Monday, 17 October 2016

Menopause: What does it mean?

All women become menopausal at some stage. Natural menopause is due to the ovaries gradually running out of egg cells and being unable to produce the usual cyclical production of oestrogen and progesterone. With changing balance of these hormones, the stimulation of the womb lining changes and so periods may become irregular and heavy. This changing phase, known as the perimenopause, can last for a few years until finally the ovarian hormone production is so low that the womb lining is not stimulated and periods stop, the time of the menopause. The resultant low level of oestrogen can produce a range of symptoms such as flushes, sweats, low mood, joint aches, disturbed sleep, and also some later consequences on vaginal, bladder, bone and heart health. The severity, duration and impact of symptoms and later health effects varies hugely between women, and hence the need for treatment is very individual.
Natural menopause usually takes place around the age of 51. However, for some women menopause can occur at a younger age and may be the result of treatment for another condition. When menopause occurs early after cancer treatment, it may seem like the last straw. Women may be unprepared for the onset of menopausal symptoms when they are also dealing with the devastating effects of diagnosis and treatment, and indeed may not initially realise what is happening.
The importance of provision of information before treatment which may lead to an early menopausewas recognised in the recent NICE guideline on diagnosis and management of the menopause which recommends that healthcare professionals should:
  • Offer women who are likely to go through menopause as a result of medical or surgical treatment (including women with cancer, at high risk of hormone sensitive cancer or having gynaecological surgery) support and:
                    - information about menopause and fertility before they have their treatment
                    - referral to a healthcare professional with expertise in menopause
For women who have had treatment for cervical cancer, the type of treatment will determine whether or not the treatment will lead to early menopause. A hysterectomy may be performed and the ovaries may be able to be conserved. The ovarian function may then continue until they naturally stop working, but of course having a hysterectomy stops any periods and so it may be difficult to know whether or not the ovaries are still working. In this situation it is important to know what signs and symptoms to look out for.
If the ovaries are removed at the time of surgery, or are exposed to radiotherapy or chemotherapy, then menopause can happen suddenly. This sudden drop in oestrogen can lead to rapid onset of menopausal symptoms for which earlier preparation with provision of information is essential.
Whether treatment for cervical cancer leads to an early menopause, or women subsequently experience menopause at the usual age, treatment options need to be considered. The main reason to consider treatments is for symptom control. Symptoms affect around 80% of women but in varying degrees and not all require treatment. Diet and lifestyle measures can be the first step, with losing weight, stopping smoking, and reducing alcohol and caffeine being helpful both for symptom control and for later health benefits.
The most effective treatment for the effects of oestrogen lack is to replace oestrogen in the form of Hormone Replacement Therapy (HRT). HRT is recommended for women with troublesome menopausal symptoms, but is also recommended in women who experience a premature, (before age of 40) or early, (before age of 45) menopause, even if they do experience symptoms since HRT offers long term heart and bone health benefits. In this situation, HRT should be continued at least until the average age of the menopause.
Many women have concerns about taking HRT after much publicity in recent years about risks, but the current view is that for most women, the benefits outweigh the small risks. Having had cervical cancer does not mean that HRT should be avoided, there being no known association between HRT use and risk of cervical cancer. The type of HRT taken will depend on the treatment, such as whether or not a hysterectomy has been performed. Particular attention should be given to vaginal health, particularly if radiotherapy has been required. In this situation, vaginal oestrogen may be required in addition to HRT to help maintain vaginal health and prevent dryness and thinning of the vaginal skin.
It is sincerely hoped that with better education and understanding, the unwanted additional effects of treatment for cervical cancer can be reduced by appropriate preparation and treatment.
Further resources:

Tuesday, 5 July 2016

What's in a Name?

What’s in a name?

When considering effects of the menopause, hot flushes and sweats regularly come top of the list of expected symptoms. Increasingly though, women and healthcare professionals are becoming aware of other symptoms due to declining and low levels of estrogen following natural decline in ovarian function, ovaries affected by other treatments, or removal of the ovaries. 

These may include sleep disturbance, low mood and joint aches. However, there is still a low level of awareness of the effects of estrogen lack on the vagina, bladder and pelvic floor, effects which can cause significant discomfort and distress yet still are hugely under reported and under treated.

