• Certain medications, such as those used to treat endometriosis and some types of cancer, can stop hormone production in your body
• Symptoms of a chemical menopause can be similar to those in menopause but usually start more suddenly and can be more severe
• Add-back HRT and testosterone can often be taken, which reduces menopausal symptoms and improves long-term health

What is a chemical menopause?

You may be familiar with the term surgical menopause – where an operation such as a hysterectomy or bilateral oophorectomy (removal of ovaries) induces menopause. A chemical menopause is another type of induced menopause caused by certain medications, including hormone blockers (it can also be known as a medical menopause).

These medications “switch off” your hormones, meaning that the production of hormones oestrogen, progesterone and testosterone is stopped or reduced. This is usually temporary while you are given the medication and is usually reversible after you stop having the medication.

RELATED: Surgical Menopause

Who experiences chemical menopause?

Chemical menopause can be induced by Gonadotropin-releasing hormone (GnRH) analogues. These are synthetic hormones that suppress the production of the hormones oestradiol, progesterone and testosterone. They’re usually given as injections or a nasal spray and brand names include Decapeptyl, Zoladex and Prostap.

GnRH analogues are sometimes prescribed to women with endometriosis, adenomyosis and fibroids. Oestrogen can worsen endometriosis in some women – GnRH analogues can suppress or reduce symptoms of endometriosis or adenomyosis, including pain.

GnRH analogues can also be prescribed to shrink fibroids, and can be used to treat PMDD if no other treatment has been effective, and also be part of some fertility treatment regimes.

Some women with oestrogen receptor positive breast cancer are given GnRH analogues as part of their treatment.

Other medications can also cause a chemical menopause, including some types of chemotherapy and some drugs for psychiatric disorders, such as quetiapine.

Women who undergo a chemical menopause are usually younger than those who experience a natural menopause. They may not be as aware of menopause and its implications, or have concerns around ageing and losing their sense of self. The impact of dealing with a health condition and its treatment, and then experiencing menopause, can be overwhelming so it’s important to know that advice and support is available.

RELATED: Endometriosis: I went through a medical menopause at 24

Postmenopausal women who experienced a natural menopause may still experience a chemical menopause due to medications. This is because your body will have been producing hormones (from your brain and other organs and tissues) after your menopause, but chemical medication blocks any hormone production, which can lead to symptoms.

What are the symptoms of chemical menopause?

The most common side effects of GnRH are due to the lowering of hormone levels (oestradiol, progesterone and testosterone) so resulting symptoms are similar to those experienced during menopause. This can include, but is not limited to, hot flushes and night sweats, joint and muscle aches and pains, low or changed mood such as anxiety, loss of libido, memory loss, genitourinary symptoms such as vaginal dryness and urinary tract infections.

Other side effects of GnRH therapies can include headaches, blood pressure changes, weight change and decreased bone density.

When women are without their natural hormones for a longer time, and at any earlier age, they have a higher risk of long-term health conditions, including osteoporosis and coronary heart disease.

RELATED: menopause symptom questionnaire

How can I treat my chemical menopause?

HRT (oestrogen, progesterone, testosterone) is the first-line treatment for menopausal symptoms for the majority of women. If you are prescribed GnRH analogues, hormone treatments are often prescribed at the same time to reduce side effects and menopausal symptoms. This is known as add-back hormone replacement therapy.

Add-back HRT is replacing the hormones that your body would have been producing naturally if they had not been suppressed by the GnRH analogues. If you are on GnRH analogues to treat endometriosis, it might seem strange to take oestrogen as part of add-back HRT but it’s a lower dose than what your body would create if ovulating – the dose is usually enough to alleviate symptoms but not stimulate endometriosis tissue growth. For some women, progesterone and testosterone are prescribed without oestrogen. It is important that add-back HRT is individualised to the right dose and type of hormones.

RELATED: endometriosis and HRT

Taking add-back HRT is also important to help protect your health – one side effect of GnRH analogues is loss of bone mineral content. Add-back therapy has been shown to reduce this loss [1] so is important in helping to prevent osteoporosis. Add-back HRT can also offer heart and brain protection.

Your healthcare professional will work with you to help determine other treatment and lifestyle options that can help alleviate symptoms. This might include reviewing your diet and exercise levels, offering vaginal hormones, advising on sleep and relaxation techniques, exploring cognitive behavioural therapy (CBT) to help improve emotions, etc. Help is available while you undergo a chemical menopause so be sure to seek it out.

RELATED: managing menopause beyond HRT

References

1. Wu, D., Hu, M., Hong, L. et al. (2014), ‘Clinical efficacy of add-back therapy in treatment of endometriosis: a meta-analysis’ Arch Gynecol Obstet. 290(3), pp513–523. Doi: 10.1007/s00404-014-3230-8

The post Chemical menopause: what is it and what can I expect? appeared first on Balance Menopause & Hormones.

Joining Dr Louise on this week’s podcast is Melanie Verwoerd, political analyst, former member of parliament for the South African ANC party under Nelson Mandela, and former South African ambassador to Ireland.

In this episode, Melanie shares her experience of radical hysterectomy, and her shock at just how little information is available to women before their operation. She tells Dr Louise how she is on a mission to close the information gap by chronicling her experiences in a book, Never Waste a Good Hysterectomy, followed by a podcast series of the same name.

Dr Louise also shares her own experience of a having a hysterectomy, and together with Melanie offers advice to women who are preparing for surgery on what to expect.

Click here to find out more about Newson Health.

Transcript

Dr Louise Newson: [00:00:11] Hello, I’m Doctor Louise Newson, I’m a GP and menopause specialist, and I’m also the founder of the Newson Health Menopause and Wellbeing Centre here in Stratford-upon-Avon. I’m also the founder of the free balance app. Each week on my podcast, join me and my special guests where we discuss all things perimenopause and menopause. We talk about the latest research, bust myths on menopause symptoms and treatments, and often share moving and always inspirational personal stories. This podcast is brought to you by the Newson Health Group, which has clinics across the UK dedicated to providing individualised perimenopause and menopause care for all women. So today on the podcast, I’ve got someone called Melanie Verwoerd who actually is from South Africa. And I don’t think I’ve interviewed someone who’s been in South Africa before. So this is a first, Melanie. [00:01:11][60.7]

Melanie Verwoerd: [00:01:12] Oh, lovely. And hello from Cape Town. [00:01:14][1.9]

Melanie Verwoerd: [00:01:15] So you’ve reached out to me and you’ve written a book which we’ll talk about, but it’s about knowledge sharing. A lot of the work that I do, many people realise is about sharing information, sharing knowledge. So as individuals, we can decide what’s right for us. So tell us a bit about you and we’ll talk a bit more in, well, in a lot of detail about hysterectomy, the operation to remove a woman’s womb. So if you don’t mind just saying a bit more about you if that’s okay? [00:01:42][26.2]

Melanie Verwoerd: [00:01:42] Yeah. Thank you so much for having me. It’s lovely to speak to you and to all your listeners, and thank you for what you do for all us women all around the world. So I don’t come from a medical background, actually, I have a political background. I was a member of parliament in South Africa with Nelson Mandela, and between our transition, 1994 to 2001, I then became South Africa’s ambassador to Ireland. I did that for four and a half years, then became executive director of Unicef in Ireland and then came back. So my day job, I’m a political analyst and I also write for newspapers. But in the middle of 2021. So during the COVID time still, I went for a regular gynaecological check-up and during, you know, I was lying there on my back and the gynaecologist was doing an ultrasound and we were chatting away… You know how it is, you always talk as much as you can when you’re having a gynaecological examination just do not concentrate on what’s happening down there. And she suddenly went very quiet and just said, oh, what’s going on here? And then the whole atmosphere in the room changed. You know, it’s like, I think anybody who’s ever had bad news from a medical doctor knows what I’m talking about and said, look, can you quickly run up and go and have some blood tests done? And I said, sure, but what are you looking for? And she said, well, cancer, I can see a huge ovarian growth. And I mean, it really shocked me because I had zero symptoms and also had been perfectly well. And I have gone through gynaecological check-ups every year, and there was nothing the previous year. And then, yeah, then I got on this very fast moving train of medical tests and CT scans and seeing more specialists, and a week later, a radicalised hysterectomy, we can talk about the terminology of course, was performed. And that then put me on this whole journey which resulted in the book and eventually also in a podcast, because I realised just how many women go through this procedure. And yet there’s such a lack of information and support. [00:03:38][115.7]

Dr Louise Newson: [00:03:39] And how old were you when you had the operation, if you don’t mind me asking? [00:03:41][2.6]

Melanie Verwoerd: [00:03:42] Not at all. I was 54, so I was lucky in the sense that I had largely gone through menopause. In fact, the day that I went to the gynaecologist was a year after my last period. So I was officially you know in menopause. So in that sense, for me, having the ovaries removed, of course, there’s always still some latent hormones present, you know, and, and I did have, again, menopausal symptoms, you know, again flushed a bit and felt very down, which could have also just been the operation. But so I was lucky in the sense that I wasn’t put into surgical menopause. I think that is an additional nightmare on top of everything else when you get such a big operation. [00:04:21][39.0]

