Let's talk about menopause

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					      Let’s talk
      Menopause expert nicole Jaff’s
      down-to-earth and empathetic
      approach offers refreshing insights
      into menopause. She talks to
      Sharon Preston about the questions
      women commonly ask, and the
      updated release of her book

      Nicole Jaff, 56 , lives with her
      husband Nicholas in Atholl. They
      have two daughters, Sophie, 29, a
      writer, composer and lyricist, who
      lives in New York, and Elizabeth,
      22, who has just completed her
      honours in politics at UCT.
          nicole Jaff is living proof that it’s
      perfectly possible to look and feel
      fabulous after menopause. As a
      menopause counsellor, author and
      speaker on the subject, she spends
      her days explaining to women that
      menopause is something we can
      all cope with, with relative ease,
      providing we have the right frame
      of mind, the proper knowledge
      and good medical advice.
          Having undergone a hysterectomy
      at 46, nicole’s experiences with
      menopause led her to believe that           Society. easy to read and simple        often been misinformed about.
      women needed to be more informed            to understand, it gives insight,        “women are often just so confused
      about this stage of their lives. She        without anxiety, into what happens      about menopause,” she says. “we
      felt so strongly that women needed          to women’s bodies as they reach         need to be empowered to ask the
      someone in their corner, that she took      menopause, how to handle the            right questions, and to be given
      up the task and spent eight years           symptoms, what options there are        answers that are medically sound and
      researching the subject in-depth, then      when it comes to treatment, and         easy to understand at the same time.”
      two years to write Menopause Today,         what research has been done on the         Here nicole, who counsels women
      A Complete Guide.                           subject. what nicole ably succeeds in   about menopause, gives the simple
          Her book has not only been a            doing is helping women to understand    facts about this female health issue,
      resounding success, it’s also been          what their bodies are going through,    and answers the seven questions she’s
      recommended by the SA Menopause             and allaying fears on a topic they’ve   most frequently asked.

34 woman&home A   BrA nd n ew At t i t u d e
                                                                                                     life inspiration

Basic facts you should know about menopause
The difference between peri-            it’s happening, but most women            women who have undergone
menopause and menopause                 do experience some symptoms. the          natural menopause. However, it’s
is that the term “menopause”            most common symptoms include hot          not recommended to take Ht to
describes the last day of your last     flushes, night sweats, mood swings,       prevent heart disease or to reduce
period ever. Leading up to that         depression, anxiety and weight            the risk of fractures.
moment of menopause is a period         changes. Generally most of these
of time that can last anything          symptoms stop after you become            When deciding what kind of HT
between two to 14 years – this          menopausal but some symptoms, like        and which dose is best, bear in
is called “peri-menopause”.             vaginal dryness, urinary problems and     mind that right now the general rule
                                        decreased sexual desire, can persist.     of thumb is that women should take
All women are bio-chemically                                                      the lowest dose of hormones that
different. it’s important to remember   Because a woman’s hormone                 help alleviate their symptoms, for the
that each woman is an individual who    levels fluctuate so dramatically          shortest possible amount of time.
has her own specific biochemistry and   during peri-menopause, it isn’t               it is thought that taking hormones
medical history. Your experience of     usually helpful to do blood tests         through the skin (transdermally) in the
menopause will be completely your       to find out                                                  form of a patch, gel
own; remember this when you             your levels                                                  or a cream may be
start discussing menopause with         of estradiol         “Menopause is                           safer, though at this
your friends.                           (a type of                                                   time there is no clear
   Also, the symptoms of peri-          oestrogen) and       definitely not                          evidence for this. Bio
menopause vary widely. Many
women have hot flushes while others
                                        However, a            a disease – if                         identical hormones
                                                                                                     (hormones that
never have a hot flush, and get bad
headaches instead. Just because
                                        blood test to
                                        check whether
                                                              you take care                          are the same as
                                                                                                     the hormones in
you’ve never had a hot flush doesn’t    your Follicle          of yourself,                          your body) may
mean you aren’t menopausal; it just     Stimulating                                                  also be a better
means your changing hormone levels      Hormone               these can be                           option, though
are causing different symptoms.         (FSH) level is
                                        greater than
                                                             the best years                          there isn’t sufficient
                                                                                                     evidence available
The symptoms of the hormonal
changes during peri- and post-
                                        20 u/L, will
                                        reveal whether
                                                               of your life”                         to substantiate this.
                                                                                                        All women
menopause can range from                you are                                                      taking Ht should
weight changes to night sweats.         menopausal or not. the doctor will        be monitored regularly – in fact, all
As we age, so do our ovaries, which     check that there are no other medical     women over the age of 50 should
results in them not functioning as      reasons causing these raised levels,      have an annual mammogram in
efficiently as they have been doing     and if there aren’t, then they indicate   addition to a gynaecological exam.
every month for some thirty-odd         that you are menopausal.                  the need for hormones should be
years. As their functions change,                                                 reconsidered at regular intervals
the levels of certain important         Before deciding whether you               and hormone therapy should be
hormones change, too. Oestrogen         need Hormone Therapy (HT), you            discontinued when no longer needed.
and progesterone start to rise and      should have a thorough physical              if the only symptom remaining
fall and this causes certain symptoms   examination, a family history should      is vaginal dryness, one should
of peri-menopause.                      be taken and your doctor should           consider using a local oestrogen
    it’s important to be aware that     discuss the risks and benefits of Ht      preparation in the form of a cream,
these symptoms could be caused          with you. women should only take          a vaginal oestrogen-releasing ring
by something other than hormonal        Ht if the symptoms (hot flushes, night    or a small pessary, which is inserted
changes, so when you have your          sweats and vaginal dryness) are severe    into the vagina.
FSH levels tested to confirm your       enough to change their quality of life.      if a woman still has her womb, she
menopausal status, you need to             women who have had a surgical          should take a progestogen with the
ask your doctor to give you a test      menopause – who’ve had their              oestrogen to prevent a build-up of
for thyroid function as well.           ovaries surgically removed before they    the lining of the womb. Her doctor
   there are some exceptionally         reached menopause – should take           will tell her which progestogen
lucky women who sail through peri-      Ht, especially since they usually         would be most suitable and the
menopause without noticing that         have more severe hot flushes than         way it should be taken. >>