To address this issue, let’s start with the name. Many terms have been used including, vaginal dryness (to demonstrate a common symptom), vaginal atrophy (to indicate thinning changes of the vagina), vulvovaginal atrophy (to include thinning effects also of the vulva or “outer lips”), urogenital atrophy (to indicate that the urological system, ie bladder, can also be affected), and, the most recently recommended term—Genitourinary Syndrome of the Menopause (GSM).

None of these roll easily off the tongue, which is indeed part of the problem. Women often find it very difficult and embarrassing to discuss gynaecological issues, especially related to the vulva and vagina and confusing terminology does not help.

Whatever we choose to call the vulva and vagina, we need to recognise that the lack of estrogen can have significant and sometimes devastating effects on this very personal, sensitive area. In fact, it is thought that up to 50% of all postmenopausal women can experience symptoms due to GSM. However, it is believed that the true number of women affected is unknown since many women do not report symptoms and so this figure is likely to be an underestimate.
Symptoms can include dryness, pain during sexual intercourse, irritation and itching, susceptibility to vaginal infection and also bladder symptoms such as urgency to pass urine, passing urine more often and urinary tract infections.

Vaginal dryness, irritation and pain during sexual intercourse are due to estrogen lack affecting vaginal and vulval blood supply, lubrication, loss of elasticity and thinning and inflammation of the vaginal walls and vulval skin with reduced sensation and response. Not surprisingly, these changes often lead to reduced interest in sex. In addition, estrogen helps to maintain vaginal acidity by facilitating production of lactic acid from lactobacilli (normal vaginal organisms). An acidic vaginal environment is a good barrier to infection. With less estrogen, vaginal acidity changes and both vaginal and urinary infection risk is increased. Bladder symptoms are due to estrogen lack on bladder muscle contractions; estrogen is thought to play a role in regulating bladder and urethral muscle contractions so that estrogen lack can lead to increased muscle contractions and feeling of urgently needing to pass urine. Further, there has been recent increased interest in the effect of estrogen on support of the pelvic floor. With low estrogen levels, pelvic floor support is reduced leading to dragging sensation and even prolapse.

It has been recognised that GSM, particularly the vulval and vaginal symptoms, can have significant impact on quality of life and relationships. Previous surveys from our Menopause Matters website visitors have shown that women often feel that these symptoms had a negative effect on their confidence, self-esteem, and relationships and many made excuses not to have sex because of the discomfort.

These symptoms often become noticeable a few years after periods have stopped, or a few years after stopping Hormone Replacement Therapy (HRT). This apparent delay in these effects appearing is due to the fact that estrogen lack on the vulva, vagina and bladder generally takes a few years to become evident, in contrast to the flushes, sweats, low mood and joint aches which are triggered early in the stage of falling and low estrogen levels.
The other important difference between urogenital symptoms and flushes and sweats is in relation to duration; while flushes and sweats can last many years, for many women they do reduce with time but urogenital symptoms do not reduce. Indeed, these symptoms gradually worsen with time and so any treatment needs to be continued long term. This message was confirmed by the recently published NICE guideline on Diagnosis and Management of the Menopause, recommending that “Treatment should be started early before irreversible changes have occurred and needs to be continued to maintain benefits” (NICE guideline. Menopause:diagnosis and management.)

For such a common consequence of the menopause which can have significant effects, it is clear that effective treatment is required, should be started early, and continued long term, perhaps even indefinitely. Before discussing which treatments are available, it is worth emphasising the need for women to be aware of this consequence, to look out for early signs and to feel able to seek help and treatment. Hopefully the wide distribution of this magazine, along with the popularity of our website and increasing use of social media will help more women to access this information.

Regarding treatment options, vaginal estrogen has been shown to be able to reverse the changes of estrogen lack and significantly reduce symptoms. For women in whom symptoms of GSM are the predominant effect of the menopause, vaginal estrogen alone can be offered and is recommended in the NICE guideline. Vaginal estrogen needs to be prescribed and can be taken in the form of a small vaginal tablet inserted using an applicator, a vaginal cream which can also be applied to the vulval area, or a vaginal ring. Personal preference, dexterity and discussion of symptoms should lead to individualisation when choosing which type to use.

Vaginal estrogen is not the same as taking HRT; HRT replaces estrogen throughout the body and is taken by a tablet, patch or gel. Vaginal estrogen is concentrated in the vagina and bladder and is minimally absorbed throughout the body. This major difference means that vaginal estrogen will not control symptoms such as flushes and sweats (systemic symptoms) nor have any effect on bone or heart health, unlike HRT. It also means that women who may have concerns about taking HRT because of past medical history, can often still use vaginal estrogen. 