Dr Louise Newson: [00:04:22] Yeah. So so I mean, a hysterectomy is just removal of the womb. Which is what it is. But like you say, there are different types of hysterectomy actually. So a simple hysterectomy is literally just removing the womb. It can be done, there’s also a subtotal hysterectomy which means that the womb is removed but the cervix still remains. And 20 or so years ago it used to be very common operation because they thought that there was more stimulation, and certainly for penetrative sex, it was more pleasurable for the woman to keep the cervix. But actually there’s not really been good studies about that. And some people think that they’re more likely to have a prolapse if they don’t or do remove the cervix. But again, it’s not really so…so a few people, for various reasons, might still have their cervix remaining and have a subtotal hysterectomy. And that’s important to know obviously, because you want to know have you still got your cervix if you need to have cervical screening or whatever. So but essentially a simple hysterectomy is just removing the womb. And then we also often talk about TAH and BSO because in medicine we love having abbreviations, lots of letters in people’s notes. But that means total abdominal hysterectomy which means the operation’s through the tummy, there’s a cut in the tummy and removal of both ovaries. But that can also be done in a vaginal way as well. So quite a few people only have their womb removed. Some people have the womb and their ovaries moved. And then you had more removed didn’t you? [00:05:54][92.1]

Melanie Verwoerd: [00:05:55] Yeah, I had everything removed. So as I understand it and it might differ from country to country. But from what I understand is that if they sit with a big ovarian growth, mine ended up being the long end of a credit card. So the circumference was like that. They are worried, first of all, of doing a vaginally or laparoscopically because they do not want any part of the tumour to chip off, you know, if there is a possibility of cancer. So they usually then do an abdominal hysterectomy. And because in my case wasn’t 100% sure that they could do the lab test in the theatre. They then did a pre-emptive radical hysterectomy. So they removed, as you said, the womb, of course, the ovaries, the cervix, some of the ligaments, and then also that sort of fatty tissue, the omentum, they call it the fatty tissue or curtain that hangs over your organs because I was told, and you can correct me, but that’s often way especially ovarian cancer tumours like to go and hide. So it was a fairly radical operation and thankfully not all women go through such a radical hysterectomy. And of course, particularly because it has an abdominal wound that took very, very long to recover from. And I think that was partly why it was so important for me to do the knowledge sharing was because just before the operation, I tried to get books, you know, to read. I’m a brainy person. I like reading stuff to be prepared and be in control, you know? And I couldn’t really find anything around hysterectomies and I could find medical journals, but that wasn’t helping me at all to prepare and then post the operation, I started looking also for, you know, information online and so on. And then I discovered all these huge Facebook groups of women who had gone through hysterectomies. Often it’s linked very closely, of course, to menopause, because it’s often women who are sort of in that period of their lives and who were so frustrated, so anxious, many of them also in the NHS, because they felt that they got no support and no information and they were asking each other, which is nice, but of course not the most reliable when you want to get medical information. So, you know, there was one example I remember where somebody said, went onto the group and said, I am eight days post hysterectomy. I just had a big bleed, big blood clots all over my kitchen floor. What do you guys think? Should I go to hospital? Is this normal or not? And of course you want to shout don’t come on to a group, you know. Please, please, please just get yourself to emergency. But that’s sort of was the illustration for me. And these groups are everywhere in the world, not just South Africa. In fact, South Africa is a very small group, but Australia, the UK, America and Europe, everywhere. Because, you know, you said it was a fairly common op procedure, but it still remains a very common procedure. You know, in America alone, 600,000 hysterectomies every year. And I think still many doctors, very unwisely, I want to almost venture inside, particularly male doctors. When women go into menopause and they experience sometimes menopausal symptoms or any other legitimate gynaecological, this becomes the operation that they turn to. And yes, in some cases it is needed and it’s life improving. And it is life saving in many cases. But I don’t think it’s an operation that should be done easily, and as the sort of easy option to deal with menopausal symptoms. And that’s been sort of part of my little activism now is to say, just make it a last resort, not the first resort if women start struggling in middle age. [00:09:29][214.1]

Dr Louise Newson: [00:09:29] Yeah, it’s really interesting. So I did, when I trained to be a GP, I’d done a lot of hospital medicine, so I didn’t have to do lots of jobs to become a GP. The only job I had to do was an obs and gynae job, and that was a long time ago. That was in 1999. And there were lots of women who, in retrospect, were middle aged women, menopausal or perimenopausal, who were having heavy, heavy periods. Mirena coil wasn’t really, it was only just sort of coming out then. And so a lot of people had a hysterectomy for that. And I just thought, gosh, you’re having an operation, but in a couple of years time your periods will be stopped. So anyway, but also as a doctor, we see people when they’re operated on, you know, in the hospital. And when we do a six week check quite often, and I, you know, and I’ve done this a lot as a GP, you know, you see babies six weeks old, the mothers for a six week check. So you don’t realise the enormity of what’s happened in that six weeks. And then my mother had a hip, well she’s had both hip replacements now, and I looked after her and I’ve seen women three to six months after a hip replacement and they’ve been okay. They’ve a bit of pain, bu they come into the surgery. We review everything. But day one after a hip replacement, oh my goodness. And then seeing the bruising down my mother’s leg and the pain she was in and I was thinking, gosh, I had no idea how awful it was because the body heals quite well. And then I had a hysterectomy a few years ago, and it was a simple hysterectomy and it was done vaginally, but oh my goodness, those first few weeks I wasn’t expecting because I think as doctors we’re not trained because we don’t see day by day. And people get discharged day two now, often after an operation, don’t they so we’re not seeing and learning, but I learn all the time from two things: my experiences if I have them, but also from what patients tell me. So what you’ve done is, is allowed people to discuss because we are different, aren’t we? But it is still a big operation. [00:11:22][112.9]

Melanie Verwoerd: [00:11:23] I know that some women, especially when they’ve had vaginal or laparoscopic and it’s a simple hysterectomy they seem to bounce back. Many women do quite quickly, but the vast majority of women that I have spoken to and made, and I speak in many places now on these issues and women and medicine and so on. And the vast majority of them sit there in tears, you know, and write to me just for once, that somebody gave validation to their experiences. And, you know, they I mean, I understand that doctors are busy and especially surgeons and specialists or I don’t know if you call them consultants in Britain, they are very busy. So they once they’ve saved your life or stitched you back up, that’s it. They’re done. You know, that’s job done. But of course for you the process only starts then, right? And I I’ll never forget my surgeon said to me beforehand, week one you’ll be in bed, week two you’ll be on the couch, in week three, you might be in the kitchen again. I objected as a feminist to the last observation, but the point was, in his mind, I should have been back doing what I do by week three. There was nothing like that. I mean, and I’m I’m tough and I’ve gone through lots of medical things, so this was nothing like anything I’ve previous experienced. And it took, I would say, about three months before I felt closer to myself. And the point was I wasn’t healed completely. There was still pain and discomfort and energy issues for at least six months, and maybe even a few months after that. And I think even if we just get permission to know that it’s really hard. And then, of course, you don’t even talk about the psychological stuff, because I think there’s a lot of psychological stuff that goes with it. I was not prepared for how long it was going to take. I was also not prepared that it was quite important to speak to pelvic floor experts, you know? That it might impact, you know, on your sexual activity. None of that I was prepared for. And I think then it comes as a big shock and it’s on top of… And of course, then women who go through surgical menopause and are not prepared for that are not helped with medication, or you know, therapy through that. I think that’s just cruel. I think that’s in a way I would almost describe it as evil, because what they go through is hell. [00:13:34][130.9]

Dr Louise Newson: [00:13:34] Yeah. I spoke to one of my patients today who’s had breast cancer many years ago. She’s young, though, she’s still in her mid-40s, but she had breast cancer when she was in her 20s. Oestrogen receptor negative. She’s had a bilateral mastectomy, but she’s found to have the BRCA gene. So she’s having her ovaries removed to, you know, obviously negate her risk of ovarian cancer, but she’s still having periods and she really wants to have hormones to replace the ones that she’s missing because she gets PMS already and she knows she’s going to feel worse without her…and I spoke to her today because she’s now got a date for her operation. And the consultant has said, let’s just see how you get on without your ovaries. And I said, you know, and they’re they’re sort of worried because she’s had this history of breast cancer, well she’s had her own periods for 20 years. So actually, that makes it a lot easier to think about hormone replacement therapy. And she wants it as well. You know, she knows that her mental health before her periods is terrible. So she’s quite rightly worrying about that after the surgery and the health risks of not having hormones for her bones, heart and brain and so forth. But to say, see how you get on, I think is, yeah, it just makes me a bit upset. [00:14:44][69.4]

Melanie Verwoerd: [00:14:44] I can’t tell you how many stories like that I’ve heard. And I was recently contacted by the mother of somebody in her late 30s who had had a radical hysterectomy, and she said to me that she was deeply worried. I didn’t know her. She just reached out to me via my website and said that she was deeply worried about her daughter’s state of health, but it was her mental health, and I asked if I would talk to her. And of course I said I would, but we need to refer her to a medical expert. And then when I spoke to her, she said exactly the same thing. The doctor said, you know, when she was released from hospital, you might start feeling a little bit off in the next day or two because, you know, you’ve gone into surgical menopause, but come see me in six weeks time and we’ll see how you get on. You know. And she said during those six weeks, because she didn’t know what was happening to her, she thought it was, you know, she didn’t understand why she was feeling so awful. And then she said to me before the operation, because hers was done because of cervical cancer, she was scared that she was going to die. Then after the operation, she got scared that she wasn’t going to die because of the impact of. And I think for me, the thing is, your patient seems to have done the right thing and that’s coming to you. But it is also to sort of as women to start taking control of our health, you know, to also insist and not take, you know, the word of one doctor. I think it’s really important then to reach out, go find the help if you have time to do it before the operation already and then after the operation if you’re not doing well to reach out for help. And it’s not because you’re weak. I think we often think we’re weak. It’s because you need legitimately need help. [00:16:12][87.9]

