Dr Jamieson has a huge interest in promoting preventative health, in particular, for women. In the 1980s Dr Jamieson was the first private doctor in Hong Kong to set up a well woman clinic. Later, in the 90s, she pioneered the use of bio-identical hormones in women in Hong Kong when other doctors were still prescribing synthetics.
The Perimenopause and Menopause relate to the time in a woman’s life when ovarian function is “winding down” – it is no longer necessary to produce eggs, ovarian follicles are depleted and so the production of progesterone and oestrogen (primarily a type called oestradiol) declines then ceases. It can be thought of as a reverse process to that of puberty, when the system is “winding up” and in both cases similar symptoms of hormonal flux occur, for instance irregular or problematic periods, or maybe a change in skin type such as developing acne.
Obviously total hormone production in the body is not stopped, so that the ‘interstitial’ tissues will continue to produce “Androgens” such testosterone. In body fat, muscle, and adrenal glands, these androgens are converted to small quantities of oestrogen, but this is a less potent form of oestrogen called oestrone. In addition, the amount produced varies tremendously between different women, explaining the variation of symptoms between women.
The classical menopausal symptoms are due to lack of oestrogen – this is hot flushes, sweats, tiredness, insomnia, depression, lack of concentration and therefore memory problems, vaginal dryness or infections, urinary problems and loss of libido.
Other less well-known side effects of “oestrogen deficiency” are changes in the skin and connective tissue. The amount of “collagen” – the structure supporting the skin – decreases, causing the skin to become thin and to increase the chances of bruising. Some ladies also complain of itch or “crawling” feelings and notice an increase in “spider veins”. Other tissues are similarly affected by collagen changes leading to dry hair, brittle nails, sore eyes or joint pains.
Another interesting change is an actual difference in body shape: premenopausal women have a “peripheral” distribution of fat in the breasts and bottom, where as later there is a more central distribution – around the abdomen. This is know as “android fat” and has been known for sometime to be a predictor of coronary heart disease.
The risk of coronary heart disease and stroke also escalates at this time of life because there are no longer the beneficial effects of oestrogen keeping the “bad” cholesterols down and the “good” up, as well as having an anti-oxidant property and generally improving circulation. Of course the benefits of oestrogen therapy in preventing the inevitable osteoporatic changes are well known now. Studies are also suggest that HRT has a protective effect against Alzheimer’s disease and colonic cancer.
Another unpleasant symptom of menopause is ‘hirsutism’, an excess of facial hair, and this is a result of the lowered ratio of oestrogen to androgen (male type hormone). Although some women may have excessive androgen when compared to oestrogen, doctors are beginning to realize that women can still become testosterone deficient. Women tend to product 50 percent less testosterone at the age of 50 as they did when aged 25. Endocrinologists are beginning to use testosterone cream on selected patients (I have to import this product) and reports so far are excellent, with doctors in Sydney finding it reduces osteoporosis, increases energy and improves memory. On top of this, testosterone gives everyone, women included, their sex drive.
For all of these reasons, hormone replacement therapy seems to be a fairly good idea. Just as women differ in their own production of postmenopausal oestrogen and menopausal symptoms, they will differ in their requirement for type, method of administration and dosage of HRT
It has recently become clear that the oestrogen:progesterone ratio is important, and that in fact progesterone is the first hormone to become deficient in the “perimenopause”. Most doctors prescribe progesterone to balance out the tiny potential for an oestrogen imbalance to cause uterine cancer, and are aware of the fact that it is these progesterones that sometime cause side effects such as headaches, breast discomfort, mood swings, bloating and of course continuation of the menstrual cycle.
Until recently these unwanted side effects were the most common cause of women stopping HRT, however the newer “natural” bio-identical progesterones used in natural or bioidentical hormone replacement therapy (BHRT) fortunately appear to cause none of these symptoms!
Until recently these unwanted side effects were the most common cause of women stopping HRT, however the newer “natural” bio-identical progesterones used in natural or bioidentical hormone replacement therapy (BHRT) fortunately appear to cause none of these symptoms! They have also proven to lower blood pressure in hypertensive ladies, and to maintain the “good” effects brought about by oestrogen in elevating “good” cholesterols, whereas the older, non bio-identical progesterones tended to reverse this beneficial effect.
Similarly the (less new) natural bio-identical oestrogens maintain the oestradiol:oestrone ratio in the body at more physiological, premenopausal levels. In trials they have been found to be more effective in reducing menopausal symptoms, as well as being more effective at decreasing cholesterol than synthetic varieties.
I personally find these natural HRT medications are more “user friendly” with fewer patients wanting to change or stop. I also find it worthwhile talking to patients about which method of administration they find suits them – daily pills, patches or gels rubbed in daily, or even an “implant” surgically inserted under the skin. Also, herbs such as Black Cohosh and Donc Quai, as well as isoflavines are useful for some women.
Recently ‘ SERM’ drugs (Selective Estrogen Reception Modulators) have become available. These are for women who are post menopausal and have not had periods for one year. They work for osteoporosis and reduction of heart disease risk, but not for menopausal symptoms such as mood swings or flushes. The advantage is that they have few side effects (eg. breast tenderness) and actually lead to REDUCED chance of breast cancer!
HRT is generally not something to be taken for a few months but more thought of as a natural replacement of hormones to levels equivalent to those in our “peak” years. It is therefore worth taking time with a doctor who is knowledgeable about this and prepared to take time to find out what the individual patient needs. It’s certainly a good thing that women have this choice in middle years, even though some (for excellent reasons) may not choose to take it.
3 Surprising Menopause Facts
- A significant proportion of women start the hormone winding down process even before they reach 40.
- Women’s hormones are produced in the ovaries and include oestrogen, progesterone and also testosterone!
- In the 80s doctors started to take the menopause a little more seriously, prescribing a replacement hormone to relieve the symptoms called Prempak — created from the urine of pregnant horses.