Women who take HRT for systemic symptoms may find that the HRT also helps GSM, but in some, while systemic symptoms may be controlled, vaginal estrogen may be needed in addition to reduce vaginal and bladder symptoms. This need for both HRT and vaginal estrogen may be increasing as lower doses of HRT are now often used. Regarding duration of treatment, many women stop treatment after a few weeks if they have not noticed a benefit, or after a few months if symptoms have reduced assuming that the problem has been cured. It is important to understand that vaginal estrogen needs to be used for a few months before full benefit can be realised, especially if significant changes are already present when treatment is started. Also, symptoms do often return after treatment is stopped and so continuing treatment is recommended.

For many women, the use of vaginal lubricants and moisturisers can help the dryness and reduce discomfort. While these do not correct the cause ie estrogen deficiency, they may be preferred for women with mild to moderate vaginal dryness or for those who do not wish to use vaginal estrogen. The value of moisturisers and lubricants was confirmed in the NICE guideline which states “..women with vaginal dryness..moisturisers and lubricants can be used alone or in addition to vaginal estrogen”.

Many types of both lubricants and moisturisers are available and knowing which to choose can be very difficult. Lubricants provide a rapid effect and are applied just before sex. They can be particularly helpful for women who experience discomfort only during sex due to dryness. Lubricants are available as water, silicone, mineral oil or plant oil based.

Moisturisers are applied more regularly such as daily or every two to three days. They rehydrate the vagina and maintain the moisture for two to three days. The longer lasting effect may be helpful for women who experience discomfort not just during sex. Moisturisers mostly contain water but different products vary in the content of other ingredients.
When choosing a moisturiser or lubricant, the pH (acidity) and osmolality (measure of concentration of chemical particles) should be considered. Many commercially available products show a high osmolality which may cause tissue irritation. It is recommended that products with pH which most closely resemble healthy vaginal pH of 3.8 to 4.5, and with low osmolality are preferred.

If lubricants are used as well as vaginal estrogen, they should be used at different times of the day since estrogen absorption may be reduced if used immediately after a lubricant. In addition regarding timing, it is recommended not to have sexual intercourse immediately after applying vaginal estrogen since absorption by the partner may occur; wait at least one hour.

It can be difficult to talk about sex and vaginas, but maintaining vaginal and vulval health after the menopause is essential. It’s time to speak up, whatever name we choose to use!

Monday, 4 April 2016

HRT and breast cancer.

HRT and breast cancer.

