Gynaecologists are organising their first symposium on menopause for the public on Saturday with the aim of dispelling “lots of misinformation and misconceptions” around the subject.
Women tend to blame menopause for all the ailments they suffer between the ages of 40 and 60, and this is not necessarily the case, said Isabelle Saliba, president of the College of Obstetrics and Gynaecology, which is behind this first informative conference for the public.
Among the changes happening in women’s lives at that age, Saliba mentioned “lots of psychological overlay”: many other factors, including psychological, come into play in that period and these are not necessarily related to the ‘change of life’ phase. Rather, they are connected to social situations, children leaving the nest, or relationship problems.
Women start to see physical changes in their bodies, notice they are getting older, that they have wrinkles and gaining weight, and they point fingers. They scramble to get hormone tests done, trying to fault menopause for the various symptoms and expecting a quick fix, Saliba pointed out.
“Menopause may mean growing fatter, that sex does not exist anymore, and you can be depressed. But many other factors contribute to these changes too.
“As we age, it is normal and acceptable that women put on a bit of weight – around 1kg a year. But if you gain 10kg, you cannot blame menopause. That is not what it does to you,” she said, adding that women need to take care of their bodies.
Solutions include lifestyle changes, exercise and diet. These will also be addressed in one of the talks at the symposium, which intends to sift the wheat from the chaff on a subject that has come to the fore globally.
It will be a full house at Verdala Castle on May 3, with a long waiting list to attend, Saliba said about the limited capacity of the venue and the possibility of repeating the conference next year.
The consultant obstetrician and gynaecologist believes the information will equip people to better understand and manage menopause.
The now-debunked bad publicity about the ‘danger’ of HRT led to resistance to treatment- Isabelle Saliba
She expects the audience to be largely made up of perimenopausal women in their 50s, whose attitude overall has changed and who are now “keen on doing something about their quality of life and are open to discussion”.
Menopause is the rest of your life after one year of no periods. But there is also perimenopause, which is characterised by hormonal chaos and instability and can take up to 10 years of irregular cycles, fatigue, palpitations, unexplainable anxiety, an irritable bladder and painful joints.
Saliba has noticed a “big difference” in the approach over the years and more awareness about hormone replacement therapy (HRT), despite some lingering fears, following a Women’s Health Initiative study that had shed a bad light on oestrogen replacement and its connection to breast cancer.
The now-debunked bad publicity about the ‘danger’ of HRT led to resistance to treatment, and though the study was reviewed and retracted, it instilled fear in both doctors and patients.
Medical students will also be attending, and while gynaecologists have noted they have minimal training on menopause during their studies, Saliba believes very junior doctors should have the basic knowledge of its complications and management options to handle minor ailments, while HRT should be in the hands of gynaes.
What they needed was a “positive perspective” on menopause and its treatment in view of some stigma around HRT that still existed, she said. It is not only patients but even doctors were still afraid of it, added Saliba, a strong advocate for HRT.
In her view “it is better to be living well until 85, doing the things we love, than living until 95 and spending the last 10 years in a wheelchair or in a bed – and HRT plays a role in improving quality of life.”
The main concerns around HRT, she explained, were breast cancer and thrombosis, but there were clear and strict guidelines about who could take the treatment: it was “out of the question” for women who have had hormone-sensitive cancer or have a very high risk of developing it.
For this cohort, there were alternatives, including lifestyle changes and herbal remedies – another topic to be broached at the symposium.
A poster promoting the symposium, which is fully booked.Every case needed to be treated individually, but whoever lacked these two problems was eligible for HRT, especially in early onset of menopause at 40, meaning increased risk of cardiovascular disease and bone, cartilage and skin problems that can be helped by the treatment.
Saliba is sceptical about “buzzwords” like bioidentical and body-identical hormones that are bandied about, saying most HRT is made of hormones that are like those the body is producing, and that both are made synthetically.
“In the past, we had equine oestrogen, which is basically from the urine of horses. How natural is that?”
The consultant obstetrician and gynaecologist said she preferred products from pharmaceutical companies that ensured “you know 100 per cent the exact dosage you are giving”.
As to the fact that testosterone is not readily available in Malta, Saliba said it was not part of the routine regimen but could help some women by giving them a “kick”.
However, she is not keen on implants, saying there is no control to stop the hormone immediately if required.
While other gynaecologists have noted that menopausal women are often automatically prescribed anti-depressants by their GPs, Saliba maintained that “sometimes, they need this” and psychological intervention was required.
Experts have called for dedicated clinics and a healthy hormone replacement therapy discussion, maintaining menopause is often sidelined for more pressing – even life-threatening – women’s health issues.
As the debate gathers momentum, the idea is that they should know they could do better, rather than just grin and bear debilitating symptoms, such as hot flushes, brain fog, lack of sleep and libido, as well as weight gain and mood swings that hit as oestrogen production slows down and stops between 45 and 55.
The symposium will address a broad range of topics, from changes in skin and mood to sexual dysfunction and contraception in menopause.
Speakers include Prof. Mark Brincat, Prof. Yves Muscat Barron, head of the gynaecology department at Mater Dei, psychiatrist Ethel Felice and other consultants from hospital.
