Our GPs are highly experienced to deliver healthcare for all women across the ages and stages of their lives. We have presented many common health topics that we help manage and look after as well as the services that are available on site at RPM including IUD insertion.
There are many types of contraception available in Australia – you need to know what works for you. No method is 100% effective and not all methods are safe in everyone.
THE PILL (COMBINED ORAL CONTRACEPTIVE PILL)
The Combined Oral Contraceptive Pill (COCP), usually called ‘the Pill’, contains two hormones, oestrogen and progestogen. The main way the Pill works is by stopping a woman’s ovaries from releasing an egg each month, which means that a pregnancy cannot begin. Most women are suitable to take the COCP. The pill is an effective contraceptive that is 99% effective if taken as directed. With typical use, it is 91% effective.
You should not take it if:
- You are over 35 and smoke.
- You have had a blood clot in a vein, stroke or heart attack
- You have a condition which makes you more prone to blood clots
- You have severe liver problems
- You have certain types of migraine
You also may not be able to take it if:
- You have had breast cancer
- You have unusual bleeding from your vagina that has not been diagnosed
- You are breastfeeding
- You have high blood pressure, diabetes, high cholesterol, heart disease affecting your heart valves, active liver disease, a family history of blood clots or you are on certain medications
- You have a body mass index (BMI) of 35 or more
- You are immobile for a period of time, eg after surgery
Please note, this list of reasons is not exhaustive and there may be other reasons why you should not take the Pill. Please ensure you discuss your individual situation with your doctor. Your doctor will also advise you how to take the pill and what to do if you miss a pill. The COCP can also be used by women to help with acne as well as manage/improve heavy or painful periods.
PROGESTERONE ONLY PILL (POP)
For women who are not unable to the COCP, it may be suitable for them to take the POP, or mini-pill. This is a progesterone only containing contraceptive pill. This pill works by making the mucus thicker so that sperm cannot meet an egg. It is 99% effective when used as directed but in practice, it is approximately 91% effective.
VAGINAL RING (NUVARING)
The NuvaRing is a soft plastic ring that contains both oestrogen and progestogen (similar to COCP). It is placed into the vagina and the hormones prevent an egg being released from the ovaries. The ring stays inside the vagina for 3 weeks, and then it is removed for one week. A new ring is then placed into the vagina for the next cycle. With perfect use, it is 99% effective. However, with typical use, is 91% effective.
LONG ACTING REVERSIBLE CONTRACEPTION (LARC eg Mirena & Implant)
There are three types of LARC that are available in Australia.
- A contraceptive implant that is placed under the skin of your arm – it lasts for 3 years (Implanon NXT®)
- An IUD (intra-uterine device). This is a small device that is placed inside your uterus – it lasts for 5 to 10 years depending on the type that is used (Mirena®, Copper IUD)
- A contraceptive injection (DMPA) given every 12 weeks
LARCs will stop you getting pregnant for a number of months or years. They are inexpensive, reversible and highly effective to prevent pregnancy (as they don’t rely on you to use). They don’t interfere with you having sex and no one knows you have one (unless you tell them!).
You don’t need to go to a hospital to get a LARC – ALL these options are available at Royal Park Medical. There are additional benefits to LARCs such as Mirena and Implanon – they are often used to help reduce painful, heavy periods.
CONDOMS (MALE AND FEMALE)
Male condoms are common. They are generally made from a fine latex which is used to collect semen. Non-latex condoms are also available. Condoms are self-lubricated but additional water based lubricants can also be used. Condoms are used once and then thrown away.
Condoms have a 2-18% failure rate. This means that if 100 couples use them for one year – between 2 and 18 couples will become pregnant.
The female condom is not as popular as male condoms. It is made from polyurethane and is inserted into the vagina before sex. It is about 15cm long and has two flexible rings, one at each end, to keep it in place in the vagina. One of the rings is closed and this end rests inside the woman’s vagina. The other ring, which is open, rests outside. These can be bought from sexual health centres.
Both types condoms can be combined with other methods of contraception. This provides effective contraception and PREVENTS sexually transmissible infections (STIs) at the same time.