When considering the use of Hormone Replacement Therapy for treating menopausal symptoms, many women and healthcare professionals have been strongly influenced by the risk of breast cancer thought to be associated with the use of HRT. Previous publications have strongly emphasised the risk and headlines such as “HRT doubles risk of breast cancer” has understandably had an impact. In many cases, this concern has led to women choosing to tolerate menopausal symptoms, which, at times, can be severe, and to healthcare professionals refusing to prescribe HRT or advising women to stop HRT unnecessarily. While no medication is entirely without risk, it is essential that risk is kept in perspective and that there is a clear understanding of the balance between benefits and risks.
Breast cancer is the most common cancer affecting women in the UK with just over 50,000 diagnoses in 2011, equating to around 155 per 100,000 women per year. However it is not the leading cause of death in women, many more women dying each year from cardiovascular disease and dementia. The baseline risk for breast cancer for women around the age of menopause in the UK is around 23 cases per 1000 women, but each woman’s risk will vary according to her history, family history, and in relation to some modifiable risk factors. While the association between HRT and risk of breast cancer is well known and often exaggerated and misunderstood, the risk from other modifiable factors is often unknown and ignored.
The recent NICE guideline on diagnosis and management of menopause included a section on breast cancer as part of the section on Long-term benefits and risks of hormone replacement therapy. Over the years many individual publications have shown varying levels of risk, with some showing no increase in breast cancer and others showing an alarming increase. Each publication has received varying levels of publicity leading to widespread confusion. The NICE guideline development group have closely examined all publications not only for their findings but also for the quality of the study. The result is an unquestionable authoritative document which supports both women and healthcare professionals to make informed choices about menopause management and use of HRT.
So what does NICE say? The first important point is that the levels of risk were reported as absolute figures rather than percentage or relative risk. This may seem an academic point but in fact how risk is reported can have a huge impact on how risk is perceived. For example, a risk being reported as “doubled” or “100% increase” sounds much more alarming than if the absolute rise was an increase from 1 case per 1000 to 2 cases per 1000. Sadly alarmist headlines rarely report absolute figures. The reporting of the Women’s Health Initiative trial in 2002 was an example of the use of percentage increases which led to dramatic loss of confidence in the use of HRT despite the fact that absolute risks were very small.
Secondly, NICE clearly describes different effect from different types of HRT. The purpose of HRT is to replace estrogen since it is the declining and low level of estrogen that is believed to cause the consequences of the menopause in terms of menopausal symptoms and later health effects. Women who have had a hysterectomy can generally take estrogen only HRT while women who have an intact uterus need to take progestogen along with the estrogen (combined HRT) to prevent estrogenic stimulation of the uterine lining. It has been suggested for some time that estrogen only is not associated with the same level of risk of breast cancer as combined HRT but there has been a lack of awareness of this difference, many young women who have had a hysterectomy stopping estrogen early or being advised to do so. NICE confirms that HRT with estrogen alone is associated with little or no change in the incidence of breast cancer. The absolute figure given is for 4 fewer cases of breast cancer in women taking estrogen only HRT per 1000 menopausal women over 7.5 years, based on baseline risk for that group being 22.48 per 1000.
For women who take combined HRT, NICE confirms that this can be associated with an increase in the incidence of breast cancer. The absolute figure given is 5 more cases of breast cancer in women taking combined HRT per 1000 menopausal women over 7.5 years, baseline risk as noted. This increase in risk appears to be associated with the length of time that HRT is taken, the risk being higher when combined HRT is used for more than 4 years. However, the risk reduces and returns to each woman’s baseline risk after HRT is stopped. Another important point highlighted is that the mortality from breast cancer does not appear to be increased compared to women who develop breast cancer and are not taking HRT. The conclusion from these two points is that combined HRT may, in a small number of women, stimulate the growth of cancer cells which are already present, rather than cause breast cells to turn into cancer, and the natural history of disease for each woman is not altered.
The NICE group did examine whether different types or routes of HRT affect risk. With the knowledge that estrogen only seems to be less likely to affect risk than combined HRT, it has been suggested that certain types of progestogen may also differ in association with risk. NICE concluded that the evidence was not yet strong enough to recommend that certain types of progestogen were better than others. It has been recommended that further research be carried out to determine if there are differences in risk between different types of progestogen within combined HRT so that preparations can be offered which maximise benefits and minimise risk.
While any diagnosis of breast cancer is devastating, it is really important to fully understand the role of HRT, that any risk is small, the risk returns to baseline when HRT is stopped, that each woman’s risk of dying from breast cancer is not affected by the use of HRT and that each woman should take this into consideration along with the benefits of HRT for her.
It has been known for some time that there are other factors which affect breast cancer risk and the table shows that being overweight, having first birth after age 31, and regular alcohol are all associated with higher level of extra cases of breast cancer than the use of combined HRT. Further, regular physical activity is associated with reduced risk. Therefore, the decision around use of HRT and consideration around health benefits and risk should also take into account other factors, particularly weight, which can be addressed.
Finally, concern and confusion often arises around the options for treatment of menopausal symptoms in women who have had breast cancer, or who may be thought to be at high risk for breast cancer, for example due to strong family history. Menopause may occur as part of the treatment for breast cancer when it may lead to premature menopause, or may occur naturally regardless of treatment. The NICE guideline recommends that women should be given information about all available treatment options. These include non-hormonal treatments such as the antidepressants, Selective serotonin reuptake inhibitors (SSRIs) which have often been used in this situation to reduce hot flushes and sweats due to the serotonin action. However the guideline emphasises that paroxetine and fluoxetine should not be offered to women who are taking tamoxifen for breast cancer treatment since interactions with medication may occur leading to the tamoxifen being less effective.
NICE also reviewed the role of Alternative therapies for women in this situation and concluded that while there is some evidence that St John’s Wort may be helpful for reducing menopausal symptoms, women should be aware that there is lack of clarity about appropriate doses, there may be variation in preparations and that it may interact with other medications including tamoxifen. Further research has been called for to examine the effectiveness and safety for treatments for menopausal symptoms in women who have had breast cancer.
Referral to a healthcare professional who is a menopause specialist is often required for women who have had, or are at high risk for breast cancer.

