The onset of menopause is something most women dread. Along with their physical symptoms, their sex lives with their partners can often also be affected.
Years ago, every woman was prescribed hormone replacement therapy (HRT) as soon as they reached menopause.
It was the standard treatment for women with symptoms like hot flushes, night sweats, vaginal dryness and loss of sex drive (libido). It was also thought to have long-term benefits in preventing heart disease, osteoporosis and possibly dementia.
Oestrogen and progesterone are hormones that play an important role in a woman's body and when levels fall around menopause a range of physical and emotional symptoms is triggered. HRT helps to restore hormonal levels, allowing the body to function normally again.
For many years, HRT was even seen as a fountain of youth that would keep women healthy and sexy long after menopause.
This all changed in 2002 when a $1 billion Women's Health Initiative study in the US was halted when researchers noticed an unexpectedly high rate of breast cancer and heart disease among women taking part in the research.
This alarming finding frightened millions of women and their doctors away from hormone therapy at menopause.
Gynaecologist John Eden, head of the Sydney Menopause Centre at the Royal Hospital for Women, disputed the findings.
Dr Eden said the majority of the participants in the study had been over 60, were not newly menopausal and would not normally be treated. He was among clinicians around the world who believed the results of the study were exaggerated and widely misinterpreted.
A decade later, medical professionals agree that the 2002 findings were flawed and that hormone replacement therapy may not be as risky as once believed. Several studies have been undertaken and the latest, the Kronos early estrogen prevention study was presented at the 23rd annual meeting of the North American Menopause Society in Florida in October.
In this study involving more than 700 women researchers concluded that oestrogen/progesterone treatment started soon after menopause appeared to be safe, relieved many of the symptoms of menopause, and improved mood, bone density, and several markers of cardiovascular risk.
Confusion persists among women and medical professionals about the best treatment for menopause.
I have spoken to many women who have been too frightened to take HRT but suffer from symptoms affecting their libido and their relationship with their partners.
Australasian Menopause Society president, Jane Elliot, says women should have easy access to HRT.
"A whole decade of women have missed out on this treatment," she says. "It is not for everyone. It's not a panacea, but it certainly should be something women feel they can consider."
Dr Elliott says the warnings on products are "extreme".
One in eight women do not receive treatment, according to Dr Eden, and experience severe flushing for many years.
He says he prescribes anti-depressants more frequently now than 10 years ago. "Having 10 to 20 hot flushes an hour, day and night, without relief, is enough make anyone depressed."
I've always suspected that medical professionals were worried about writing scripts for HRT because of the 2002 report and fears that amounted to a scare campaign.
This was confirmed in a recent Sun Herald article about Sydney GP, Ginni Mansberg. She and many of her female GP contemporaries prescribed it for themselves – even though they don't for patients, out of fear for being sued.
Dr Mansberg says: "Menopause is a 10-year process for a lot of women and they should have the option of HRT.
"The panic is so out of control that women are walking around with no sleep; they can't function and they feel old and have no sexual function."
GPs should not talk women out of taking HRT but should explain the risks and benefits and give them an informed choice. Why should women feel miserable during menopause, if they don't need to?
The excellent Jean Hailes for Women's Health, a not-for-profit organisation providing services for women across Australia, conducted a webcast in October called "Fifty Shades of Midlife - Menopause, Mood & More" which was streamed all over Australia.
The panel consisted of five women – a GP, clinical psychologist, sex educator, naturopath and gynaecologist.
It was a live, interactive event where the health experts gave practical advice for managing menopause. They talked about sexuality and maintaining intimate relationships when you get older, mood, emotional wellbeing and mental health.
They told women "to embrace menopause" and they gave the thumbs up for HRT.
Certainly well worth viewing – especially with your partner.
Matty Silver is a sexual health therapist based in Sydney, www.mattysilver.com.au.
