evidence of humble good. Most of them do not have much concrete evidence. And some of them do have some actual risk, especially when used in combination with other medications. Natural does not necessarily mean safe or effective.
The phytoestrogens are naturally occurring compounds that are present in some plant foods, especially soy, linseed (flaxseed), chickpeas and other legumes. They are much similar to human oestrogen and may weakly bind the oestrogen receptors within the body.
The data indicate minimal effects in regard to the hot flushes on some women, especially when taking quantities that are in accordance with a common Asian diet. Notably, food phytoestrogens are not linked to the higher risk of breast cancer. There is some evidence that they are possibly slightly protective. There is less evidence around concentrated isoflavone supplements and they are only worth it to discuss with a healthcare professional.
The most researched herbal treatment of menopause is black cohosh and is the most commonly prescribed herb by patients themselves in Australia. The evidence picture is transparent: There are those studies where hot flushes and mood symptoms have a modest benefit; those studies where it has no benefit over a placebo. The study is too weak to be able to give a thumbs-up on it, but it is not too weak to disregard it altogether.
With regard to safety, preliminary fears regarding liver toxicity have mostly not been confirmed in larger reviews. It seems to be fairly safe in both normal doses and up to six months in most women. The hormone-sensitive cancer has a history and requires women to talk to their doctor before taking it.
There has been some evidence of St Johns Wort to assist in mild to mild depression and mood symptoms. In combination with black cohosh, small studies indicate significant changes in attenuating the mood symptoms of menopause and eliminating hot flushes. Nevertheless, there is also crucial caveat: St Johns Wort also combines with a tremendously broad spectrum of drugs, the contraceptive pill, certain antidepressants, blood thinners. A person should never take it without consulting a pharmacist or a doctor.
Some of the most popular ones are used with minimal or no substantial evidence that they are effective in treating menopause symptoms. They are wild yam cream, dong quai, evening primrose oil, and or maca. Curiosity is not bad but it is preferable to learn that evidence is truly loose before investing money in them.
Controlled studies have not demonstrated reliable benefit of acupuncture, reflexology, and magnetic therapy in the treatment of menopause symptoms. There is a limited of evidence of hypnotherapy with sleep and hot flushes but not yet consistently enough to recommend. Although not specifically tested in menopause symptoms, mindfulness and mediation are well tested in terms of its ability to reduce stress and improve the quality of sleep, which is also applicable to the effectiveness of symptoms tolerance.
No matter the other means of treatment that a woman opts to obtain, lifestyle produces a positive, uniform effect to the extent to which the symptoms of menopause can be managed, as well as their effect in long-term health after the transition.
Not smoking: It is linked to an earlier onset of menopause, poorer vasomotor symptoms, and much greater risk of health in the long term. It is among the factors which are the most subject to change in this entire picture.
What is best treatment of menopause really depends on the individual. The correct direction is dependent on what bothers you most of all, your own and family history, the conditions that you have that could predispose you to what is not safe, as well as your values and preferences.
Some guidelines that are apt to make the choice more explicit:
Treatment of menopause can be achieved by the majority of GPs. In more complicated cases, such as early menopause, not knowing the correct method, or cancer history, a women’s health specialist or a menopause clinic will be worth attempting to find.
The choices of menopause in Australia are actually more than most women themselves were raised believing they are and the evidence base is more substantial and more vibrant than what social media is trying to give it credit, in one way or another.
MHT is still the most effective intervention, and in most healthy women during the first decade of menopause, it is also a safe intervention. Non-hormonal prescription drugs, CBT, and the use of complementary options that are selected carefully have a place in different situations. And sound lifestyle pillars keep them all.
Prepare before your GP appointment, be specific about your symptoms, and ready to ask direct questions. You should have an opportunity to talk about your experience and have a choice, not an indicator of a one-size-fits-all answer.