                                                                                             woman&home A    Br And new Attitude   35
life inspiration

7     Questions commonly asked about the menopause
      1   What will happen to me if
          I don’t take HT?
         Hormone therapy is not an anti-
      ageing medication, it’s taken to alleviate
      the symptoms of the peri-menopause
      and menopause.
         don’t be
      concerned that
                                                      women who are at risk of stroke due
                                                   to high blood pressure or heart disease
                                                   may be at greater risk of having a
                                                   stroke if they take Ht.
                                                      Although new research has shown
                                                   that oestrogen may have a protective
                                                                       effect on heart
                                                                       disease in women
                                                                                                   At this time of their lives, many
                                                                                               middle-aged women are having
                                                                                               problems with their long-term
                                                                                               relationships, have issues with their
                                                                                               body image and are dealing with
                                                                                               other life stresses, all of w which may
                                                                                               interfere with their sexual desire.

                                           “Don’t be
      you’ll become dried
      up and wrinkled if
      you don’t take Ht.
                                         afraid to ask
                                                                       who take oestrogen
                                                                       therapy at the onset
                                                                       of menopause, it
                                                                                               5   Why have I put on weight now
                                                                                                   that I’m menopausal and why is
                                                                                               it so hard to lose weight?
      there is no clear
      evidence to show
                                           questions                   appears that older
                                                                       women who start
                                                                                               You can expect to gain a couple of kilos
                                                                                               during your peri-menopausal years.
      that oestrogen                        to find                    taking Ht 10 years      there are oestrogen receptors in your
      protects women                                                   after menopause         fat cells, and it seems that your body
      against dementia                    out what’s                   may be at greater       wants you to gain more weight to keep
      or that menopausal
      women are at an
                                         happening to                  risk for heart
                                                                                               certain levels of oestrogen in your body.
                                                                                                   Also, you are less active at this age,
      increased risk of                   your body”                                           and could have some impaired thyroid
      major or minor
         Oestrogen does reduce the risk
                                                                      3   What are
                                                                          the main
                                                   symptoms? How long will my
                                                                                               function or, as you gain weight, your
                                                                                               level of insulin may rise which could
                                                                                               lead to insulin resistance.
      of post-menopausal fractures caused          symptoms last?
      by osteoporosis, but there are other
      medications that can be taken to
      reduce this risk.
                                                   the main symptoms of peri-menopause
                                                   are hot flushes, night sweats, vaginal
                                                   dryness, depression, mood swings and
                                                                                               6   How do I know whether I am
                                                                                               Your periods will probably become
                                                   lowered sexual desire. Of these, usually    erratic or change before stopping

      2   Will I get breast cancer if I take
          HT? What are the other risks?
                                                   only vaginal dryness and lowered sex
                                                   drive persist into menopause.
                                                                                               completely. You may experience the
                                                                                               symptoms of peri-menopause. if you

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      breast cancer increases after five years     symptoms while others have only a           and there are no other health reasons
      of taking oestrogen and progestogen          few, and there are some very unlucky        for this, you are almost certainly
      therapy.                                     women who have many and severe              menopausal.
          the latest research doesn’t specify      symptoms that can last anything from           the safest way to see whether you
      when a woman should stop taking              two to 10 years.                            are menopausal or not is to have a
      Ht. the length of time she takes it will                                                 blood test to see whether your FSH
      depend on her individual needs – and
      this should be reviewed once a year.         4  Why do I seem to have lost my
                                                      libido now that I’m menopausal?
                                                                                               level is raised above 20u/L.

      Generally, no woman over the age of
      60 should start taking Ht.
         women taking Ht may have denser
                                                   there are many reasons for this. Some
                                                   researchers believe that this is due to
                                                   the lower levels of testosterone in post-
                                                                                               7  Why is my memory so bad now
                                                                                                  that I’m menopausal?
                                                                                               Memory lapses in peri-menopause, like
      breast tissue – this makes mammogram         menopausal women, but this is not the       hot flushes, are due to rising and falling
      screening more difficult and means           only reason.                                levels of oestrogen.
      cancers are harder to detect.                   Vaginal dryness, which can cause            these memory lapses usually
         women with a family history of            painful sexual intercourse, is common       improve when your hormone levels out
      breast cancer should be aware that they      in menopause.                               and you become fully menopausal.
      may be at risk before they decide to
      take Ht, especially if the family member
      had an oestrogen or progesterone
      positive cancer.                                 Nicole’s popular book updated
         there’s also an increased risk of             Nicole Jaff’s book, Menopause Today, A Complete Guide, has assisted many
      clots in women who are taking Ht;                South African women through this stage of life. The book has now been
      research has shown that this risk may            updated and goes into its second print in March. Look out next month for
      be lowered if women take oestrogen               Nicole’s column in W&H on menopause, in which she’ll give feedback to
      transdermally (through their skin) rather        readers about how best to cope with peri-menopause and menopause. w&h
      than orally.

36 woman&home A   BrA nd n ew At t i t u d e