The emergency contraceptive pill is available from pharmacies (there is no need to see a doctor beforehand). The emergency contraceptive pill can be taken up to 5 days after the event but the sooner the better. See your doctor soon after to discuss contraceptive options to prevent the need to take emergency contraception in the future.
Permanent options include tubal ligation, uterine ablation and hysterectomy for females and vasectomy for males.
CANCER AND CANCER SCREENING
Bowel cancer is the second most common cancer in Australians. It is also known as colorectal cancer and usually develops from growths in the bowel called polyps. Polyps can become invasive cancers if undetected. Symptoms of bowel cancer can include a change in bowel habit, blood in the stool, unexplained weight loss or fatigue, tummy or anal pain. It is important to see your GP if this is occurring in you, promptly.
There are factors that increase your risk of bowel cancer. This includes
- a family history,
- Genetic factors
- Eating a diet high in red meat – especially processed meats
- Excessive alcohol intake
- Inflammatory bowel disease
BOWEL CANCER SCREENING
The faecal occult blood test (FOBT) uses chemicals to check a stool (poo) sample for blood. If you’re over 50, you should have this test once every two years, or after you turn 40 if you have a family history. Women at high risk of bowel cancer may need a colonoscopy. During this test, the doctor inserts a slender instrument called a colonoscope through the anus to visually check the rectum and large bowel for any abnormalities.
Every person should know the symptoms and signs of breast cancer, and any time an abnormality is discovered, it should be investigated by your healthcare professional.
By performing regular self-checks on your breasts, you will be able to more easily identify any changes. These changes can include a new lump or bump, a change to the skin, nipple or shape of a breast or even developing breast pain. If you have any concerns, or simply want to learn how to do a proper self-check – see your experienced health care professional.
BREAST CANCER SCREENING
1 in 8 Australian women will develop breast cancer.
Screening is highly recommended for ASYMPTOMATIC women. Detection of breast cancer in its early stage provides the best chance of providing effective treatment with increased survival and improved quality of life.
- Women aged 50-75 are eligible for FREE 2 yearly screening mammograms
- Women aged 40-49 and over 75 years of age are also eligible for FREE screening mammograms BUT they do not receive an invitation (This needs to be initiated by you)
- For women of all ages, who are at increased risk of developing breast cancer, it is recommended to speak to your health care professional for an individualised surveillance program
Call BreastScreen today on 13 20 50 to arrange a screening appointment or visit breastscreen.org.au
For anyone with a concern about their breasts – please make a prompt appointment with your family doctor.
NATIONAL CERVICAL CANCER SCREENING PROGRAM (PREVIOUSLY KNOWN AS PAP SMEARS)
The National Cervical Screening Program aims to prevent cervical cancer by detecting early changes in the cervix. The recommendations for screening have changed. The two-yearly Pap test for women aged 18 to 69 will now be a five yearly human papillomavirus (HPV) test for women aged 25 to 74, who have been sexually active.
The changes include:
- The Pap smear will be replaced with the more accurate Cervical Screening Test
- The time between tests will change from two to five years
- Women will be invited when they are due to participate via the National Cancer Screening Register
- The age at which screening starts will increase from 18 years to 25 years
- Women aged 70 to 74 years will be invited to have an exit test.
Women of any age who have symptoms such as unusual bleeding, discharge and pain should see their health care professional immediately. HPV vaccinated women still require cervical screening as the HPV vaccine does not protect against all the types of HPV that cause cervical cancer.
Changes to the screening guideline has caused increased concern amongst some women. If this includes you or your loved one, please make an appointment to speak to your family doctor to discuss further.
It can be difficult to diagnose ovarian cancer because the symptoms are ones that many women will have from time to time. Women who are diagnosed with ovarian cancer report four types of symptoms most frequently;
- Abdominal or pelvic pain
- Increased abdominal size or persistent abdominal bloating
- Needing to urinate often or urgently
- Feeling full after eating a small amount
If you have any of these symptoms, they are new for you and you have experienced them multiple times during a 4-week period, go to your GP.
Other symptoms to be aware of;
- Changes in your bowel habit
- Unexplained weight gain or weight loss
- Bleeding in-between periods or after menopause
- Back pain
- Indigestion or nausea
- Excessive fatigue
- Pain during intercourse
It is important to remember that most women with these symptoms will not have ovarian cancer. Your doctor should first rule out more common causes of these symptoms, but if there is no clear reason for your symptoms, your doctor needs to consider the possibility of ovarian cancer. There is no screening program for ovarian cancer currently available.
