By contrast, small quantities of progestogen help to prevent osteoporosis. There is also a possibility that it might slightly decrease your chance of developing breast cancer, but as some research has suggested otherwise it is difficult to be sure.

In conclusion, if you still have a uterus, the form of HRT you take must contain a progestogen, but with any luck the new non-oral low-dose varieties will reduce the side-effects, new progestogens may overcome many of the present disadvantages, and the future of no-bleed HRT looks hopeful.

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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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One of the most distressing of the emotions reported by women at menopause is anxiety, which is often described as a feeling of impending doom. In the case of Joan, anxiety attacks became so severe around the time of her menopause that she withdrew from most of her former activities outside the home. Her state of anxiety was reduced markedly by a program of vigorous physical activity (exercising to loud music), which she started in her own home before joining the aerobics class at her local recreation centre.

Evening primrose oil tablets, St John’s wort, oatstraw and Anemone pulsatilla are often advocated by herbal therapists and naturopaths for women disturbed by anxiety and panic attacks. You will need to consult such therapists for dosages.

Headaches

Biofeedback training has been used with some success in patients with migraine headaches. Migraines around menopause have also been treated with the prescription medication clonidine, in lower doses than when it is used to treat blood pressure problems. The results of studies to assess symptom relief have been conflicting, and side effects may include dizzy spells, visual disturbances, and – astonishingly – headaches.

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While HRT causes no major side effects in a majority of women, some others experience unwanted results that are totally unexpected. Sometimes women accept the risks of HRT because of an anticipated improvement in their quality of life in the immediate or distant future.

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Sydney neurologists have described the case of a woman attending aerobics classes who experienced mysterious throbbing headaches, nausea and intermittent dizziness that were eventually traced to her hormone patches. Dr Kathryn North and Dr Llewelyn Davies, from the Royal Prince Alfred Hospital, said the headaches invariably started within an hour of her completing classes and did not improve when she switched from a ‘high impact’ to a low impact’ exercise scheme. They feared initially that the woman, aged forty-eight, had a brain tumour. On further questioning her, the doctors realised that the onset of the post-exercise headaches coincided with a switch from oestrogen pills to patches. They suggested that the woman’s aerobic activities were expanding the blood vessels under her skin, resulting in increased absorption of the hormone and the triggering of her headaches.

To test the theory, the woman removed the patch before each of her next six aerobic classes and the headaches ceased. When she exercised while wearing it, the headaches returned. ‘Aerobics classes are popular in urban Australia’, Drs North and Davies said in a letter to the international medical journal the Lancet. ‘With the increasing use of transdermal oestrogen replacement therapy in postmenopausal women, this unusual headache may occur more often. Instruction from the pre-scriber will limit this disabling complication.’

There is a specified-purpose Pharmaceutical Benefits listing in Australia at approximately $15 a month for women who cannot tolerate oestrogen by mouth. Private prescriptions cost between $28 and $42 a month, depending on patch size.

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