The most common sign is irregular bleeding – a light period followed by a couple of heavy ones that go on for much longer than usual. You might also notice that you break out in embarrassing hot flushes for no apparent reason. Uncharacteristic moodiness is also quite common, and so are sleeplessness and difficulties with memory or concentration.

? I had an early puberty at the age of eleven. Will this affect the age at which I go through menopause?

No. The average age of menopause – forty-eight to fifty-three for most Australian women – has changed little over the centuries, while girls now begin their periods at an earlier age than they once did.

? My periods have stopped after several months of irregularity. How long should I wait before having sex without contraception?

You should use a barrier method of contraception such as condoms or a diaphragm until you have not had a period for a year. You can then throw away your contraceptives.

*107\38\8*

HRT AND OVARIAN CANCER No consistent link has been demonstrated between HRT and ovarian cancer, but such a link has not been adequately ruled out. There is some evidence of ovarian cancer a substantial time after long-term HRT use. On the other hand, Pill-users (taking similar hormones to those of HRT but at higher doses) seem to be protected somewhat from ovarian cancer. Research in this area is continuing, but as yet no definitive conclusions can be drawn.

WOMEN WITH EXISTING LIVER DISEASE This condition becomes evident from abnormal liver function test results indicating that the liver is having difficulty doing its job of breaking down a wide range of substances. Recommendations regarding HRT for women with liver disease usually hinge on the nature and severity of the problem. In cases of severe active liver disease with abnormal liver function, HRT should be withheld. If the liver disease is mild or has resolved, HRT may be appropriate; in these cases the patch is the preferred way of administering it. This is because it is less demanding on the liver for absorption of hormones to be through the skin than via the stomach. While patches may be suitable for women with mild abnormalities of liver function, remember the reservation expressed at the beginning of this chapter about the lack of long-term research data on patches.

WOMEN WITH UNDIAGNOSED VAGINAL BLEEDING

Until the reason for unexplained vaginal bleeding is diagnosed it is unwise for women to have HRT. The safest course of action is to have the bleeding investigated. This may entail a hysteroscopy and biopsy or curettage.

*73\38\8*

For reasons that are unclear, high doses of progestogen alone may prove helpful in relieving the problem of hot flushes if you are one of those women for whom oestrogen has not been recommended (such as those with a personal experience of breast cancer).

TESTOSTERONE ALONE OR COMBINED WITH OESTROGEN AND PROGESTOGEN

Testosterone alone or combined with other hormones may be given to women concerned about their loss of libido when this does not seem to be caused by psychosocial factors or discord with a partner. Testosterone is usually given by implant six-monthly or by injection into muscle tissue every three to six weeks. The dosage by implant is about one-quarter that prescribed for men with libido problems.

*38\38\8*

We’ve talked about the experience of menopause to countless women, the majority of whom have experienced some signs of change in their body chemistry – hot flushes, headaches, depression, mood swings, sleeplessness. Some are less concerned about these difficulties than about future health problems caused by a possible inherited high risk of heart disease or cancer. Still others have broken a bone soon after menopause and show early signs of reduced bone density (osteoporosis). The questions they ask vary accordingly. Will HRT settle my symptoms? Will it reduce or increase my risk of future disease? Can it stop my existing medical problems getting worse?

We are the first to admit that the women with whom we have discussed the menopause and HRT do not necessarily represent all women. We certainly do not want to stereotype menopause in an excessively negative way. But it is believed that about three out of four women in countries like Australia experience some physical signs associated with menopause, even though only one in four feels she needs medical help to deal with them. Maybe women who don’t seek medical advice consider their symptoms to be unimportant, maybe they have not been told about the kinds of help available, or perhaps they are coping perfectly well regardless.

As your GP will tell you, you can be sure menopause has occurred only when you have had no menstrual bleed for twelve months. Three or so months without a period are not enough: about one in five women near menopause menstruates again after that.

Raise the issue of menopause at any gathering of women, and it is clear that the term has come to mean more than just the end of monthly bleeds. Menopause has become shorthand for the many changes occurring during the transition from regular periods to no periods at all. It is a quick way of summing up hormones in flux, children leaving home or returning, ailing parents needing help, changing relationships with partners, and altered responsibilities in the workplace. An alternative catch-all term for this time of midlife change is the perimenopause.

The last menstrual period for most Australian women occurs between the ages of forty-eight and fifty-three (and can happen quite normally five or so years earlier or later than this). It is less tied to age, however, than at any time in human history due to developments in surgery and cancer treatment. These medical procedures can result in a woman having an artificial menopause (that is, one caused by removal of or damage to the ovaries) from the age of puberty onwards.

*4\38\8*