Menopause & Perimenopause Care
Menopause is a natural stage of life, but the symptoms can be disruptive. Dr Laarnie Pe Benito consults at Women’s Care in Castle Hill and can discuss options, including menopausal hormone therapy (HRT).
Perimenopause and menopause explained
Perimenopause is the transition leading up to menopause, when hormone levels fluctuate and periods often become irregular. It can last several years. Menopause is diagnosed after 12 months without a period. The average age in Australia is around 51, although it varies. Menopause before age 45 is considered early, and before age 40 is premature; both warrant medical assessment.
Common symptoms
Women experience this stage very differently. Symptoms may include:
- hot flushes and night sweats
- irregular, heavier or lighter periods during perimenopause
- sleep disturbance, tiredness and difficulty concentrating
- low mood, anxiety or irritability
- vaginal dryness, discomfort or pain with sex, and urinary symptoms such as urgency or recurrent infections
- joint aches and changes to skin and hair
These symptoms can have other causes, such as thyroid conditions, iron deficiency or depression, so it is worth discussing them with a doctor rather than assuming.
When to seek assessment
It is a good idea to see your GP or a gynaecologist if symptoms are affecting your quality of life, if you are under 45 and your periods have stopped or become very irregular, or if you want to understand your options. Some bleeding patterns need investigation:
- any vaginal bleeding after menopause
- very heavy bleeding, bleeding between periods or after sex during perimenopause
- periods that are much closer together than usual
Assessment of abnormal bleeding may include ultrasound, hysteroscopy and a biopsy of the uterine lining; see heavy periods, fibroids and adenomyosis.
Treatment options
Menopausal hormone therapy (MHT or HRT)
Menopausal hormone therapy is the most effective treatment for hot flushes and night sweats and for vaginal symptoms. It replaces oestrogen, and for women who still have a uterus a progestogen (or a hormonal IUD) is added to protect the uterine lining. Oestrogen can be taken as a patch, gel or tablet. Low-dose vaginal oestrogen treats local symptoms and has little absorption into the rest of the body.
Like all medicines, hormone therapy has benefits and risks. These depend on your age, the time since menopause, the type and route of treatment, and your personal and family medical history, including breast cancer, blood clots, heart disease and stroke. Starting MHT within about ten years of menopause, or before age 60, is generally associated with a more favourable balance of benefit and risk. Longer-term combined therapy is associated with a small increase in the risk of breast cancer, and oral oestrogen carries a small increase in the risk of blood clots. These risks are discussed individually, and MHT is reviewed regularly.
Non-hormonal and supportive options
- lifestyle measures such as regular exercise, limiting alcohol and caffeine, and keeping cool at night
- cognitive behavioural therapy and other psychological support for sleep, mood and hot flushes
- non-hormonal medicines that may reduce hot flushes in some women
- vaginal moisturisers and lubricants for dryness
Contraception and long-term health
Pregnancy is still possible during perimenopause. Contraception is generally recommended for two years after the last period if you are under 50, and for one year if you are over 50. Menopause also affects bone health and heart health, so these are considered alongside symptoms, and cervical screening should continue as scheduled.
How Dr Pe Benito can help
Menopause care is part of Dr Pe Benito’s clinical focus. At Women’s Care in Castle Hill she can assess your symptoms, investigate abnormal bleeding, and discuss and prescribe menopausal hormone therapy where it is suitable for you, working with your GP.
She consults women from Castle Hill, Baulkham Hills, Kellyville, Rouse Hill, Bella Vista, Cherrybrook, Glenhaven, Dural, Glenwood and the wider Hills District.
Common Questions
Is hormone therapy safe?
For many healthy women under 60 or within ten years of menopause, benefits outweigh risks, but this depends on your own history. There are conditions in which MHT is not recommended. Your doctor will discuss the benefits and risks that apply to you.
How long can I take hormone therapy?
There is no set time limit. Treatment is reviewed at least yearly, using the lowest effective dose for as long as it is helping and remains suitable for you.
Do I need a test to confirm menopause?
Usually not. In women over 45 with typical symptoms, menopause is diagnosed from your symptoms and period history. Blood tests are used mainly in younger women or when the picture is unclear.
Consultation Enquiries
Dr Pe Benito is a female gynaecologist consulting at Castle Hill Women’s Care. A GP referral is recommended for Medicare rebates on specialist consultations. Please contact the rooms to arrange an appointment.