Dr Louise Newson: [00:16:12] You’re absolutely right. My consultant was brilliant because he said to me, each day you do a minute and then you double it. So you do one minute walking, then two minutes, then four minutes and eight minutes. And I thought, you know what? I’m really fit. That’s ridiculous. But I took it literally because I really wanted to feel better. But actually some days I found it really easy and some days I found it really, really, really difficult. And I think there’s two things really for me that I was not expecting so much because I didn’t have a scar because it was done vaginally. So you look down and you think, have I really had an operation? And so I think women forget that internally you have had an operation. But the two things really was my pelvic floor. I do a lot of yoga. I do a lot of pelvic floor exercises. I couldn’t even feel the muscles like I tried to tighten them, you know, as you do, you need to your pelvic floor, I was like, I don’t even know where they are, have I got them? And I knew I do, of course. So looking at that, but also like not being worried that you can’t do it straight away. A lot of women, even if they’re on HRT before the operation or they’re having their own hormones, often need vaginal hormones when things have settled down, which is very different to HRT. And that’s really important because if you’re, and we talk a lot about sarcopenia, this loss of muscle mass that occurs in the menopause, well you have sarcopenia of your pelvic floor muscles as well. So we can all do our pelvic floor muscles as many times as we can, but there’s no point doing them if you haven’t got the muscles there and the muscle strength. So that’s something that’s really important. But it can take a long time. It really can take three, six months for your pelvic floor muscles to come back. And I wasn’t prepared for that. I don’t know whether that’s the same for you or people you’ve spoken to? [00:17:55][102.7]

Melanie Verwoerd: [00:17:56] Definitely. And, you know, there’s all kinds of problems. I mean, as you will know, I mean, the dreaded which is most probably apart from sex, the thing most spoken on the groups, the dreaded constipation, you know, after the operation, especially when it’s abdominal cuts and so on. So there’s a lot of pain, but also of course general anaesthetic and slow down everything. And then women are scared and all these things I have on the podcast series that I then did on this, there’s a physiotherapist who’s a pelvic floor expert that we speak to, and she talks about if women just come to her beforehand, she can teach them how to actually go to the bathroom after the operation, which can be a major point of anxiety and fear and, and things. So it’s even little things. [00:18:36][40.3]

Dr Louise Newson: [00:18:36] Absolutely. [00:18:36][0.0]

Melanie Verwoerd: [00:18:37] Well, little. It’s not little when you’re into it, you know, but something like that. [00:18:40][3.3]

Dr Louise Newson: [00:18:41] No, but it seems little when you’ve got normal bodily functions. And the other thing that happened to me, which is not uncommon, is that my bladder didn’t work properly. So yes, I was catheterised, it was taken out, I couldn’t empty my bladder. And the first nurse that put my catheter in inflated the balloon on my urethra. It was really painful. She didn’t believe me and I said, just give me a syringe. I’m going to take the water out. Take it out myself. It was awfully painfuL. I knew…and so then the consultant came in and catheterised me. That was fine. I had a catheter in for a few days at hospital. Then I had it taken out just before I went home, and then at three in the morning I was in so much pain and discomfort. I’m very fortunate that my husband’s a urologist, so he went to the local hospital and got a catheter and everything else, and very unromantically catheterised me because I didn’t want to go back to the hospital. I hate hospitals, I really didn’t want to. I knew they would admit me and I didn’t want to. So I had a catheter. But then I had an indwelling catheter for six weeks. So I had a leg bag. I was, you know, wearing my husband’s pyjamas, you know, having the bag next to the bed in the daytime. I have a leg bag initially and then I would just have a clamp. And it was it was really interesting because my husband’s a reconstructive surgeon, does a lot of work for people who have permanent catheters to enable them to urinate through properly through their urethra, but I hadn’t realised how awful it feels having a catheter in. You feel like people know that you’ve got it in, and of course they don’t. There’s something really horrible about losing control of a normal bodily function, and I then took my catheter out too early, so he had to re-catheterize me. So and then I had awful urinary tract infections. And many people listening I’m sure would have had urinary tract infections and… it was awful. I can’t even begin. There was one I had, I had a few and I had one that hadn’t responded to two antibiotics, and it was just excruciating. I can see why people even become suicidal with the pain of having a urinary tract infection, because my bladder was all inflamed, it had this catheter in it, and then I had this infection and oh, I can’t tell you it was awful. And like, I’m married to a urologist, I’m a doctor. I was really scared and I didn’t know who to ask for help. I knew I couldn’t get an appointment with my GP. And it’s accessing help and care. And you know when you’re in a lot of pain, it’s really scary. [00:21:10][149.2]

Melanie Verwoerd: [00:21:12] It really is. And the thing is post-operative, you’re so vulnerable. And then I think there is an additional issue for women and that is asking for help. I think men, you know, they might struggle as well. But I think in particularly also when it’s got to do with gynaecological health, which we are, still no matter how open societies have become still hiding, you know, still not talking about as often, you get the message you should get on with it, you know like and and especially after hysterectomies where, you know, they are children and they are pets to be fed and they are food to be made and washing to be done and jobs to get back to. And women just persevered through it, you know, and that’s often very unwise from a physical and mental perspective. And I think that’s one of the things, a doctor recently wrote to me and said, a gynaecologist, that she had listened to my podcast. And one thing that had changed after the podcast was that she decided she will never do a hysterectomy again, unless she’s also made the partner of the woman involved. [00:22:10][57.8]

Dr Louise Newson: [00:22:10] How interesting. [00:22:10][0.0]

Melanie Verwoerd: [00:22:11] Because she realised just if the the partner, be they male female, whatever the partner’s relationship is, if they are not prepared for what happens and are being able to be in a supportive capacity there, then she realises how much the patient is going to suffer. And I think, you know, how often do we just go to gynaecologist or for exams on our own? And yeah, so important. [00:22:34][23.0]

Dr Louise Newson: [00:22:35] It’s really interesting. So I also, one of my friends had a hysterectomy when she was young. She’s a doctor as well. She was 38 and had a hysterectomy for another reason. And she said to me, Louise, I made the mistake of doing too much, emptying the dishwasher too quickly, and I had to be readmitted because my scar broke down internally. She said, you don’t want that. So then I made this rule. I loved it, for three months, well not quite, I didn’t quite do it for three months, but I said to the children and my husband, look, I’m really not, you know, I’ve cooked for the freezer, food’s all done. I’m really not going to. And I loved the time because I worked a lot. I had my laptop and I caught up with loads of articles and all sorts of things that I wanted to do, and I actually, that’s when I created the Confidence in the Menopause course. I found a company to help me with it. I had lots of time, but it is making sure that people understand that. And I had three caesarean sections. So you do naively think. [00:23:28][53.8]

Melanie Verwoerd: [00:23:29] It’s the same, exactly. I had two. [00:23:29][0.0]

Dr Louise Newson: [00:23:31] Yeah. And it’s not the same. And I think the other thing is and I’m quite happy to talk about it, but the intimacy, if you do have a partner and you want to have sexual experience, it can be, I think, harder than after a baby because especially when you’ve had a total hysterectomy, you can’t visualise is your vagina the same length, does it feel the same your pelvic floor is not the same, you know? And in fact, Sam Evans, who’s a great nurse-trained sexual health person, and she actually contacted me before my hysterectomy and said, Louise, you need to think about your clitoris. You need to think about sort of stimulation, and in a different way. And I thought, gosh, why don’t we talk about this? Why do we just have to think about penetrative sex? And that’s all we can think about. But our clitoris isn’t damaged or affected, usually in a hysterectomy. And we need to talk very closely to our partner what is comfortable, what isn’t, how things change. Because you say that first three, six months, our vagina, our pelvic floor, these tissues change quite a lot don’t they? [00:24:35][64.0]

Melanie Verwoerd: [00:24:36] And the thing about it is that of course in many cases when they remove the cervix they also do shorten the vagina sometimes. So there is a difference in how it feels. Of course if the hormones are, if you have affected hormonally of course, also the vagina as I know you speak about a lot, can get dry and you know, so it’s very important that that can dealt with if there’s an actual wound of course that’s sore. And then psychologically women are worried, you know if there’s now because of course now if the cervix is removed there’s stitches up there, you know. And of course women get anxious. What if that gets undone? Of course they tell you not to have sex for the first six weeks. But it’s quite important that partners also understand that sometimes it takes a lot longer for women to get back into the sexual game. You know, they don’t feel well, they don’t feel themselves. It’s going to take a lot of time and patience, and that’s okay. For women also must feel that it’s okay and not feel obliged. Some women on the groups are day three and they’re like ready to rock, you know, not wise maybe, but I mean and I think it’s actually most probably something that’s not only to do with hysterectomy, but is also for women in menopause generally, you know, is to rediscover our bodies, to make peace with a body that changes dramatically, you know, not only hormonally but also in the ageing process and so on. And for me, I write about that in the book that’s not in the podcast is a medical more of a medical podcast, but the book itself I talk a lot about how I had to go through my personal journey of re-looking at my body, looking at sexuality, you know, sort of really interrogating that and what it meant and, you know, femininity. And. Yeah. So I think it’s not something that’s unique to hysterectomies, but of course, there is a sort of physical and psychological aspect to that. But I think it’s also a general issue around menopause. [00:26:21][104.7]

