Menopause is a powerful marker of age, and the end of menstrual periods confronts women with their own ageing more dramatically than any biological process experienced by men. This is at once a boon and a problem. It may be regarded as a boon because it can trigger a stocktaking by women that allows them to recognise the importance of taking on new challenges. A major problem is that society’s attitudes to women at and after menopause, and women’s own attitudes and experience of this stage of life, can trigger feelings of anxiety for the future, diminished self-confidence and grief.
In talking to women generally, and more specifically to those seeking medical advice, we have clearly seen that the significance of menopause extends beyond an end to the possibility of having children. From childhood and adolescence onwards, we learn to attach great significance to our sex hormones, developing an uncanny ability to tune into them. We can often ‘tell’ when our periods are approaching, when we are ovulating, when we have become pregnant.
The notion that our ovaries, a major source of our sex hormones, effectively ‘die’ at menopause, leaving us in a state of hormonal deficiency, is incorrect, except in women whose ovaries are removed or irreparably impaired. In general, sex hormone output after menopause settles to a lower but still quite measurable level. It makes sense that there should be some change, for we are no longer ovulating, menstruating or conceiving.
Hormone replacement therapy can seem like a lifeline both for women who do not have functioning ovaries and for other women. It promises relief from severe symptoms, it can improve our coping abilities, and can perhaps prevent some of the future health problems we worry about. As with most medications, however, there are uncertainties, and unwanted effects sometimes.
The Australian Menopause Society recommends that most women should consider HRT, not for a year or two, but for a minimum of five to fifteen years and probably for longer. Other authorities, like the Key Centre for Women’s Health in Society at the University of Melbourne, are more cautious. As its director, Professor Lorraine Dennerstein, explained to a packed lecture theatre of middle-aged and older women at the University of Melbourne in 1992, more information is needed about the long-term effects of HRT formulations, and about the dosages now being used. ‘HRT does relieve debilitating symptoms, but a lot of work needs to be done on dosage and there is much that women can do to minimise symptoms themselves.’
In this atmosphere of uncertainty, women are faced with decisions about whether or not to use HRT, decisions that have the potential to affect their daily lives and perhaps also their future health and wellbeing. This book aims to peel back the layers of half-truth and confusion that surround HRT, so that women retain in their own hands the power to decide and a belief in their own ability to do so.
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