Overall, the association of breast cancer risk with use of HRT does cause concern to many women and healthcare professionals but the NICE guideline provides clear information and goes a long way in putting the small risk in perspective. Work is still required to understand which treatments can be safely offered to women who have had breast cancer.

Thursday, 19 November 2015

Menopause: Time for Change.

Menopause: Time for change
Women need clear, evidence-based information to break through the conflict and confusion about menopause treatments
Often referred to as “the change”, the menopause refers to the biological stage in every woman’s life when their periods stop and the ovaries lose their reproductive function. Usually, this occurs between the ages of 45 and 55, but in some cases, women may become menopausal in their 30s, or even younger.

The recent launch of the NICE guideline on the diagnosis and management of the menopause was a monumental menopausal moment! For the first time, leading experts in the field have examined all of the existing evidence and we have been presented with information and advice which will not only enable women to better understand the consequences of the menopause and make informed choices about their treatment, but also ensure that healthcare professionals can provide women with evidence-based information about the benefits and risks of different treatment options in order to come to decisions on an individual basis.

Every woman experiences the menopause differently. Symptoms can last from a few months to several years and up to 80% of women experience physical and/or emotional symptoms during this time. These can include; hot flushes and night sweats, tiredness and sleep disturbance, joint and muscle ache, mood swings and depression, forgetfulness or lack of concentration, vaginal dryness and loss of interest in having sex.

With life expectancy at 83.2 years, many women are living in this post-menopausal phase for half to one third or their life, and these symptoms can have a significant impact on their health and wellbeing as well as their work and relationships. The menopause is not something that just affects ‘older women’ but those in ‘mid-life’ - often when they are juggling demanding jobs, school-age children and elderly parents. Despite this, many women are unaware of the impact of symptoms and later health problems and that diet and lifestyle changes can help improve their symptoms. Sadly, many are also often confused about the benefits and risks of treatment options.

We know that many women choose to go through the menopause without seeking treatment. Others prefer to help to manage their symptoms either by using hormone replacement therapy (HRT) or an alternative treatment option such as cognitive behavioural therapy, relaxation techniques or herbal medicines such as black cohosh, isoflavones (plant estrogens) or St John’s wort. 
HRT has been controversial for many years and has frequently divided opinion. The evidence underpinning the benefits and risks has been accumulating for many years and this guideline has focused specifically on the risks of breast cancer, heart disease, stroke and bone health in women aged between 50 and 59.

This guidance is unequivocal in recognising that HRT is an effective treatment for menopausal symptoms, particularly with the management of hot flushes. However, the benefits and risks will stack up differently for each woman, and whether or not to take HRT is an individual choice.

Let’s start with the good news. The evidence tells us that HRT not only reduces symptoms but can also improve bone health and reduce the risk of osteoporosis and fractures in later life.

The slight increased risk of breast cancer associated with HRT has been widely documented and is not disputed in this guidance. To put this into perspective, breast cancer is the most common cancer in women and approximately 23 in every 1,000 women in the general population will suffer from breast cancer over a period of 7.5 years. For women taking estrogen and progesterone HRT, we will see around five extra cases of breast cancer over the same timeframe. Estrogen only treatment, which is given to women who’ve had a hysterectomy, shows four fewer cancers in same time frame. It’s the progesterone which appears to have effect of increasing disease. This risk is related to the treatment duration and reduces after stopping HRT, suggesting that HRT may, in a small number of women, promote the growth of breast cancer cells which are already present rather than cause the cancer .

Heart health and stroke risk are other areas that are widely debated. Looking at the most recent evidence from the Cochrane collaboration, we can conclude that if 1,000 women under 60 years old started HRT, we would expect six fewer deaths, eight fewer cases of heart disease and five extra blood clots over about seven years, compared to 1,000 similar women who did not start HRT.

We must remember that HRT is just a small component of post-reproductive health and the treatment of menopause depends on a clear and complete understanding of an individual woman’s circumstances as well as the health of women in their later years. Our focus as healthcare professionals is to ensure that women receive clear, evidence-based information to help them make decisions about their health.