FERTILITY AND PREGNANCY
If you’re trying to have a baby or just thinking about it, it is never too early to start preparing.
Pre-conception health care focuses on things you can do before and between pregnancies to increase your chances of having a healthy baby. This can include managing any medical conditions which might affect your health or the health of your baby both during and following your pregnancy. It also involves reviewing lifestyle factors such as smoking and alcohol intake. Some medications including both prescription and over the counter may be harmful to your unborn child. There may be some vaccinations that are recommended before you become pregnant. Having the correct vaccinations prior to pregnancy can protect your baby from serious health complications.
For the vast majority of couples, pregnancy occurs naturally within 12 months of trying to conceive. For approximately 20% of couples it is a different story. These couples either do not fall pregnant, or achieve pregnancy only to miscarry. Infertility is the inability to carry a pregnancy to live birth. There are many contributing factors to infertility.
Effects of age on fertility
Both men and women have a reproductive lifespan. Female fertility starts to decline slightly from age 30 and this rate of decline increases towards the end of her 30s. Miscarriage rates also increase as a women ages. The effect of aging on a man’s fertility is not as well established. More research is needed.
Knowing your cycle length helps to determine when ovulation occurs (on average, this is 14 days prior to your period starting). Cycle lengths can vary between women, as well as within the same woman. There are a number of commercial kits available to help predict ovulation. If you are thinking of using these, speak with your family doctor further. Having intercourse in the week leading up to ovulation optimises your chances of pregnancy.
Healthy Diet, Weight and Fitness
Eating a healthy well balanced diet, maintaining (or achieving) a BMI in the healthy weight range (20-25) and staying fit will optimise your chances of pregnancy. This is true for both women and men. This is also important whilst pregnant.
There is no safe amount of alcohol to drink during pregnancy therefore for women who are pregnant or planning a pregnancy, the safest option is not to drink. Alcohol can affect the health and development of an unborn baby for life. For men trying to conceive – it is important not to overdo alcohol intake as it will affect sperm quality. Men are encouraged to drink no more than 2 standard drinks on any one occasion. Women are encouraged not to drink at all whilst trying to conceive.
Certain medications and all recreational drugs can be detrimental to fertility as well as to your unborn child.
Folate, Iodine and Vitamin D supplementation
It is recommended that women start to take folic acid 1 month before becoming pregnant, and to continue it for at least the first trimester. Taking folic acid daily before and during pregnancy prevents the occurrence of neural tube defects, such as spina bifida, in your baby. For most women, at least 0.4mg daily is sufficient. However, if you have a family history of spina bifida, take certain epilepsy medications, have diabetes or have a BMI>35, you should be taking 5mg daily.
Iodine is another nutrient important for healthy brain development. To ensure adequate intake, eat fish 1-3 times per week, use iodised salt or take a 150mcg iodine supplement (can be contained within your pregnancy multivitamin).
Vitamin D is important for the development of bones and teeth. Low levels have been associated with muscle weakness and pain in women. Vitamin D is largely made in the skin when exposed to sunlight, but small amounts can be found in egg yolks, some milk fortified with Vitamin D and oily fish. You are more likely to be deficient if you have darker skin, cover most of your body with clothing or spend significant time indoors. Your GP may order a vitamin D test and consider supplements whilst pregnant or breastfeeding.
Rubella and Varicella
A blood test can show if you are immune to rubella and varicella. Women are encouraged to check their immunity prior to pregnancy. If you are not immune, your doctor can arrange immunisation prior to pregnancy. These infections may cause significant harm to your unborn child if you are infected during pregnancy.
Genetic Carrier Screening
Genetic carrier screening gives individuals information about their chance of having a child with a genetic condition. 3 conditions are tested for in the Prepair test. Cystic Fibrosis, Fragile X Syndrome and Spinal Muscular Atrophy. Your doctor can speak with you further about this test. Further information can be found at www.vcgs.org.au/prepair.
