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The menopause occurs when the ovaries stop producing hormones. This usually happens between the ages of 45 and 55 (average age 51years). Many symptoms are blamed on the menopause but only the cessation of periods and hot flushes are reliable symptoms. Symptoms such as mood change, irritability, sexual problems and vulval symptoms may be caused by the menopause but other causes should be considered.
A menopause around the usual age of 50 years is a natural event and does not require any treatment unless the associated symptoms are troublesome and prolonged. A premature menopause (before the age of 45 years) is a different matter because of the risk of developing osteoporosis (thin bones that can break easily).
Until the publication of the WHI study in 2002, many women took Hormone Replacement Therapy (HRT) because it was felt to be beneficial to general health, preventing heart attacks and strokes, even though its use had already been linked to an increased risk of developing breast cancer.
HRT is now believed to increase the risk of developing heart attack, stroke, breast cancer and clots in legs (deep venous thrombosis) and lungs (pulmonary embolus). The increase in risk is not great and are likely to be greater in older (in their 60's) than younger women. No-one has shown that it is harmful for women in their 40's who have had a premature menopause to take HRT.
Types of HRT
A typical HRT preparation will contain a form a oestrogen +/- a form of progesterone. The type of HRT that you will be offered is mainly determined by whether you still have your uterus or not. Women with a uterus need to take a preparation that will protect the lining of the womb (endometrium) and prevent it from developing a cancer. This usually involves taking a form of progesterone.
Oestrogen can be given in several ways - tablet, patch, topical gel and implant.
Progesterone can be given as a tablet, patch, topical gel or as an intra-uterine device (Mirena coil). Women who have had a period within the last year should be given a form of HRT that causes monthly periods (but could have a Mirena coil if they were keen to avoid periods). Women who have not had a period for over a year can take a form a HRT which does not cause periods but which can cause light bleeding, especially in the early months of treatment.
Tibolone (Livial) is a novel form of HRT which has both the actions of oestrogen and progesterone and used as a period-free preparation.