Menopause treatments are becoming personalized

Menopause does not have to equal suffering. In recent years, the treatments have improved significantly. But do they increase the risk of cancer?

Our view of menopause tends to be bleak: hot flushes cause frustration, sex is painful, and irritability increases as the quality of sleep degenerates. Joints start aching, as the production of estrogen, the female sex hormone, peters out in women over the age of 50.

At the same time, middle-aged women are subjected to the pressures of professional life. Regardless of the discomfort they experience due to menopause, they are expected to work efficiently. And if they lose their job, they should look for a new one, even though that may not be easy for women of menopausal age.

However, Hanna Savolainen-Peltonen, a docent at the University of Helsinki and chair of the Finnish Menopause Society, has comforting news. Severe menopause-related symptoms are relatively rare, and most women are able to live their lives to the full in spite of temporary symptoms.

“In recent years, even the treatment of severe symptoms has improved and become increasingly personalised.”

Medication only when symptoms appear

Of menopausal Finnish women, 20–30% use hormone preparations.

“Hormone therapies are used by women whose quality of life is affected significantly by menopausal symptoms. Roughly 20% of women suffer from very severe symptoms,” Savolainen-Peltonen says.

In the past, hormone therapy could also be offered as a way to prevent long-term illnesses. Today, familiarity with the benefits and risks of hormone preparations has increased. Courses of therapy are no longer needlessly prolonged, as that would significantly increase the risk of breast cancer.

“In recent years, the treatment of symptoms has become increasingly effective and targeted. Medication is only administered for as long as the symptoms persist. In other words, therapy doesn't need to be continued ‘just in case’, but it won't be discontinued too early either,” Savolainen-Peltonen notes.

Locally administered therapy carries no risk

Genes are the principal factor affecting the severity and the age of onset of menopausal symptoms. On average, the symptoms persist for five to seven years, and only a small group of women experiences symptoms for more than 10 years. Even after the symptoms have disappeared, some women may need locally used estrogen preparations that are administered through the vaginal mucuous membrane.

“For certain women, local estrogen therapy continues for the rest of their life. It cares for the dry and fragile mucuous membrane, which is important in terms of sexuality. There are no long-term risks associated with using estrogen locally.”

Oral and transdermal hormone therapies are effective against hot flushes and sweats, and also improve the quality of sleep. Estrogen slows down increased bone fragility, prevents lipids from accumulating in the abdominal cavity and protects against type II diabetes.

“With correctly timed hormone therapy soon after menopause begins, estrogen slows down the onset of arteriosclerosis,” says Savolainen-Peltonen.

A Finnish study has demonstrated that hormone therapy also reduces the risk of death caused by vascular dementia. At the same time, long-term hormone treatment increases the risk of breast cancer, as cautioned by an extensive study recently published in The Lancet journal. Local, vaginally administered hormone therapy is an exception.

The initiation of hormone therapy can also be detrimental to elderly women or women suffering from a serious heart disease.

“Tablet-based hormone therapy is associated with an elevated risk of venous thrombosis, but with transdermally administered hormones this is not an issue.”

If a person is unable to use hormone preparations, hot flushes can also be alleviated with small doses of mood-altering drugs. The efficacy of natural remedies as alleviators of menopausal symptoms has not been demonstrated.

Exercise reduces symptoms

During menopause, sleep problems in particular can be serious. Weight management, exercise and regular habits improve the quality of both sleep and life.

“Smoking leads to premature ovarian failure a year or two earlier compared to non-smoking women. Additionally, smoking can also aggravate menopausal symptoms. Considerably overweight women may experience more sweating, while alcohol consumption may also increase discomfort,” Savolainen-Peltonen says.

In fact, women in their 50s should look at their health in a comprehensive manner, giving themselves a bit of time and attention.

“Women of menopausal age experience increased health risks, which makes it advisable to take time to check your blood pressure and cholesterol levels, among other things. While at it, you can consider with your physician whether there is a heightened risk of osteoporosis and whether you are getting enough vitamin D and calcium.”

Help from health centres

Until recently, menopause was not a topic of public and professional discourse. Of course, various ailments have been compared and personal wellbeing has been discussed in the breakrooms of workplaces – at least in the absence of men and supervisors.

False beliefs and inadequate knowledge are still associated with menopause. Certain women of menopausal age – and their physicians – are still unable to link all relevant symptoms, such as muscle and joint ache, with menopause.

Many believe that only specialists in gynaecology have the ability to treat menopausal symptoms. In Finland, help is also available from general practitioners at health centres and occupational health physicians. This information could be helpful to many families living on a tight budget, which makes a visit to a gynaecologist quite an investment.

“Menopausal hormone therapy is covered by primary healthcare. In problematic situations, a gynaecologist is consulted,” Savolainen-Peltonen emphasises.

Grandmothers increased children’s survival

Virpi Lummaa, Academy of Finland professor of evolutionary biology, started considering years ago why female humans live for such a long time after menopause. The females of nearly all species die after becoming unable to produce offspring.

“We are a rare exception. After undergoing menopause in our 50s, we remain fully vital and able to go on living for decades more.”

Being able to live to an old age is not solely the result of modern medicine. It was already entirely possible to live to over 70 years of age during previous centuries, provided you succeeded in avoiding epidemic diseases in childhood and warfare in adulthood.

Compared to other animal species, human beings have an extremely long childhood. Female chimpanzees, for example, care for a single infant until it becomes independent, only then having another baby. Human mothers, on the other hand, typically have several children to look after at the same time.

“We are a species whose mothers cannot tend to their offspring by themselves. Contributions are made by the entire village or at least a number of individuals in the herd.”

In the early 2000s, Lummaa began developing a theory on the significance of grandmothers with her colleague Mirkka Lahdenperä. The grandmother hypothesis investigates whether older women have historically held a key position in childcare. The hypothesis has been significantly substantiated by the study of grandmothers in different countries and of different ages, and even of generations of elephants.

Lummaa and Lahdenperä studied church registers from the 18th and 19th centuries when child mortality was extremely high. If a grandmother was alive and present in a family’s life, the children were more likely to survive the critical first years.

“The mortality rate among children of roughly two to five years of age was high. That was the period during which the mother weaned the previous child and gave birth to a new one. With the grandmother present and providing assistance, the children had much better chances.”

Mothers taking a long leave after having a baby is an entirely new situation for the human species, and not only a positive one.

“It causes a lot of problems. Mothers don’t necessarily have the strength to do everything on their own. We’re not designed for that,” Lummaa points out.

The article has been published in Finnish in the Y/07/19 issue of Yliopisto-lehti.