It’s also important to remember that lifestyle factors such as obesity and smoking play a huge role in a woman’s short and long-term health and we encourage all women, no matter what their age is, to maintain a balanced diet, engage in regular physical activity and refrain from smoking. This advice is particularly relevant for menopausal women, as lifestyle factors – particularly being overweight - impacts on the severity and length of menopausal symptoms and on later health.

Women deserve high-quality information on their choices. Although we appreciate that too much information may be confusing for women, who may want their health professional to tell them ‘what’s best’, managing the menopause is an area of medicine that is truly individual and we hope this guidance will empower both health professionals and women to work together on deciding the best treatment options for them.

Friday, 3 July 2015

Women’s Views on HRT and Alternative therapies.

Women’s Views on HRT and Alternative therapies.

It is well known that many women and healthcare professionals are uncertain about the pros and cons of treatment options for menopausal symptoms and are particularly concerned about risks of Hormone Replacement Therapy. 

It is also recognised that many women consider using Alternative therapies for control of menopausal symptoms, a previous survey published in 2007 showing that 96% of women would try alternatives before using HRT.

With much media attention and sometimes conflicting reporting of study results, it is understandable that both women and healthcare professionals are unsure what to believe and so what decisions to make.

Results of a recent survey on the Menopause Matters website has provided further information about women’s views on alternative therapies and hormone replacement therapy. 1476 responses were received from 33 countries, with 92% from the UK.

Regarding women’s views on HRT, almost 70% had used or would consider using HRT with almost 30% saying that their views on the use of HRT had changed for the better over the last 5 years. There appears to have been an improvement in women’s understanding of HRT since the previous survey, with now the majority feeling that they were clear about risks and benefits, many aware that different types were associated with different risks and over half were aware that the age at which HRT was started affected an individual’s risk.

While the percentage of women who felt that they know enough about HRT to make an informed choice has increased from 27% in 2007 to 53.2% in 2014, it is still concerning that almost half from this survey did not know enough. Most women obtained their information from their health professional or the internet and so it is essential that health professionals are up to date and able to provide correct information. Sadly, over half felt that their family doctor did not recognise the importance of the menopause.

Regarding women’s views on Alternative therapies, still the majority of women (76%) would try alternatives before taking HRT for menopausal symptoms. Around 55% of women had used alternatives despite almost 40% of those women stating that they did not know enough to make an informed choice. The main reasons for trying alternatives were desperation, concern with risks of HRT, seeming to be more natural than HRT and recommendation by a friend. Of those women who had not used alternatives, almost 40% were unconvinced that they were effective or had concerns about safety.

Whatever is decided for managing menopausal symptoms whether it be diet and lifestyle changes, alternative therapies or hormone replacement therapy, women should be supported to make the right individual decision. The recent survey suggests that much is still required to help this to happen.
It is very much hoped that more and more women will have access to accurate information so that they can make truly informed choices about what treatment option they choose.

Monday, 16 December 2013

Award winning Menopause Magazine, what is it all about?

