Menopause in the Workplace

by Pat Duckworth

Treatments

Many women do not need treatment for the menopause, but about one in ten women seek medical advice. The type of treatment provided will depend on the nature and intensity of the symptoms being presented, medical history and client preferences. Treatment options include

  • Hormone replacement therapy (HRT)
  • Bio-Identical Hormone Therapy
  • Tibolone (similar to HRT)
  • Clonidine
  • Anti-depressants
  • Vaginal lubricants.

Hormone replacement therapy

Hormone Replacement Therapy (HRT), also referred to as hormone therapy, has been available since the 1930s. The earliest prescription drug for replacement oestrogen, Premarin, was an oral medication made from the urine of pregnant horses. This was followed by a synthetic form of progesterone, called Prempro. Newer medications combine oestrogen and progestin.

Initially, it was thought to be safe for women to start taking HT at the onset of menopausal symptoms and then stay on it for the rest of their lives. Now, following the report of the Women’s Health Initiative in 2002, it is recommended that women only stay on HRT for the short term (such as five years), due to potential health risks, which include an increased risk of heart attacks and breast cancer. The drawback is that as soon as women stop taking HRT, they may experience menopausal symptoms, no matter what age they are.

There is now a large range of HRT products, manufactured from a variety of ingredients. These are administered in several ways, including implants, tablets, skin patches, vaginal rings, gels and creams.

HRT can have unpleasant side-effects, including depression, skin rashes, hair loss, vomiting, bloating and a cystitis-like syndrome. It is unsuitable for some women, particularly those who smoke or have high blood pressure, benign breast disease, endometriosis, pancreatitis, epilepsy or migraines.

Bio-Identical Hormone Therapy (BIHT)

Bio-identical hormones have been prescribed in the US for many years, but have only recently become available in the UK. They have structures identical to human hormones and are mostly derived from plant sources, including soy and Mexican yam root.

Some bio-identical hormone products are produced by big pharmaceutical companies. Others are produced by compounding pharmacies, according to the individual formulation of the prescribing practitioner. Practitioners prescribe a compound of hormones tailored to the needs of the individual, often based on the results of saliva and blood tests.

As with HRT, BIHT can take a variety of forms, including tablets and creams, to suit different symptoms. They can also give rise to side-effects. Practitioners will normally aim to treat with the lowest dose for the shortest period of time to minimise the associated risks.

Tibolone

Tibolone is a synthetic hormone that acts in a similar way to HRT. It is effective in treating menopausal symptoms such as hot flushes and night sweats and it can also prevent fractures of the spine.

Tibolone carries a slightly increased risk of breast cancer, cancer of the womb and stroke. It is not recommended for women over 60 years of age.

Clonidine

Clonidine was designed to treat high blood pressure, but has been found to reduce hot flushes and night sweats in some women.

It can have unpleasant side effects, such as dry mouth, drowsiness, depression, constipation and fluid retention. Patients are normally given a trial period of two to four weeks. If the menopausal symptoms do not improve or the patient experiences side-effects, the treatment may be stopped.

Anti-depressants

Although they are not designed or licensed for the treatment of menopausal symptoms, some doctors prescribe anti-depressant medications for this purpose. These include

  • Venlafaxine
  • Fluoxetine
  • Citalopram
  • Paroxetine

Potential side-effects of these antidepressants can include nausea, dizziness, dry mouth, anxiety and sleep problems.

Doctors may also prescribe treatments for specific medical issue that arise during menopause, such as high blood pressure, sleep problems, constipation and so on.