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FEATURE


Managing A


s the average life expectancy of women in the UK is 82.6 years, approximately 30 years will be


spent in the post-menopausal phase1 .


Community pharmacists are in an ideal position to assist women in managing this stage of life as best as possible through individualised treatment.


Symptoms of the Menopause Menopausal symptoms develop in 80% of women, with as many as 45% of women finding their symptoms distressing2


. However only 10% of


women will go on to seek medical advice. Most symptoms are self- limiting, lasting between two and five years, although some women experience symptoms for much longer.


Absolute Contra-indications


Abnormal undiagnosed genital bleeding Current, past or suspected breast cancer


Diagnosed or suspected oestrogen-sensitive cancer Untreated endometrial hyperplasia


Active/recent myocardial infarction or angina Untreated Hypertension Untreated liver disease Porphyria cutanea tarda


Table 1: The Absolute and Relative Contraindications for Hormone Replacement Therapy 40 pharmacyinfocus.co.uk


Menopause


According to the World Health Organisation, the average age at the menopause is 52 years old in industrialised societies, including the UK2 to the cessation of menstruation1


Hot flushes occur in 75-80%of women, most commonly during the first year after the final menstrual period. A hot flush is a vasomotor symptom which is felt as a wave of heat which spreads across the upper body, creating flushing of the face, neck and chest followed by sweating, palpitations and tachycardia3


.


It is not fully understood as to what causes the vasomotor symptoms. Most hot flushes only last a few minutes, but more severe and frequent hot flushes can occur in women with a high BMI, those who smoke and those who have a high alcohol consumption3


.


Relative Contra-indications Diabetes Mellitus


Gallstones Obesity Epilepsy


Sleep disturbance occurs as a result of night sweats and can cause irritability and difficulties with concentration and short term memory3


.


Approximately one third of women suffer from vaginal symptoms such as dryness, itching, discomfort and dyspareunia during the early postmenopausal period. Vaginal symptoms can persist or worsen with ageing and recurrent lower urinary tract infections are also common.


Women can experience other symptoms including loss of libido, palpitations, headaches, mood changes, weight gain, skin changes and cognitive disturbances4, 5


.


Hormone Replacement Therapy HRT has a well-established roll in reducing vasomotor symptoms as well as relieving the symptoms of genital atrophy. It is also effective in reducing sleep and mood disturbances caused by night sweats and hot flushes. For the majority of women under the age of sixty years, the benefits of short- term HRT outweigh the risks.


. Menopause occurs when a reduction in follicular activity leads and it is usually diagnosed after 12 months of amenorrhoea.


There are two main types of HRT – oestrogen therapy and combined therapy (which is both oestrogen and progestogen). With combined therapy, progestogen is administered alongside oestrogen to women with a uterus so as to reduce the risk of endometrial hyperplasia and cancer.


These are conditions which can develop with the sole administration of oestrogen; approximately 20% of women who take oestrogen alone develop endometrial hyperplasia after one year6


The decision to use HRT for the treatment of menopausal symptoms should take into consideration all appropriate factors, with patients made fully aware of both risks and benefits particularly in light of current safety guidance.


In 2013, the British Menopause Society advised that the decision to use HRT should be made by each woman having been given sufficient advice so as to make a fully-informed decision.


. Table 1 shows the absolute and relative contraindications for HRT.


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