Dr Louise Newson: [00:26:22] Yeah, absolutely. I think totally. And like I’ve always said, we’re all individuals. So one person might have the operation, be bouncing back, like you say. Others might not either physically or psychologically or both. And that’s fine. Nothing’s right, nothing’s wrong. But the most important thing is that we are listened to and understood and know that, you know, time really helps, but we can be different in our experiences of the same operation. So I’m really grateful for your time. Before we finish, I just you’ve got your book there, haven’t you, just to hold up so you can share it, just three reasons really why people might want to read the book, whether they’ve had a hysterectomy or not. Many people will know someone that’s having one or had one or going to have one. So three reasons, sort of why we should look at the book or listen to your podcast series that you mentioned. [00:27:12][49.9]

Melanie Verwoerd: [00:27:13] So the book, which is called Never Waste a Good Hysterectomy. The first half of the book is about my experience with hysterectomy and women who have read it have very kindly said to me that they felt like it was them speaking, you know, they really associated with what was happening with them and the fear and anxiety and of bewilderment and so on. And then there’s a little bit of activism in there as well, you know, about, why not more research money is spent on specifically ovarian cancer, you know, so little money and the survival rate hasn’t improved. And I should say, mine in the end turned out to be benign. I should have said that at some point, thankfully. So I think for me it is about if you’re feeling lonely, if you need a voice, you know, if you need to read something that might, might be similar to your experience, that’s definitely there. The second part of the book is more for anybody who’s going through menopause. There I deal with, you know, so many of the issues I think women go through during menopause money issues, fears of relationships, the good girls scenario, the superwoman things, all of that. And then the third sort of thing about the podcast itself, the podcast under the same title, Never Waste A Good Hysterectomy, is a 12-episode series that is different from the book. It consists of interviews with doctors and medical experts. So it takes you through and that’s specifically for women with either have gone or going through a hysterectomy. It takes you from the terminology because, you know, I have to say, I was lying on the operating theatre and I had to, you know, they ask you for permission for everything they going to do. And they say they hysterectomy and I said yes. And then they said oophorectomy. And I sat up and I went, hold on, what’s that? You know, like, here’s me not knowing what they’re going to do to me. So the terminology, what to pack for the hospital, what to expect on the day, the pain relief, it takes you through the recovery period afterwards, the sexual issues after a hysterectomy, the pelvic floor issues, there’s an episode for men or partners specifically, and a psychological interview as well with the psychologists about the impact and that, so if you are going through a hysterectomy, or you have a mum or a friend who’s going through it, the podcast I think would be very, very helpful. And women from all over the world is, in the weirdest places in the world is downloading it. And clearly because they feel that they’re not empowered enough by the information. [00:29:32][139.5]

Dr Louise Newson: [00:29:34] Wonderful. So lots of good tips that somebody mentioned. Yeah lots of reasons, but I’m really grateful for you opening up this conversation. You learn so much from what people really experience, but I hopefully, people will just think a bit more about it. And also to be able to ask the right questions if they’re going for surgery themselves. So we will share the links in the notes. But thank you so much for your time. I’ve really enjoyed it. Thank you. [00:29:58][23.8]

Melanie Verwoerd: [00:29:58] Thank you very much. [00:29:59][0.6]

Dr Louise Newson: [00:30:03] You can find out more about Newson Health Group by visiting www.newsonhealth.co.uk. And you can download the free balance app on the App Store or Google Play. [00:30:03][0.0]

ENDS

The post My hysterectomy story: here’s what I wish I’d known appeared first on Balance Menopause & Hormones.

This week on the podcast, Dr Louise is joined by Dr Corinne Menn, a New York-based, board-certified OB-GYN and North American Menopause Society Certified Menopause Practitioner, with more than 20 years of experience caring for women.

When she was 28, Corinne was diagnosed with breast cancer. Following her BRCA2+ diagnosis, she underwent multiple surgeries and chemotherapy then navigated pregnancy and menopause plus longer term survivorship issues.

Corinne received support from the Young Survival Coalition, an organisation that advocates for women under 40 with breast cancer, and worked with her oncologists to manage her pregnancy, menopause and treatment options.

She feels passionately that women who have or have had breast cancer receive individualised care and treatment for their cancer and menopause symptoms, and shares three tips to help with quality of life:   

1. Do not minimise your menopausal symptoms, your hot flushes, your night sweats, sleep etc. So whether you use hormonal therapy or non-hormonal medications, make sure you get help and can sleep so you function better and breaking the vicious cycle of spiralling menopausal symptoms.
2. Please do not neglect vaginal sexual health. Again, if you can preserve a little bit of that, it can stop a negative cycle of suffering, of urinary tract infections and relationship and intimacy issues.
3. Scheduling time to have a separate appointment with your oncologist and your GYN. Come prepared. Listen to Louise’s podcast. Listen to Menopause in Cancer podcast and Instagram page. Be empowered because you and your quality of life are worth it.

You can follow Corinne on Instagram at @drmennobgyn

Click here to find out more about Newson Health.

The post Dr Corinne Menn: I’m a doctor who’s had breast cancer: here’s what I want you to know appeared first on Balance Menopause & Hormones.

Here, she shares her story – and her advice for other women in similar circumstances.

‘In my only appointment with the gynaecological surgeon before having my ovaries removed at the age of 41, I told her I was worried about the impact of going through an instant menopause.

‘She barely looked up as she replied: “You just don’t have periods anymore, it’s great.”

‘In one sense she was right, I don’t miss the inconvenience of my periods. But, as I suspected, I definitely do miss my hormones.

RELATED: Surgical menopause

Deciding to have surgery

‘I decided to have surgery to remove my ovaries and fallopian tubes after I found I was the carrier of the BRCA1 (breast cancer 1) gene.

‘This is a deeply unpleasant mutation which gives me an up to 90% chance of developing breast cancer and up to 60% chance of getting ovarian cancer.

‘I was tested for the gene after my younger sister was diagnosed with terminal breast cancer when five months pregnant.

‘Leah died at the age of 34 when her son was 18 months old. She never heard Seth call her mummy or take him to his first day at school. Listing all the things she has missed out on, and the ways we miss her, is impossible.

‘After finding out I had the same faulty copy of the gene I was keen to do anything to protect my health and hopefully avoid cancer.

‘I found the choice to have a double mastectomy, which would remove as much of my breast tissue as possible, very straightforward, and couldn’t wait for it to be done.

‘For this I had an incredible team of surgeons and specialist nurses, and – under national guidelines – I had to undergo a psychological assessment to check I had made the right decision.

‘There was excellent care before and after, and the breast reconstruction specialist nurses were always on the end of the phone if I ever needed help. I had this procedure done when I was 39 and felt mainly relief.

Preparing for an early surgical menopause 

‘When it came to my ovary removal, I was referred to the gynaecological surgery team at a different hospital.

‘My care was absolutely fine, but just much more perfunctory – with the surgery seen as routine and not a big deal.

‘Throughout there was a sense that all women go through the menopause, so why would I be concerned about going through it a decade early?

‘But for me the instant and early loss of the hormones produced by my ovaries was very worrying.

‘While I have two children, and didn’t plan to have anymore, knowing that my fertility would abruptly end on that day felt very strange, and hard to accept. I felt it changed my identity, pushing me into a new phase of life I didn’t really feel ready for.

‘I also worried about the physical and emotional impact of menopause which, thanks to my job as a health journalist, I knew a bit about.

‘When I asked my surgeon if I would feel the same after my ovary removal as I do now, she was honest. “Not everyone does,” she said.

How talking helped process my feelings

‘The day before the surgery I felt wretched. I was surprised how strongly against it I felt, despite knowing I was lucky to have options that I wish my sister could have had.

‘I called the phone line of the gynaecological charity the Eve Appeal where a wonderful specialist nurse listened to my fears, let me cry and told me what I felt was completely normal. She had spoken to women diagnosed with ovarian cancer who still found the idea of ovary removal difficult.

‘Hearing someone say that was so profoundly helpful. 

‘I always knew I would go through with the surgery; I want to be around to watch my children grow up and I knew it was the right choice for me.

‘But someone telling me the turmoil I felt was completely normal helped me enormously.

The day of my operation

‘On the day of the operation, when I was dropped off alone due to COVID-19 restrictions, the surgeon asked if there was anything I needed that she could help with.

‘I was last on the Friday surgical list, due to be discharged that night, and I asked if I could leave with some HRT.

‘While HRT may not be available for some women with a higher breast cancer risk, I had already had my mastectomy, and was told I could have it safely.

‘The guidance from the National Institute for Health and Care Excellence (NICE) recommends that women who have a BRCA mutation, have not had breast cancer and have had their ovaries removed, have HRT until the age of 51 or 52 – the average age for menopause in the UK.

‘My surgeon seemed surprised I was worried about accessing HRT promptly and said it was something I should go to the GP about. I said: “But what if menopausal symptoms kick in straight away this weekend?”

‘She listened to me and kindly came back before my operation with a pack of estrogen patches.

Starting HRT

‘I put my first patch on two days later as I felt pretty unwell and in pain after the surgery, and didn’t want to add menopausal symptoms into the mix.

