Question: As I get older I am scared about the problems of menopause. My mother had a terrible time and I have no desire to follow in her footsteps. Can the menopause be controlled?
I find the biggest problem with the menopause is the failure of my patients to tell me exactly what they are feeling and what affects the menopause is having on them. The first step in treating someone with menopausal symptoms is explanation.
The sex hormones are controlled by the brain, and are released from the ovaries into the bloodstream on regular signals from the pituitary gland, which sits underneath the centre of the brain. Once in the blood, these hormones have an effect on every part of the body, but more particularly the uterus, vagina, breasts and pubic areas. It is these hormones that make the breasts grow in teenage girls, give you regular periods as their levels change during the month, and cause hair to grow in your groin and armpits. For an unknown reason, once a woman reaches somewhere between the early forties and early fifties, the brain breaks rhythm in sending the messages to the ovaries. The signals become irregular and sometimes too strong, at other times too weak. The ovaries respond by putting out the sex hormones in varying levels, and this causes side effects for the owner of those ovaries. The periods become irregular, vary in length and intensity, and may become painful.
Other symptoms can include bloating and associated headaches and irritability as excess fluid collects in the brain, breasts and pelvis; hot flushes, when hormone surges rush through the bloodstream after excess amounts are released by the ovaries; abdominal cramps caused by spasms of the uterine muscles; and depression which can be a reaction to the changes in the body, a fear of ageing or a direct effect of the hormones on the brain.
Menopause cannot be cured, because it is a natural occurrence, but doctors can relieve most of the symptoms. Hormone tablets or patches are the mainstay of treatment. One hormone is taken for three weeks per month, and a different one is added in for the last 7 to 14 days. Minor symptoms can be controlled individually. Fluid tablets can help bloating and headaches, and other agents can help uterine cramps and heavy bleeding. Depression can be treated with specific medications.

Question: Should all women use hormones after menopause to prevent osteoporosis?
Women should consider their options at the time of the menopause and discuss them with their doctor. Generally, all women should be on hormone replacement therapy (HRT) after the menopause, not only to prevent osteoporosis, but to also prevent heart disease, strokes, premature ageing of the skin, Alzheimer’s disease and generally protect the body from ageing too quickly.
It always necessary to exclude any contra-indications to HRT, such as liver disease or blood clots.
If a woman is small boned and has a family history of osteoporosis, she has an increased risk of osteoporosis, and HRT is even more important.
The main problem most women complain of with HRT is the continuation of their periods beyond the normal time for their cessation. These periods are usually very light though, and often cease with time. Other side effects are usually related to an incorrect hormone dosage. They include headaches, depression, flushes and pelvic discomfort. As all women are different, finding the correct dosage can sometimes be a matter of trial and error.

Question: I have had breast cancer and a total hysterectomy at a relatively early aqe. I am concerned about premature aqeinq but my doctor says I cannot take hormones. What can I do?
This is an extraordinarily difficult problem to deal with. Most women who have a total hysterectomy take oestrogen to prevent the problems of menopause, but if you have had breast cancer, most doctors believe that you should not use this hormone because it may result in a recurrence of the cancer. More recently, some doctors are using oestrogen in this situation as they argue that oestrogen does not cause breast cancer. I would suggest that you avoid oestrogen unless it is absolutely necessary to use it.
To prevent osteoporosis you should eat plenty of dairy products and take calcium tablets. The premature growth of facial hair can be controlled by a medication called spironolactone. Exercise is important to keep your body toned up as much as possible. A well-fitted bra and possibly plastic surgery may help the sagging breasts and can replace a breast removed for cancer. Skin moisturizers and plastic surgery can be used to control premature skin ageing in all parts of the body.
By being careful with your body and taking the appropriate medical advice there is no reason why anyone should place you in an older age group than you are, and you should live a full and normal life well into your 80s.