Both men and women should stop smoking as fertility is affected in both sexes. Quitting smoking before pregnancy is the most effective way of protecting your baby from serious complications during pregnancy. Smoking reduces your likelihood of conceiving, and increases your risk of miscarriage and premature delivery. It can lead to erectile dysfunction and poor egg/sperm quality.
Sexually Transmitted Infections (STIs)
STIs may impact on fertility. Chlamydia in particular is common and if untreated can cause problems for both men and women. See our comprehensive section regarding STIs under Sexual Health.
Not getting pregnant?
Women aged 35+ shouldn’t wait too long before seeking expert advice. The current time frames would suggest that if after 6 months of trying to conceive you have not been successful, you should seek advice from your GP. For women under 35, a general rule of thumb is to seek medical advice after 12 months of trying to conceive.
Your GP can refer you and your partner for some initial tests such as oestrogen level and day 21 progesterone to check if you are ovulating regularly, AMH (Anti Mullerian Hormone) to check your ovarian reserve, and possibly some other hormone tests for conditions such as thyroid imbalance and Polycystic Ovarian Syndrome. Your GP can also refer your partner for semen analysis. Having these initial tests performed by your GP can help identify the cause of your fertility difficulties at an earlier stage whilst you are waiting to see a fertility specialist.
EARLY PREGNANCY CARE
Once you have had a positive home pregnancy test, it is important to make an appointment with your GP within a few weeks. If you have not already commenced folic acid, then you should do this immediately.
Your GP will take a medical history to assess if your pregnancy is low or high risk, order some blood and urine tests, date your pregnancy as accurately as possible (sometimes a pelvic ultrasound is required for this if you are unsure of your dates), and discuss your early pregnancy health including dietary and lifestyle advice. It is important to inform your GP if you have any vaginal bleeding, pelvic discomfort or severe nausea or vomiting.
Your GP will also discuss the two different types of 1st trimester genetic screening tests that are available. These are to assess the likelihood of your unborn baby having Down’s syndrome, Edward’s syndrome or Patau syndrome. These tests are:
- First trimester screen (or Triple test)- this involves an ultrasound to measure certain features in your baby and a blood test to measure the level of certain proteins in the blood. This test has a high detection rate (95%), but also a high false positive rate (this is a result that indicates a given condition exists, when it does not).
- NIPT (Non-Invasive Prenatal Testing)- this involves a blood test from the mother to analyse the babies’ DNA. This test is very accurate (97-99%) in detecting the 3 conditions.
Your GP will also discuss genetic carrier screening with you (See Genetic Carrier Screening in the section above).
The next step is to arrange a referral for antenatal care. There are different models available for this and your GP at RPM will be able to offer a referral for either public or private hospital based antenatal care or shared care between your GP and the hospital. Dr Liz Morris and Dr Sarah Humphry are accredited to provide Shared Maternity Care to our patients.
It is important to look after your health in the postnatal period and we advise all women to attend their GP for a postnatal review appointment at 6 weeks after having their baby. This appointment involves a review of any health problems you experienced during your pregnancy, an abdominal examination, a check up on your mental health and discussion about your contraception plans. We would recommend combining this appointment with your baby’s 6 weeks immunisations.
If you find yourself in the position of experiencing a pregnancy that is unplanned and you need to discuss your options, please make an appointment to see a GP at RPM at your earliest opportunity. We will offer non-judgmental, confidential advice and will support you in whatever choice you make.
45-49 YEAR HEALTH CHECKS
Women should have regular health checks. The age that you should start having these and the frequency of the checks is dependent on your individual health risk factors and you should discuss this with your GP.
Women in the 45-49 year age bracket are eligible for Medicare rebates for a thorough health check if they are at risk of chronic disease. This would involve your doctor taking a history of your health, lifestyle and family history, a physical examination and blood test. Your doctor may also refer you for further tests such as an ECG, bowel cancer screening, breast cancer screening, plus any other tests that are required depending on your doctor’s risk assessment of your health.
The decision that a patient is at risk of developing a chronic disease is a clinical judgement made by the GP. However, at least one risk factor must be identified. Risk factors that the GP may consider include, but are not limited to: lifestyle risk factors, such as smoking, physical inactivity, poor nutrition or alcohol use; biomedical risk factors, such as high cholesterol, high blood pressure, impaired glucose metabolism or excess weight; and a family history of a chronic disease.