RELATED: Endometriosis: I went through a medical menopause at 24

‘Looking back, I think my experience has been much better than I feared before surgery. I have had virtually no menopausal symptoms, I do all the things I did before and I have never regretted my choice to have my ovaries removed.

‘The main aspect I have found challenging is one I hadn’t really considered. I have had chronic eczema and very dry skin my whole life, and going through the menopause has definitely worsened the condition.

‘While I knew my skin was never going to age well, I can feel and see that it has aged quite dramatically since I had the surgery two years ago. 

RELATED: Will menopause make my eczema worse?

‘Ageing is a privilege that too many women in my unlucky family were not offered but, occasionally, guiltily, I wish my skin looked different. 

‘It is sore and fragile, and I wake in the night scratching, something that probably hasn’t happened since it was a child.

‘My bad skin also reacted to the estrogen patches, so I quite quickly moved over to taking estrogen oral tablets. I had a Mirena coil fitted during the surgery which provides me with the progesterone element of HRT for five years.

‘I have the option of seeing my surgeon every year or to check my HRT, and currently I’m on a relatively high dose of 3mg of estrogen a day.

Be informed and advocate for yourself: my advice to others

‘For someone else considering this surgery, I would say be informed and find out as much as you can before seeing your surgeon, as you probably won’t have many appointments with them. 

‘Also ask about HRT and if it could be suitable for you, as I think my journey would have been very different if I hadn’t been able to take it.

‘And if you find it a difficult decision, know that you are not alone. It is a very personal decision, I feel I took the right option for me and I have never regretted it.’

Would you like to share your experience of perimenopause or menopause? Write to us at shareyourstory@balance-app.com

The post My story: early surgical menopause appeared first on Balance Menopause & Hormones.

Endometriosis is a common condition where the type of cells that normally line your womb (uterus) are found elsewhere in your body, such as your ovaries and fallopian tubes, bowel and bladder. Endometriosis can cause heavy, painful periods, pain in your abdomen and pelvis, and for some women, problems with infertility.

The condition affects one in 10 women, girls, people and teenagers, a similar number to those affected by diabetes.

Yet it takes on average eight years from onset of symptoms to get a diagnosis due to health inequalities and a lack of research.

Here, campaigner Emily Griffiths shares her story of her struggle to get a diagnosis, and how endometriosis treatment led to her going through a medical menopause at the age of 24.

‘It took nine long years for me to be diagnosed with endometriosis.

‘My symptoms started in my teens: I began having extremely heavy periods and severe pain, but my symptoms were continuously dismissed by healthcare professionals and I was told my symptoms were in my head.

‘I endured years of excruciating pain, both during my period and in between periods. There were countless hospital trips, and I had more mental health referrals than scans for my ovaries.

How sepsis led to my endometriosis diagnosis

‘It wasn’t until I was rushed to hospital aged 21 with sepsis where I almost lost my life before I was diagnosed with endometriosis and adenomyosis.

‘Since my diagnosis, I’ve undergone two privately funded lifesaving surgeries to save my kidneys, to remove a 25cm endometrioma cyst from my left ovary and disease from all over my pelvic nerves, bladder and bowel.

‘As treatments for endometriosis are extremely limited, I’m currently in medical menopause from an injection called Prostap, which temporarily stops my ovaries from functioning and therefore the production of estrogen. HRT has been a really tricky process due to the limited supply I can take but I’m powering through the best I can. Treatments like Prostap slow the progression of endometriosis and so relieve pain, but they don’t stop the growth of endometriosis altogether, and this is why it’s so important to have improved research.

RELATED: Endometriosis and HRT factsheet

The impact of a medical menopause

‘Going through the menopause at just 24 has been really difficult. My menopause symptoms have been varied: hot flushes, body aches, headaches, low mood and insomnia.

‘It’s felt a lonely journey due to menopause being known as something you go through at a later stage of your life, not when you’re young.

‘The emotional impact of menopause is substantial, it’s in your everyday life and so it’s  important we continue to talk about the menopause, especially raising awareness of the young people going through it due to a medication or a medical condition.

Campaigning for better endometriosis and adenomyosis support

‘I really hope in the future that all women can have access to education and correct care for the menopause including treatments like HRT, and the speciality of support for those going through the menopause no matter where you live. I speak openly about living with endometriosis, adenomyosis and menopause, and raise awareness at any given chance in the hope to help someone else and create change for future generations.

‘Women’s Health is mostly misunderstood, and I really want to see that change, we will simply not be “pushed away” anymore.

RELATED: Podcast: endometriosis and the menopause

Educate and advocate for yourself

‘I really admire the work of balance and all the information provided which really helped me feel less anxious. My advice to others is to know as much information as possible, track your symptoms, be ready to advocate for yourself, ask questions to medical professionals and if you’re not happy with the result ask for a second opinion, remember you know your body better than anyone else.

‘I respect that diagnosis can be a privilege and this needs to change, I also understand that not everyone has someone to talk to but please know you are not alone if you’re feeling unwell and there are some amazing online communities and online groups you could join. ‘Both endometriosis and menopause have impacted my life hugely. It’s been several years of suffering and unfortunately I will need another surgery soon but I hope every day that soon we will hopefully have the positive change we really need.

RELATED: Adenomyosis and the perimenopause and menopause

‘I campaign every day, I work with government members including my local MP. I’ve also worked with organisations like the United Nations and other organisations for the rights of women and girls with a focus on healthcare and menstrual health, written and featured in many articles about my experiences of living with a chronic illness.

‘My future hope is seeing a change for conditions like endometriosis and menopause where care is at a much better standard with more research. I also have hope for future generations of women to be able to access healthcare without stigma and worry of dismissal and where women’s symptoms are listened to so they can live a fulfilling life.

‘If we all come together, talk about our experiences, raise awareness and strive for the change we want to see, I’m really hopeful we will see it.’

Would you like to share your experience of perimenopause or menopause? Write to us at shareyourstory@balance-app.com

The post Endometriosis: I went through a medical menopause at 24 appeared first on Balance Menopause & Hormones.

Dr Walter Rocca is a neurologist from the Mayo Clinic in Minnesota, USA, where he studies common neurological diseases as well as the aging processes between men and women. He has a particular focus on estrogen and the effects of menopause on health risks.

In this episode, Dr Rocca explains how sex hormones have a much greater role in many of the body’s functions than simply regulating the menstrual cycle and reproduction. He explains why it’s so important to treat women with hormone replacement after bilateral oophorectomy with or without hysterectomy or early menopause, especially younger women.

Dr Rocca’s three take home messages:

1. The ovaries are a tremendously important organ for healthy functioning of our heart, brain, bones, kidneys, lungs and more.
2. For healthcare professionals: be very careful when thinking about removing the ovaries and/or the uterus, unless there is a very clear clinical indication. The longer-term harmful effects of these surgeries are greater than the apparent short-term benefit to symptoms.
3. If a woman has a high genetic risk of ovarian cancer (>40% risk level), removal of the ovaries is appropriate, but she should be given estrogen therapy afterwards as the risk associated with this treatment is very low (including for BRCA carriers). If a natural menopause occurs early or prematurely, these women should also be offered estrogen therapy, unless there is a specific contraindication.

More about Dr Walter Rocca

Episode transcript:

Dr Louise Newson [00:00:09] Hello, I’m Dr. Louise Newson and welcome to my podcast. I’m a GP and menopause specialist and I run the Newson Health Menopause and Wellbeing Centre here in Stratford upon Avon. I’m also the founder of the Menopause charity and the menopause support app called balance. On the podcast, I will be joined each week by an exciting guest to help provide evidence-based information and advice about both the perimenopause and the menopause. So today I’m very, very excited actually, to introduce to you someone that I’ve been stalking from afar without him realising for quite a few years, someone called Dr. Walter Rocca, who works out of the Mayo Clinic in Minnesota. I first heard him lecture a few years ago at a conference about what happens when younger women have their ovaries removed and the changes that occur, especially the health risks that occur. And everything he lectured on made sense. And I thought, how do I get hold of this person? So I’ve been reading a lot of information and emailing him from afar, and then I have the privilege of meeting him in real life at the International Menopause Society in Lisbon last year, in 2022. And now he’s here that I can speak to in my studio. So thanks ever so much, Walter, for joining me today.

Dr Walter Rocca [00:01:33] You’re welcome. It’s a pleasure.

Dr Louise Newson [00:01:35] So tell me about your work and your background and why you do what you do, if you don’t mind.

Dr Walter Rocca [00:01:41] Well, that can be a long, long question, but I’ll try to keep it focused if we can. I by training am a neurologist. So, a brain specialist. But I also spent quite some time learning research methods. So how can you use data to answer questions in medicine? You know, like in medicine, we are dealing with a lot of uncertainties, a lot of things that are not clear or that are not resolved. And then we progress by creating evidence or data or pieces of knowledge on which we can then build a bigger theory. And so I got trained formally in research methodology, and then I tried to work on neurological diseases. And while I was doing neurological diseases, primarily dementia and Parkinson’s disease, I discovered that they were potentially connected with reproductive issues, which at the beginning I thought was strange because we think of the head and the pelvis far away.

Dr Louise Newson [00:02:51] Of course.

Dr Walter Rocca [00:02:52] And so I said, oh, so the pelvis and the brain are connected. And so then I started doing work on endocrinology, like the production of sex hormones by the genitalia and the relation of that to the brain. And that’s how some of the stories developed.

