A word from a Women’s Health GP - Tackling the hard questions with Dr Corinne Glenn

A good women’s health GP is like striking gold during Menopause. In this blog Dr Corinne answers some tricky and common questions about the medical side of Menopause.

Navigating the Murky Menopause Medication Maze – where does medication fit?

As a GP who has a special interest in menopause one of the most common questions I am asked is “How do I know if I need medication?” and “When is the right time to start medication?” The simple answer is when symptoms of perimenopause or menopause are impacting on your quality and enjoyment of life.

I thought it might be helpful to outline some of the most frequent questions I get and how I usually respond:

I don’t feel like myself – could this be perimenopause?

Some common symptoms associated with perimenopause include changes in frequency of periods or the heaviness of periods. Some people experience periods that are more frequent rather than the less frequent periods associated with perimenopause. Other symptoms include new onset anxiety, low mood, severe fatigue, muscle aches and pains, decreased libido and genital dryness and discomfort. All these symptoms can be associated with the menopause transition. They can also be associated with iron deficiency from heavy periods or restrictive eating, thyroid dysfunction, autoimmune disorders, vulval skin disorders, vaginal infections and mental health concerns. Discussing your symptoms with a GP with an interest in this area, often with the addition of blood tests as required can help rule out these other issues that need addressing. 

What does medication for menopause look like?

Typically medication involves oestrogen, plus progesterone if you still have a uterus. What form that takes depends on your symptoms and your individual needs such as whether you are still getting periods, if your mood declines terribly around your periods, if you still need contraception, and other medications you are on as well as your overall cardiovascular risk. Sometimes additional medications such as antidepressants or topical testosterone can be helpful for some people. 

I’ve had breast cancer and my symptoms are terrible. Can anything be done for me?

If you personally have had breast cancer that usually means menopause hormone therapy is not safe for you (other than vaginal oestrogen) however there are other medications we can try to help with your symptoms. Reach out for help if you need it! 

What about lifestyle changes?

It is important to have a diet rich in protein as well as fibre, vegetables, fruit and complex carbohydrates. Strength training is so important for bone density and strength. Squats will keep you out of the nursing home in 20-30 years time. Making time for rest and sleep is important. Avoiding excessive alcohol and caffeine intake will also help with symptoms. Sometimes you need medication before you can actually implement some of the lifestyle changes because you feel so awful with out it. You do not need to “earn” access to menopause medications by having a perfect lifestyle prior to seeking help. For some people lifestyle changes are enough.

I hear a lot about the health benefits of menopause hormone therapy. Am I hurting my health by not taking it because I don’t have any symptoms?

Absolutely not! If you don’t have symptoms, you don’t need hormones. You will not leave yourself at risk of cardiovascular disease or dementia or other scary illnesses if you don’t have menopause hormone therapy. The exception is people with premature ovarian insufficiency or very early menopause where hormones are recommended until the typical age of menopause. While it is fantastic we are talking a lot more about medications for menopause as their safety is better understood and validated, it doesn’t mean you should take a medication if it isn’t needed.

Will menopause hormone therapy fix everything?

Menopause hormone therapy cannot fix all the situational stressors we find ourselves with in midlife. It won’t reduce our work stress, it won’t make our kids do their homework or chores, it won’t fix a relationship that is unfixable. It can help make life a bit more tolerable so we have the energy to face those other challenges.

My GP isn’t confident in menopause care, what should I do?

The Australasian Menopause Society website has a directory of doctors with an interest in this area. If there is no one close to you, some menopause telehealth services provide great menopause care.