MENTAL HEALTH & DOMESTIC VIOLENCE
DEPRESSION, POST NATAL DEPRESSION, ANXIETY AND OTHER MENTAL HEALTH CONCERNS
Mental health problems that include depression, anxiety, postnatal depression (PND) and post traumatic stress disorder (PTSD) – to name a few- are common. You do not have to suffer alone and unsupported.
If you have concerns regarding your headspace, see your GP today. At RPM we have experience in managing and coordinating appropriate care for patients with mental health concerns. See our section on Chronic Disease and Mental Health Care Plans to learn more about medicare funding.
No one should fear violence at any time, but especially in the home with a domestic partner. Your GP is an excellent resource and support if you are experiencing domestic violence. We can guide you to relevant community supports as well as discuss how to keep yourself safe at home. We are here to support you, not judge you, your partner or the living situation you find yourself in.
WHAT IS MENOPAUSE?
Menopause is the final menstrual period. It is difficult to know which period is your last until adequate time goes by without one. Blood tests are not useful to indicate if your most recent period is your last one. This is because oestrogen & FSH (another hormone involved in regulating a woman’s menstrual cycle fluctuate for a further 2-4 years after menopause. Menopause is usually said to have occurred when a woman describes 12 months of no periods, at the typical age, with or without menopausal symptoms.
However, there are a number of reasons why periods stop so if you are younger than 45, have not had periods in a few months and are not experiencing any menopausal symptoms – it is worthwhile seeing your health professional to discuss further.
HOW DO I KNOW IF I AM GOING THROUGH MENOPAUSE?
Women are born with approximately 1 million eggs in each ovary. By the time of menopause, all active eggs have been exhausted and a woman will no longer ovulate. Hormones such as oestrogen, progesterone and testosterone are particularly relevant at this time. Menopausal symptoms are caused by changes in these hormones. These changes typically occur over many months or years – in the lead up to menopause – and can cause periods to become very irregular. This time is referred to as “peri-menopause”. If menopause is induced due to surgery or medical cancer treatment, menopause will be hastened and often women will experience more dramatic symptoms of menopause.
Let’s look at the hormones that are involved to understand this process better.
Oestrogen – a hormone produced by cells in the ovaries with a variety of physiological effects including helping to maintain muscle tone, skin elasticity, the lining of uterus (endometrium) and cervix, lining breast ducts and protecting bones. It also exerts effects on the bladder and brain. As women transition to menopause, oestrogen production fluctuates. Sometimes it is high, and other times it might be low. As the final period draws nearer – oestrogen levels fall by over 90%.
Progesterone – a hormone that is responsible for mucus changes in the vagina, regulating the pH of the vagina and also in the breast tissue. Progesterone is produced only when a woman ovulates and usually facilitates pregnancy promotion. In menopause, ovulation stops and therefore the hormone levels drop.
As women approach menopause, they might experience heavy, irregular bleeding due to these fluctuations in hormones.
Testosterone – a hormone that we traditionally consider to be a ‘male’ hormone. Women also need testosterone – as it is involved in muscle & bone strength, libido including sexual desire and emotional wellbeing. Testosterone gradually decreases over the course of a women’s lifetime. We’re still learning more about the role of testosterone in women, and in menopause.
WHAT ARE THE SIGNS AND SYMPTOMS OF MENOPAUSE?
Most women reach menopause between age 45-55, with an average age of 51-52.
There are 3 stages we can consider in menopause.
Peri-menopause – the months and years leading up to the final period, where menstrual irregularities are common and bleeding can be heavy.
Menopause – the 12 months from the final period.
Post menopause – the time following this.
For most women, peri-menopause will last an average 4-6 years but can be as short as 1 year, or as long as 10 years. Periods can be extremely variable; lighter, heavier, lasting longer, finishing earlier. Menopausal symptoms usually begin during this time.
During peri-menopause, hormones can fluctuate and feel a little chaotic. Oestrogen can be high and also dip erratically low, resulting in some months not ovulating and other times, women may ovulate twice.
There is no specific test to diagnose peri-menopause.
What are the signs and symptoms of menopause?
Signs and symptoms of peri-menopause often overlap with what we all commonly think of as menopause. This is largely due to hormonal fluctuations, and in the longer term, a reduced oestrogen level.
