(The following represents Dr Janet’s personal opinion only)

Women’s health encompass a woman’s healthcare from menarche to post-menopause.

From early menarche issues such as menstrual issues (irregular cycles, endometriosis, adenomyosis, PCOS), contraception, fertility issues, pregnancy care to peri-menopause and post menopause health, GPs play an important role supporting women through these many life changes, providing diagnosis, investigations and treatments including referring the patient to relevant specialists and allied health as appropriate.

Many GPs like myself, do more than making diagnosis and management of gynaecological and obstetric conditions.  GPs are also involved in preventive care such as cervical and breast cancer screening; supporting women through mental and sexual health issues, in some cases involving domestic violence.

For women going through peri-menopause and menopause transition, this period may start on average 1-5 years before the final menstrual period and clinically can be classified into 7 stages (STRAW + 10 Criteria).  The median age of onset is 47.5 years in industrialised countries. (Gold EB. Obstet Gynecol Clin North Am 2011;38(3):425–40)

If you are currently going through this menopause transition, you may experience any of the following symptoms such as:

1. Vasomotor symptoms (hot flushes, night sweats)

2. Sexual Symptoms (vaginal dryness, age related changes in the genital area, loss of libido)

3. Sleep Symptoms

4. Mood changes (Anxiety, Depression symptoms), and

5. Other symptoms (such as urinary tract infections, lethargy, joint aches and pains, brain fog)

As a result of the revised Women’s Health Initiative (WHI) and the Million Women Study, we can now safely reassure women that for the average low risk perimenopausal women, the benefits of commencing Menopausal Hormone Therapy outweigh the risks, if Menopausal Hormone Therapy is commenced within the first 10 years of menopause. 

Similar to any other medical treatments, Menopausal Hormonal Therapy does have risks, such as a small increased risks of breast cancer (after 4-5 years of use), thrombosis (blood clots), stroke and gallstone disease.

However, Menopause itself is associated with several undesirable health consequences that can impact significantly on the quality of life of women.  These include various menopausal symptoms, accelerated bone loss with the risk of osteoporosis and fractures, central obesity with a definite increased risk of cardiovascular disease, diabetes and changes in blood fats (increased cholesterol).

Going through menopause is not an option, every women will go through menopause, irrespective of your occupation, educational or socioeconomic status.

However you have the option to choose wisely to reduce those menopausal symptoms, reduce the future risks of osteoporosis, delay that “first fracture”, reduce that central obesity, reducing the risks of cardiovascular disease, stroke, diabetes and possibly dementia. 

Even if you are not a suitable candidate of Menopausal Hormone Therapy because of a past history of breast cancer, lifestyle interventions that include exercise and nutrition, reducing alcohol and cigarette smoking, should be adopted in all postmenopausal women, due to their positive influence on menopause-related health problems.

There are also non-hormonal pharmacological therapies can be effective for the management of menopausal symptoms in women who are unsuitable or unwilling to undergo hormonal therapy.

In summary each woman need to be assessed individually for their personal own risk factors (personal and family history) and not everyone is suitable for Menopausal Hormone Therapy (MHT), thus appropriate counselling must be undertaken before embarking on MHT, as some benefits (such as maintaining bone density and cardiovascular health) may take a few years of treatment before the benefits can be attained and also the timing of commencement of MHT is important.

As from my clinical experience, one of the issues I feel strongly about is the identification of women who experience early menopause (before the age of 40). 

Many women who suffer early menopause do not realise the importance of preventive care, especially osteoporosis and cardiovascular health, therefore missing a golden opportunity to prevent bone loss and fracture prevention. 

Finally, I would like to list my other special interest – non hormonal gynaecology vaginal Laser treatment.  I have many years of clinical experience using this Fotona IncontiLase Laser since it was available to me from 2016. It is a very safe treatment and may improve the quality of life for patients who have been assessed for the appropriate indications such as urinary tract symptoms, symptoms of stress or urge incontinence and local menopause symptoms due to vaginal atrophy.  Each patient must be assessed individually for suitability and failed first and second line treatments such as pelvic floor exercises and topical vaginal hormonal preparations. 

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