Dr Louise Newson [00:03:07] Very interesting. And it is very interesting for lots of reasons, because when we think about the menopause it’s often defined as loss of ovarian function, so our ovaries stop working, but actually breaking down the word menopause is about our periods stopping. So, a lot of people think it’s related to our endometrium, the lining of our womb, or it’s related to fertility stopping, you know, being able to have children. Now, I’m a menopausal woman and I don’t really care about my fertility because age 52, I really shouldn’t be having children. I’m, you know, very fortunate. I have three daughters, but also, I’ve had a hysterectomy. So I don’t have periods. So I can’t be defined by my menstruation because obviously I’m not going to bleed because I haven’t got a womb. So, then it’s really if you think about ovarian function, some people don’t have their ovaries. So, for me it’s more about the hormones not being there in our body or if they are, they’re in there in at low levels and about our hormones being biologically active throughout our body, whereas for a lot of people they just think our ovaries are about our womb and they regulate our womb and don’t realise that actually these hormones get into our brain and the neurotransmitters and they get everywhere in our body, don’t they?

Dr Walter Rocca [00:04:27] Yes. And this is the central misunderstanding. So for now, 30, 40 years there was this idea that the ovaries were very important to produce ova, which would then get fertilised and make babies okay, and they would also make hormones. But these hormones were important for the endometrium, for the vagina, for the breasts. They were sex hormones. They were not hormones for the body. And if you followed this misunderstanding and you think that the ovaries are reproductive organs, period, then you completely miss the point. So people were saying, okay, when a woman has completed her period, she does not plan to have additional children and she’s having any even minimal issues with bleeding or pain or anything, well, then we just take everything out. So if these organs are only reproductive and they are not “needed any more”, then we can just simply clean it all out and we will then protect these women from developing cancer of these tissues. Of course, if you don’t have the uterus, if you don’t have the ovaries, you will not develop ovarian cancer or uterine cancer. And there was also the belief that that would also reduce breast cancer. Well, unfortunately, that was a big misunderstanding because the ovaries produce estrogen, progesterone and testosterone in addition to other less important hormones which end up having effects on many, I would say almost all, organs and tissues and at the cellular level so that basically the full body of a woman is under endocrine control all the time. And the same for men with testosterone and estrogen. Of course, as you know, men have also organs equivalent that are the testis and they produce testosterone and estrogen and other steroids which are essential to control the body of man. And the body is all of the tissues. So whether it’s cardiovascular disease, your heart, your bones, your brain, your kidney, your lungs, your skin, your eyes. So it’s amazing, our complete misunderstanding. So, these became clear starting around 2005, 2006, there was a famous colleague from California, from Los Angeles, who in 2006 said, well, if you look at the data out there, there is some suspect that when you remove the ovaries to a premenopausal woman, yes, you have a reduction of ovarian cancer. Yes, you may have some reduction of breast cancer, but these women simply die faster than if you didn’t. This was 2005. And that was the first person that got to say, what we do may not be correct. And then, of course, now we are like 15 years later. And we can say pretty comfortably that we now know exactly what was going on. But for many, many years, the practice was done with complete confidence that it was based on good evidence. It was simply wrong evidence and was absence of evidence. So sometime medical practice is based on judgement, preference, human emotions, and it is not corresponding to evidence, meaning to any attempt of applying scientific methods to nature to understand what’s happening there. As you know, Western science started in the 1500s in Europe and was the idea of bringing people out of beliefs, the irrational belief, magic, religions into something that would be reproducible, trustable and that’s all the development of science. But even in 2023, we still have many things that we do that are not based on science, and they are based on tradition, preferences, who knows, anthropological phenomena.

Dr Louise Newson [00:08:54] Well, there’s always a combination, isn’t there? And often in medicine, it’s also what our peers are doing or how we’ve been taught. And that often can have a bigger impact than maybe an article that we’ve read or actually what happens now, everyone’s too busy, so they don’t always read the evidence. Or if the evidence is not quite what they thought, they tend to ignore it. And that’s what’s happens a lot with menopause, actually, because the more I talk about it as a hormone deficiency, the more actually on social media and everyone’s saying, how dare I? Of course, it’s not a hormone deficiency. Well, if I don’t have hormones being produced by my ovaries, I have a hormone deficiency. I don’t understand quite how else to explain it. But certainly when I was training as a medical student in the eighties and early nineties, you’re absolutely right. The standard practice was, oh, well, you might as well remove the ovaries, especially if they don’t need children or don’t want children. Take them out, then they won’t have ovarian cancer. But when I had my hysterectomy, I was in my late forties, so I was perimenopausal. I’d started HRT, but it took me quite a long time to decide should I have my ovaries out or not? But I just thought, any hormones that they’re squirting out, I might as well keep them for as long as possible. And that’s a personal, individual choice. But actually, the work that you’ve done, looking at women who are under the age of 40, so who are young and they’re young to be menopausal. And it’s very interesting whether you call it a surgical menopause, you know, it’s a lot of women have their ovaries removed and not their womb. So are they menopausal because they’ve still got their womb? It doesn’t really matter. You’ve actually removed their ovarian function, haven’t you? And their hormones are very low. So looking at this accelerated ageing, this inflammation that occurs in the body, which we know occurs during the menopause, but it’s quite accelerated, isn’t it, in these young women who suddenly have their hormones withdrawn from their body?

Dr Walter Rocca [00:10:46] Yes. In my experience, at least in the data that we have collected here in the United States, the majority of women that have the ovaries removed, they also have the uterus removed either at the same time or they had the uterus removed before. So, the majority of women that come out of a surgery to remove the ovaries are also without the uterus. But of course, you could consider removing the ovaries and keeping the uterus. Absolutely, that would be completely possible. But it’s very uncommon historically. One problem that we are working on is my concern for women who have their uterus removed, even if the ovaries are conserved, is that sometimes these women then don’t have menses. And so it becomes very difficult to then decide precisely when they become menopausal. And so if they don’t take estrogen or treatment and they don’t know when they become menopausal, they may kind of fall through the cracks and be in the limbo because they are not having menses, but they may still be hormonally active, but at some point they will become hormonally silent and they may or may not realise it. If they have very major symptoms, they may then complain of the symptoms and that will maybe attract the attention of the physician and of the woman to do something about it. But sometimes they don’t. And so there may be women that have the uterus removed and they conserved the ovary, which is the correct thing to do if you really need to remove the uterus, if you have a strong indication, but these women, then we cannot really say when they became menopausal. And I’m actually just now writing a paper that should be coming out in Maturitas in the United Kingdom, where we actually argue that for these women it’s difficult because nobody wants to spend the money to do the testing of their blood every six month. I mean, you would have to test these women every six months, they come and we measure their hormones until one day we say, oh, your hormones are low, some hormones are low some hormones are high. And so you are menopausal. That doesn’t make any sense because it’s costly, it’s invasive. So these women may walk around without knowing when they became menopausal. They can tell you when they stop menstruating because that will be the day after their hysterectomy, but they cannot tell you when they became menopausal. So if they were naturally predisposed to be premature or early menopause, having removed the uterus before will conceal or will censor their menopause. So, they may not know that they are having a premature or early cessation of ovarian function. The doctor will not treat them and they may be at a disadvantage if they don’t get treated because nobody knows that there is a problem. So that is kind of an interesting group of women and they are not uncommon as you testify. It’s a good big group of women who are now walking around and they have undergone hysterectomy, they have the ovaries in place and they are in this limbo state. And some of them, they should be treated and they are not being treated.

Dr Louise Newson [00:14:03] Absolutely. And we see a lot of these women who are on antidepressants and they’re often on blood pressure lowering treatment. They’re sometimes on sleeping tablets, they’re often on cholesterol lowering treatment. And when you talk to them, they say, oh, I’ve been feeling so dreadful. I’ve given up my work, my partner has left me, my relationship has been really terrible, I’ve been diagnosed with osteopenia, osteoporosis, I’ve got arthritis of this. And then you say, well, when did your health start to deteriorate? Oh, it was about a year after I had my hysterectomy. But I don’t think that’s related because it was just my hysterectomy. And you can see it’s all happened. But even women who have had their ovaries removed at a young age, certainly in the UK, a lot of them are still not offered hormone replacement routinely. And so we tend to pick up the pieces further down the line. And we’ve seen quite a few women in my clinic recently have been told by the surgeon ‘just see how you get on. You don’t really want hormones to see how you get on and come back if there are any problems’. Well, a lot of women and then waiting for flushes and sweats because that’s all they read about with the menopause. A lot of young women, women in general often don’t get them, I never had a hot flush at all, so how would they know? But then they’re presenting with all these other symptoms. But I think what’s really interesting is your list of diseases that are associated with having their hormones removed or reduced at a young age, because even your list of all those conditions includes psychosis and kidney disease and Parkinson’s disease, your lovely paper that’s recently come out. So, there’s a lot of these inflammatory conditions, but conditions that you wouldn’t necessarily put together. And I don’t think anyone that goes to a renal clinic, renal physicians would even think about hormones.