It might include
- hot flushes
- poor sleep
- mood changes
- feeling like you can’t cope or manage
- increased joint pains
- sore or tender breasts
- vaginal dryness, painful intercourse or recurrent bladder infections
Menopause & Hot Flushes
Hot flushes can be described as overheating or flushing. It’s not completely understood why these occur in menopause, however oestrogen plays a role with the thermostat (temperature sensor) in our brain. The duration and frequency of hot flushes varies from woman to woman. Stress, anxiety, alcohol and certain foods can also impact on flushes.
Tips for dealing with hot flushes
- Reduce your intake of spicy food, caffeine and alcohol
- Eat foods with phyto-oestrogens (plant based oestrogens) including soya bean, soya bean, tempeh & legumes
- Wear layers of clothing, utilise small hand held fans and consider a water spray bottle to cool down
Menopause & Mood
Many women can feel a dip in their mood in peri-menopause & menopause. This is particularly true for women who have a past history of depression and/or who experience significant PMS symptoms. Menopause does not cause depression.
Tips to help with mood changes
- Keep fit and healthy, exercise regularly
- Ensure you have regular time out and participate in hobbies
- Socialise with friends and loved ones
- Minimise alcohol
- Ensure sleep routines
- Medications and counselling are useful in some women
Bladder, Vagina & Vulval Symptoms
Reduced oestrogen can cause many women to feel changes in nether regions. Genitals can become dry & irritated, intercourse can be uncomfortable or painful, libido may be affected. Urinary frequency, urgency and infections can arise. A woman may experience none, some or all of these symptoms.
Tips to help with urogenital symptoms
- Drink plenty of water
- Strengthen pelvic floor muscles
- Consider using lubrication with intercourse
- Speak to your GP about vulval care and treatment options if symptoms are impacting your quality of life.
WHAT ARE THE TREATMENT OPTIONS?
Management of peri-menopause is dependant on a number of factors including your age, symptoms, preference and suitability to certain treatments. There are a large number of options available to help alleviate symptoms.
Many women find menopausal symptoms are mild and don’t need to take any specific medication or therapy. Some women are able to manage through lifestyle measures including keeping fit, good nutrition, exercise and limiting alcohol/caffeine. It is advised to not smoke.
However other women will have such significant impact on their quality of life, that lifestyle measures will be inadequate alone. As menopause is unique for every woman, and a range of management options are available for different symptoms – it is worthwhile having a comprehensive discussion with your health professional about your choices.
Along with lifestyle measures, these might include
- Options to manage vaginal dryness
- Non-hormonal prescription medications
- Complementary therapies
- Menopausal hormone therapy (MHT, previously called Hormone replacement therapy, HRT)
Some treatments are well supported by research, whereas others have less evidence supporting their use. It is important to have accurate and reliable information about your treatment preferences before you start any treatment. To make an informed choice about your options – we recommend you read widely from reputable sources and also speak to your health professional about your personal circumstances.
A summary of the treatment options;
Vaginal dryness can be improved with lubricants such as olive oil or almond oil as well as other commercially available moisturisers. Having 2 tablespoons of linseed in your daily diet has evidence for improving vaginal dryness too. Oestrogen replacement – either topically, or systemically can also be helpful. Some centres also offer vaginal laser treatment, which has also noted benefit.
Non-hormonal prescription medications
These include medications that are commonly used to treat depression, chronic pain and/or migraine – but are also found to be helpful with hot flushes.
Many patients are keen to explore all their options – including complementary medicine. There is evidence emerging that some medicines are effective but not many of these studies meet gold standard. More time & research is needed. Black cohosh and red clover have the most evidence supporting their use to manage hot flushes.
Menopause Hormone Therapy
MHT is the replacement of hormones – namely oestrogen, progesterone and sometimes testosterone. As this is such a large topic in itself – we will dedicate another post purely to it.
3 hormones play a role in menopause; progesterone, oestrogen and testosterone. MHT is the replacement of some or all of these hormones, which reduce in menopause. MHT can help with
- Hot flushes
- Night sweats
- Joint Pains
- Vaginal Dryness
Types of MHT
Replacement of oestrogen may help relieve many of the symptoms of menopause. Women who have had a hysterectomy, replacement of oestrogen may be all they need to help relieve their symptoms. For women who still have a uterus, oestrogen on it’s own may cause the lining of the uterus to overgrow, and increases their risk of endometrial cancer (uterine cancer). These women need to also take progesterone to protect them from this risk.