The Menopause affects ALL women and is a phase of significant hormonal, physical and psychological change. While all women are affected very differently, they should all have access to accurate, non-biased information to empower them to make informed choices about the management of their menopause. At Menopause Matters, our mission is to provide such information and support. To achieve this aim,Menopause Matters Ltd was founded in 2001, and in January 2002 launched what is now the leading UK based, award winning menopause website attracting an average of 4,500 visitors per day.
To provide essential information and support in a complementary, glossy format, reach a wider audience, and satisfy an evident need for a hard copy resource, Menopause Matters magazine was launched in summer 2005. Menopause Matters magazine is currently the only magazine of its kind, written specifically for women approaching and experiencing the menopause. Menopause Matters combines medical facts with glamour in an upbeat, readable style. Menopause Matters magazines are posted out to individual subscribers, GP's surgeries and menopause clinics and to gyms and yoga studios. While our print run has increased, so too has the use of our website where the online magazine can be viewed, the two mediums complementing and promoting each other, achieving our aim of a continued increase in the use of both.
With the medical background and knowledge of Dr Heather Currie, a national expert in Women’s Health and the menopause, the editorial skills and extensive publishing experience of Mr Andrew MacKay, the website expertise of Mr Rik Moncur and the advertising expertise of Mrs Annie Preuss, this innovative team cross public and private sector, medical and non-medical boundaries to provide accessible, accurate, readable, attractive information and support which is essential for all women.
Surveys of both women and health professionals showed:
  • 90% considered Menopause Matters to be very useful
  • 96% found Menopause Matters content good or very good
  • 91% found the advertisements useful
  • 90% said that the magazines were received well or very well by patients
  • 97% wish to keep receiving the magazines
  • 99% felt that the magazines should be available in all GP’s surgeries and menopause clinics
  • 98% felt that Menopause Matters helped women be better informed
While providing general menopause information, Menopause Matters magazine also sensitively tackles embarrassing menopause related topics, enabling women to understand, seek help when necessary and go on to lead as healthy, full lives as possible. With current NHS constraints, Menopause Matters goes a long way in empowering women to cope with an inevitable health process, without necessarily needing to use NHS resources.
I have just picked up a copy of 'Menopause Matters' at the GP surgery and I found it really refreshing and confidence boosting - the fact that somebody out there believes that we 55+ women are not on the sexual decline was heartening and in particular, that vaginal atrophy is treatable. I want to thank you sincerely for producing this magazine which offers such a ray of light in the apparent gloaming. You have given me such great hope.
I am sure there must be many colleagues who equally find balancing careers with the menopause a real challenge.............I cannot thank you enough for putting me back in the driver’s seat.
ALL females should have access to the magazine young & old!
Fabulous magazine. Really helpful tool and good for staff too
Brilliant. Magazines go like hot cakes
Excellent up to date glossy mag for ladies. I give copies to all my menopausal patients
Read by staff and patients alike – excellent
Please can we have some more magazines for the surgery- they go like hot cakes!
I just LOVE Menopause Matters magazine!  Thank you for sending to the United States.
My patients have found the magazines very useful, especially when they realised that other women had similar symptoms of the menopause to them and they were not alone.
Was just reading the articles in your last edition about STD issues in my age pocket, awesome piece!!! Glad to see someone getting the info out there!
Magazine extremely useful and allows women to look information for themselves and educates and builds confidence
Excellent resource for profession and public

Tuesday, 17 September 2013

Preventing endometrial cancer - is it possible?

Endometrial cancer (cancer of the womb lining) is known to be associated in many cases with being overweight, since an imbalance of hormones and growth factors which then stimulate the womb lining can be produced in fat cells. But can maintaining a healthy weight prevent this common disease? According to a new report, it is estimated that 59% of the cases of endometrial cancer (about 29,500 annually in the United States) could be prevented if women engaged in physical activity for at least 30 minutes per day and maintained a healthy body weight, with a body mass index (BMI) from 18.5 to 25.0 kg/m².

The Endometrial Cancer 2013 Report, which was published by the American Institute for Cancer Research (AICR) and World Cancer Research Fund International (WCRF), also notes that coffee consumption reduces the risk.

Increasing evidence has suggested a link between cancer risk and physical activity and body weight. Physical activity and a healthy body weight have been associated with a reduced risk for a number of cancers, including breast, prostate, and colon.

But in the case of endometrial cancer, the relation is quite striking. Currently it is thought that 7 of 10 American women are overweight or obese, and more than half do not get enough exercise to protect themselves against endometrial cancer.

The researchers also found that a high glycemic load, a diet rich in sugar-laden drinks and processed foods high in carbohydrates boosted the risk of developing the disease; it seems that diets that contain a lot of processed foods and sugary drinks can make a difference in the metabolic environment.

Coffee consumption is also associated with a reduced risk for endometrial cancer. Although too much caffeine can affect sleep quality and have other detrimental effects such as on bone health, this study shows that moderate amounts of coffee can be part of a healthy diet, and drinking decaffeinated coffee was also protective.

However, despite the increasing number of studies linking lifestyle and weight to cancer risk and the subsequent media coverage, many people are still unaware of the connection. Surveys have shown that while many people are aware that being overweight increases the risk of type 2 diabetes and heart disease, about half do not see it as a risk factor for cancer.

For someone who is sedentary and overweight, change can be a daunting task. Weight loss should be viewed as a long-term effort, not something that needs to be done immediately. Changes should be made gradually both for weight loss and for increasing exercise. This report did find that activity of all types is important, not just recreational but occupational as well. Physical activity can be done in short bursts of time, even during the work day - go for a 15-minute walk, get up from your desk periodically, take the stairs instead of the lift. It is possible to work physical activity into daily life, even if you have a sedentary job.