Dr Walter Rocca [00:15:50] Yes, indeed. When we published our paper showing that absence of adequate estrogen at the right age is linked to chronic kidney disease, which then would lead to dialysis to death due to kidney failure. It was somewhat official for us, it was a first. I mean, there was some data, but not very convincing on the estrogen effect, the menopause effect. But clearly nobody would have even expected these. The same with lungs. We found that there is an effect on chronic obstructive pulmonary disorder, which again was very clear. The situation is a bit more complicated with asthma. Okay, so the confusion with the lung is between asthma and chronic obstructive pulmonary disorder and chronic bronchitis bronchiectasis, because the estrogen is slightly different in the two conditions. Estrogen sometimes is worsening asthma symptoms but in the same time it’s protecting your lung tissue. So you have to be very careful not to lump everything into a single package. Otherwise you say, oh, yesterday’s not really important in the lung. Well, it’s important in different ways. So whether you protect the mucosa, you protect the alveoli or you have this constriction which is more acute. But very fascinating work on the lung we have done in collaboration with the group of experts on the lung here at the Mayo Clinic. So it’s fascinating what we are learning. And the way I see it is that of course, I’m taking a bit of a scientific perspective because for me the scope is to understand what’s going on. Of course, for other people to translate this understanding into improving the health of women. So I think I’m contributing to improving the health of women, but by understanding what’s happened in the background. And so from the background, we can consider the women that now are living in the UK or in the US or in any other country, these women that have had surgery, we should study them because they will teach us what to do for the next generation. So even though you can say, well, I’m very sad that they had the surgery, but they did have the surgery. So at this point it’s rather good pragmatism to study them and see what happened to them, understand them, and then we can tell their daughter or their sister or the new generation, you know, this is not a good idea. This is a good idea. And so, in a sense, what’s happened to women that the ovaries removed young becomes almost like a window to understanding ageing, to understanding menopause, and that it’s really revealing to us a lot of things that we didn’t know before of the effect of estrogen on organs like the kidney or the lung or the skin that you would not think about unless you start looking at big groups of women who had the ovaries removed.

Dr Louise Newson [00:18:40] And to me, I’ve got a pathology and immunology degree as well, and I’m very interested in basic science. Sometimes in medicine, if we can’t understand things or things sound conflicting, I always go back to basics because it’s just easier, actually. And I remember having a lot of lectures by a very eminent professor of biochemistry talking about our inflammatory cells, especially our macrophages, and if they’re not switched on properly, they become very pro-inflammatory. So they’re not good in the body. They turn on us almost. Whereas if we’ve got the right stimulation, they become very anti-inflammatory, which helps protect our body from inflammatory diseases, and that includes diseases such as heart disease, osteoporosis, Type 2 diabetes, dementia, all the diseases in fact, that are related to that list that you have seen and women that have their ovaries removed. So the lack of estrogen is switching those immune cells in a bad negative way. So, it actually makes sense. You know, your research is confirming some basic science that we’ve known for many, many years.

Dr Walter Rocca [00:19:42] Right now it has been shown that even the women that have a high-risk genetic marker. So even women that carry BRCA 1, BRCA 3, or Lynch syndrome, these women currently we believe, they should consider oophorectomy at the given age range because their risk is so high, 40, 50%, then it justifies at that level of risk the risk of having all of the other diseases. But, even if they have a high risk of cancer, ovarian and breast, it’s still indicated to give them estrogen because that’s been shown that estrogen in these women is not risky and does not worsen the cancer risk, but did benefit the dementia, the cardiovascular and the bones. So, I would say that we have now learned that even women who have high genetic risk, they should be comfortable in taking estrogen at the appropriate dosage.

Dr Louise Newson [00:20:47] Yeah, looking at young women, I sort of really think, why are we not giving hormones rather than should we be giving hormones? Because certainly up to the age of 51, we are really designed to have these hormones in our body. And so it really should be the minority of women following an oophorectomy or an early menopause should be not having HRT yet. We still know only the minority actually are given HRT. And it’s really difficult, as you say, we don’t have a diagnostic test. It’s easier if someone has their ovaries removed because then we know. But actually there are still so many women who are young without any contraindications, who have both ovaries removed, who are not routinely given HRT or even had the conversation. And that should be really the conversation should occur before the surgery, shouldn’t it as we know, because so many women don’t still know what the menopause means. And actually they think, Oh, if it’s a few hot flashes, I’ll get through them and then I’ll be okay. What people really need to do is to talk about, you know, your studies, your research showing these health risks if people don’t have hormones back when they’re young.

Dr Walter Rocca [00:21:59] Yes, absolutely. The hot flushes may be quite invasive and quite challenging on the life of women. I’m not saying that I’m not diminishing, but certainly those are not the kind of problem we are concerned about. We are concerned about cardiovascular, neurological, you know, major functionality of kidney, lung. So those are big issues.

Dr Louise Newson [00:22:21] I see some people who say, no, I have no symptoms at all. And then you start to talk to them and you say, well, what’s your sleep like? Oh, it’s terrible. I don’t sleep very well. Do you have any muscle or joint pains? Oh, yes. I spoke to a patient today, actually, and she tells me that she’s waking every night with awful muscle and joint pain. And it started when her periods stopped. And then you say, well, some people have got dry eyes. They can’t wear contact lenses or they’ve got urinary symptoms or they’ve got headaches or tinnitus. But they won’t say that’s related to their menopause because they don’t realise these symptoms. And it’s often when you give HRT, they say, goodness me, I can think clearly, I’m sleeping better, I’ve got no muscle pain, I’ve got more energy. And it’s these sort of subtle symptoms that make it quite difficult. And even certainly when I was perimenopausal, I didn’t know whether my symptoms were just because I was working too hard or whether I, you know, was in the wrong job or just because of having children and everything else. And then I thought, no, I’m just not coping. Maybe I’m just failing as a person and then it’s only having hormones back. You think, goodness, while the lights are on, I can think and colour again. Everything’s come back. But we’ve talked a lot about estrogen. But testosterone is also another important hormone that a lot of women find that they miss, especially when they’re young and have their ovaries removed, isn’t it?

Dr Walter Rocca [00:23:37] Yeah, unfortunately we know so much less about the dosage and possible toxicity, which then makes it difficult to really use it, which is probably it should be used more, but we should have then, you know, good data to support because again, there is fear. I mean, the problem, the enemy is always the fear. Oh, I take this medication and it will cause something bad to me. And yes, it could cause something better. You could also add to you a great deal. It could make your life much less miserable. So it’s always a matter of knowing precisely the correct dosage, the correct amount and all of that in that, you know, for example, in the United States, we don’t have a good product of testosterone for women in other countries like Australia. I think UK, you have some.

Dr Louise Newson [00:24:20] Well no, Australia is licensed for women in the UK, we don’t have a licensed product. We often use the Australian cream that we can use or we use a male licensed testosterone in lower doses, but we’ve been doing a lot of analysis of our patients actually of how their symptoms improve when they’re already on estrogen and we add in testosterone and we find that libido can improve unsurprisingly, and then we give it for reduced libido. But we’re monitoring all the other symptoms and we’ve found that actually mental health symptoms, so mood, anxiety actually improved significantly more than the reduced libido improves, and also muscle and joint pains improve. So we’ve got quite a lot of numbers and we are going to publish it soon. But that’s really interesting actually. And we find clinically women say my mood my energy, my concentration, my stamina improve. And we know from some of the preclinical studies looking at testosterone in mice, it’s exactly the same this anhedonia this can’t be bothered to do anything that creeps in when testosterone’s low. And it makes it very hard because a lot of women they’re not either listened to or no one thinks about testosterone or they’re sort of scared about it. But if you give it as a physiological dose and assess and I feel very strongly that women can be in control of this actually, and a lot of women, myself included, I wouldn’t be able to function without testosterone. But I mean, my level is still very, very low, but it was incredibly low. So it’s just still low, normal. But it’s fine. I can function. I haven’t got a beard, I don’t have any hair anywhere. I don’t have any side effects. So it’s my decision that I want to carry on knowing that I’m monitored carefully. And actually I just think of it as replacing a hormone like I would if I had low thyroxine. It’s very unusual, I think, to have a long-term problem, but we need more data. And this is where it’s so frustrating. The lack of science and good quality research in menopausal women. It’s just been neglected for so long, hasn’t it?

Dr Walter Rocca [00:26:22] And that’s why in 2005, 2006, we were doing massive gynaecological surgeries. Assuming that was good, there was no problem. And, you know, like nobody thought that there would be any consequences because if you follow women for six months or a year or two or three years, you don’t see anything. You have to follow women for 15, 20, 25, 30 years to see the long-term sequelae of this derailing of the endocrine system. You know, short term, you can see effects on sleep, on mood and anxiety, on feelings, quality of life, but you don’t see the damage to the kidney, to the long, to the arteries or to the brain. This takes 20, 30 years. We could only show these effects because we were able to follow women historically for a very long period of time. And that’s what we did. What the registries in Europe, like in Denmark or in Finland. Other studies where there were very good registries. They could then follow women with data for a very long period of time. If you only follow women shortly, it’s a short-term effect it’s a completely different question.

Dr Louise Newson [00:27:37] But now we’ve got this data I feel really strongly to improve the global health of women. To prevent disease, we have to act on, you know, your data, your results. And we certainly, even if we did start looking at young women, they really shouldn’t be neglected from hormones, especially, you know, if there’s no contraindication because of the health benefits in their health, preventative benefits that you’ve clearly shown.

Dr Walter Rocca [00:28:01] Absolutely.