Other women may benefit from testosterone replacement if they have a low libido or experience significant fatigue – even after oestrogen replacement. Testosterone replacement in menopausal women is an area of active research and many unknowns remain. As there are currently no approved forms of testosterone replacement in Australia (as approved by the TGA), we won’t focus on this beyond here.
So what are the risks and benefits of MHT? How long do you take them for and what preparations are available? Well hang in there. We know it’s a long post, but we’ll try to keep it short and sweet.
Risks Of MHT
- Slight increased risk of breast cancer (approximately 1 extra women with breast cancer in 1000 treated with MHT, per year)
- Low risk of blood clots. The risk is higher in oral preparations and in the first year of treatment
- Low risk of stroke
- Gallstones (higher risk in oral preparations and combination therapy)
- Endometrial cancer (if a woman with a uterus is treated with oestrogen alone)
Benefits of MHT
- Symptom management of menopause including hot flushes and night sweats
- Decreases the risk of heart disease, osteoporosis & bone fracture, colorectal cancer, cataracts and the onset of diabetes (type 2).
It is unknown whether MHT play any role in loss of memory, dementia or Alzheimer’s disease. Ongoing studies are taking place.
Some women due to their previous medical history are not suitable to take MHT. This includes women who
- Have or have had breast cancer
- Known oestrogen dependant cancers such as in the breast or uterus
- Have a history of previous blood clot/current blood clot
- Uncontrolled blood pressure
- Coronary heart disease, stroke or dementia
There are other rare conditions, which may make it inappropriate for your doctor to prescribe MHT to you.
MHT can also cause side effects
- Nausea, bloating, breast tenderness & fluid retention
- Breakthrough bleeding
So what types of MHT are there?
MHT comes in a variety of options including pills, patches, gels, pessaries and intrauterine device (IUD). Implants are currently not approved in Australia. Doses and methods of administration of MHT depend on patient preference, response to treatment as well as previous medical history. Your GP can discuss the options with you, and also closely supervise whether methods of administration need to be changed or doses adjusted. It can take up to 6 months of trialling different doses/applications before you feel you are on the right combination.
How long can I take MHT for?
Current guidelines recommend taking the lowest effective dose of MHT, to alleviate symptoms for as long as is required. The benefits of MHT in healthy women far outweigh the risk in the first 10 years of menopause or between the age of 50-60. It is important to have an annual conversation with your doctor to ensure your health and risks around taking MHT are evaluated regularly.
RPM strongly advocate for all patients to take a balanced and evidence based approach to inform them about their choices regarding menopause management including MHT. As such, we encourage you to speak with us, and do further reading on websites such as www.jeanhailes.org.au or www.thewomens.org.au
Osteoporosis is a common disease affecting women. Bones become brittle and more prone to breaking compared to normal bones. Risk factors for osteoporosis can be categorised into the following;
- Lifestyle – Smoking, excessive alcohol, being underweight, not exercising regularly
- Medications – Certain medications including high dose, long term steroids
- Malabsorptive conditions like coeliac disease, inflammatory bowel disease
- Hormonal/endocrine causes including low testosterone in men, thyroid overactivity, reduced oestrogen
- Genetic factors – Family history and gender
Osteoporosis is diagnosed by doing a Bone Density Scan. This is a special scan that your GP can order if you are at risk. It takes 10-15 minutes to do. It will help determine the density of your bones and what action needs to be taken to maintain their health. Medicare rebates for Bone Density Scans apply for many but not all patients. Your GP can help you understand whether your circumstances will qualify. You may see other establishments advertise a Heel Ultrasound to measure your bone density. This is not a recommended diagnostic test for osteoporosis currently in Australia.
This information is intended to support, not replace, discussion with your doctor or healthcare professional. The authors have made considerable effort to ensure the information is accurate, up to date and easy to understand. Royal Park Medical accepts no responsibility for any inaccuracies, information perceived as misleading, or the success of any treatment regimen.