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

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

From early menarche issues, fertility advice, menstrual problems (such as irregular cycles, endometriosis, adenomyosis, PCOS), 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 just providing diagnosis and management of physical gynaecological 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, this menopause transition period may take on average 1-3 years before the final 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)

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 patients that for the average low risk perimenopausal women, the benefits of Menopausal Hormone Therapy outweigh the risks, when 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 an increased risks of breast cancer (after 4-5 years of use), thrombosis (blood clots), stroke and gallstone disease.

Menopause is associated with several health consequences that may have significant impact 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 risks of cardiovascular disease and changes in blood fats.

Lifestyle interventions that include exercise and nutrition should be the firstline therapy in postmenopausal women, due to their positive influence on menopause-related health problems.

Non-hormonal pharmacological therapies can be effective for the management of menopausal symptoms in women who are unwilling to undergo hormonal therapy or for whom hormonal therapy is contraindicated.

In summary each woman need to be assessed individually for their personal own risk factors (including 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 for my clinical experience, one of the issues I feel strongly about is the identification of women who experience early menopause. 

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 Laser since it was available 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 including 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 oestrogen preparations. 

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