Dr Louise Newson [00:28:02] So we need to change the tide. We need to move the needle. We need to, you know, allow women to have what they can have with their hormones back to not just improve symptoms but to reduce disease. So I’m very grateful for you to talk to me, Walter and I’m very grateful for the research you’ve done actually. And I just hope we can shout about it more and more. But before we finish, I know you’re so diligent that you’ve already done your three take home tips. Do you mind sharing them with us, please?

Dr Walter Rocca [00:28:31] Well, yes, I thought because I wanted to make sure that they would say something that is really useful to the people that are listening to us to be as beneficial as we can in terms of sharing our experience. These 15 years that I’ve spent looking at these issues and reading the literature and listening to my colleagues and debating with my colleagues have really put me in this position to have some opinion. So, the first message is that I would really like to impress on the listeners that the ovaries are a tremendously important organ and they are not only a reproductive organ, but as we said at the beginning, they are glands like the thyroid. So these are the adrenal gland, they are vital. They are needed to function normally and so they have influence on outside of the reproductive system, especially on the heart, the brain, the bone, the kidney and the lung. This is the most important. Of course, they have effect on the cartilage, the skin, the eyes. But I would say these are a little bit less vital than the others.

The second message is that I would really like if this reaches anybody who is in practice, in gynaecology or in internal medicine, to be very careful about suggesting the removal of ovaries or uterus in women unless there is a clear, clear documented indication. These are not surgeries that should be done light-heartedly they are not nonconsequential. And because we have now shown that the harmful effects are way, way greater than the immediate apparent benefit of having less bleeding or less abdominal pain or things of that sort. So don’t remove the genitalia light-heartedly because it may be a dangerous idea.

If a woman, finally, the third message really is the minority of women that have a genetic high risk. And these women, of course, exist and they have a serious problem, women that carry a BRCA1, BRCA2, or they are affected by Lynch syndrome and a few other rare conditions you probably don’t know the name of these women, that they are a risk of ovarian cancer. And I really mean 40, 50, 60%. Okay. Those are the ones that should be serious about using the removal of their organ as a preventive technique, not the women that are at 2%, 3%. That is a crazy idea. But if they are at high genetic risk, they should then consider removing the ovaries at the proper time window, which varies depending on whether you have BRCA1 or BRCA2. But even if you remove the ovaries, these women should be prescribed estrogen replacement therapy because they are going to be deprived of estrogen in a period of life in which they are supposed to have the estrogen. So you remove the organ which you think is where the cancer may develop, but you give the hormone that the organ would have produced to protect the remaining organs of the body, such as the brain, the bone and the heart. So the indication today and I would say there is consensus on this, is that these women should receive estrogen. Similarly, for women who naturally, without any medical intervention, experience premature meaning below 40 or early between 40 and 45 years menopause also, these women should be treated as if they had had the surgery because they were having premature or early menopause and they are having unusually low levels of circulating hormones that are supposed to be there. And so these women might actually benefit from being treated properly through the age of 50, 51 at least.

Dr Louise Newson [00:32:43] So very good advice. Thank you so much for your time and I look forward to reading even more papers as you publish them Walter, so thanks very much for your time today.

Dr Walter Rocca [00:32:53] Thank you very much. And thank you for the invitation. And I hope this is useful to the listeners.

Dr Louise Newson [00:32:58] Absolutely. Thank you. For more information about the perimenopause and menopause, please visit my website, www.balance-menopause.com. Or you can download the free balance app, which is available to download from the App Store or from Google Play.

END.

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Les œstrogènes ont un impact bénéfique sur de nombreux tissus, organes et fonctions  de votre corps : le cerveau, la peau, les os, le cœur, les fonctions urinaires et la zone génitale – de faibles niveaux d’œstrogènes peuvent affecter toutes ces parties de votre corps.

Qu’est-ce que la périménopause?

Le terme périménopause est souvent utilisé pour décrire la période précédant la ménopause, pendant laquelle vous ressentez les symptômes de la ménopause mais avez encore vos règles. Les cycles changent généralement au cours de la périménopause et peuvent être plus longs ou plus courts ; les règles peuvent être plus irrégulières et avoir un flux plus abondant ou plus faible.

Les hormones œstrogènes et progestérone sont complémentaires pour réguler votre cycle menstruel et la production d’ovules. Pendant la périménopause, les niveaux de ces hormones fluctuent fortement et c’est souvent le déséquilibre de ces hormones qui entraîne l’apparition des symptômes de la ménopause. Pour certaines femmes, les symptômes ne se manifestent que pendant quelques mois, puis leurs règles s’arrêtent complètement. Cependant, d’autres femmes ressentent des symptômes pendant de nombreux mois, voire des années, avant l’arrêt de leurs règles. Souvent, lorsque vous lisez des articles sur les symptômes de la ménopause, ils incluent également les symptômes de la périménopause, car ils sont identiques et tous deux sont dus à l’évolution des taux de vos hormones.

Quand cela se produit-il?

L’âge moyen de la ménopause au Royaume-Uni est de 51 ans, ce qui signifie que les dernières règles surviennent, en moyenne, à 50 ans, mais cela peut être plus tôt pour certaines femmes. Les symptômes de la périménopause commencent souvent vers 45 ans. Si la ménopause survient avant l’âge de 45 ans, on parle de ménopause précoce. Si elle survient avant 40 ans, on parle d’insuffisance ovarienne prématurée (IOP). La ménopause précoce ou l’IOP peut parfois être héréditaire.

La ménopause chirurgicale

Bien que la ménopause soit un événement normal dans la vie d’une femme, certaines conditions peuvent entraîner une ménopause précoce. Par exemple:

si vous avez subi une ablation des ovaires

si vous avez subi une radiothérapie dans la région pelvienne pour traiter un cancer

si vous avez reçu certains types de médicaments de chimiothérapie pour traiter le cancer

si vous avez reçu un traitement médical ou chirurgical pour l’endométriose ou le syndrome prémenstruel. Certains facteurs génétiques et auto-immuns peuvent contribuer à une ménopause précoce.

Si vous avez subi une ablation de l’utérus avant la ménopause, par une opération appelée hystérectomie, vous pouvez connaître une ménopause précoce même si vos ovaires ne sont pas enlevés. Vos ovaires continueront à produire des œstrogènes après l’hystérectomie, mais il est fréquent que votre taux d’œstrogènes diminue plus tôt que la moyenne en raison de la réduction du flux sanguin. Étant donné que les femmes n’ont pas de règles après une hystérectomie, il se peut que vous ne sachiez pas exactement quand vous êtes en “ménopause”, mais vous pouvez développer certains symptômes typiques lorsque votre taux d’œstrogènes diminue.

Poser le diagnostic de la ménopause

Si vous avez plus de 45 ans, que vous avez des règles irrégulières et d’autres symptômes de la ménopause, vous n’avez normalement pas besoin de tests pour diagnostiquer la ménopause. Votre récit des symptômes que vous ressentez constitue la base du diagnostic de la périménopause ou de la ménopause. Il est utile de suivre vos symptômes à l’aide d’une application mobile telle que “balance” menopause support, ou vous pouvez remplir le questionnaire Greene Climacteric Scale disponible sur le site Web www.balance-menopause.com .

Si vous avez moins de 45 ans, votre professionnel de santé peut vous demander de passer certains tests avant de poser un diagnostic. Le test le plus courant est une analyse de sang mesurant le niveau d’une hormone appelée hormone folliculo-stimulante (FSH). Si ce taux est élevé, il est très probable que vous soyez ménopausée. Ce test sanguin est souvent répété 4 à 6 semaines plus tard. Si vous avez moins de 40 ans, il peut vous être conseillé d’effectuer des examens complémentaires afin d’exclure d’autres pathologies susceptibles d’interrompre les règles ou d’affecter le fonctionnement de vos ovaires.

Traitements de la ménopause

Le traitement le plus efficace des symptômes de la ménopause consiste à remplacer les hormones que votre corps ne produit plus. Le traitement hormonal substitutif (THS ou THM) contient des œstrogènes, un progestatif (ou de la progestérone) si nécessaire, et dans certains cas, de la testostérone.

Le THS ou THM protège également votre santé future contre la maladie qui affaiblit les os, connue sous le nom d’ostéoporose, et contre les maladies cardiaques, le diabète de type 2 et la démence.

Pour la plupart des femmes, les avantages du THS ou THM  l’emportent sur les risques.

D’autres moyens de minimiser l’impact négatif de la ménopause sur votre santé et votre bien-être consistent à améliorer votre mode de vie en arrêtant de fumer et en réduisant votre consommation d’alcool, en faisant régulièrement de l’exercice pour garder votre cœur en bonne santé et vos os solides, et en adoptant une alimentation équilibrée qui favorise la santé intestinale. Trouver du temps pour faire des choses qui vous aident à vous détendre et avoir des liens sociaux et émotionnels forts avec les autres peut également aider à traverser cette transition ménopausique .

The post Qu’est-ce que la ménopause? / What is the menopause? Factsheet (French) appeared first on Balance Menopause & Hormones.

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Ellie experienced the menopause aged 15, after treatments for cancer. She had to learn about the menopause for herself and take action to get the right help. Louise is a GP and menopause expert, who created the free ‘balance’ menopause support app.

The post A young woman’s guide to menopause after treatment for cancer appeared first on Balance Menopause & Hormones.

Please note – The information provided in these talks is designed to support, not replace, the relationship you have with your doctor or nurse.

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