Episode 187 - Perimenopause, Menopause and MHT with Dr Sugandha Kumar (Part 1)
It is now increasingly recognised that women’s health care needs at menopause have been both under-recognised and under-treated by medical practitioners, and that menopause management has not been emphasised adequately in graduate and post-graduate education. Considering that half the world’s population spend about a third of their lives after menopause, this unmet need must be recognised and addressed. I was curious to explore this subject in greater detail and welcome the opportunity to review some basic science and definitions.
Menopause, also known as the climacteric, is the time when menstrual periods permanently stop, marking the end of the reproductive stage for females. It is often defined as having occurred when a woman has not had any menstrual bleeding for a year.
Perimenopause is the natural stage in a woman’s life occurring before the final menstrual period, or menopause, when a woman's body transitions away from its reproductive years. Based on these criteria, perimenopause starts when there are persistent differences in cycle length of seven or more days between consecutive cycles and continues until 12 months after the last menstrual period. During this time, the ovaries gradually become less functional, leading to changes in menstrual cycles and potential infertility.
Perimenopause is a time when risk factors for chronic disease need to be considered, including acceleration of bone loss, increase in cardiovascular risk arising from adverse changes in lipids and altered glucose metabolism. Cancer screening programs, including bowel, breast, and cervical cancer should also be discussed with patients at this time.
Medical treatment of perimenopause and menopause is aimed at ameliorating symptoms and to prevent bone loss and is centred on the use of menopausal hormone therapy (MHT) with replacement of oestrogens either alone, in the case of previous hysterectomy, or combined with progesterone when the uterus is present.
Many of the concerns about MHT raised by older studies are no longer considered barriers to its use in healthy women. The risks arise around discussions of breast cancer, uterine cancer and cardiovascular disease including thromboembolic events and strokes.
For cardiovascular disease the evidence pertaining to MHT risk relates to timing and the use of oral rather than transdermal oestrogen. If oral or transdermal oestrogen therapy is initiated within 10 years or earlier since menopause or less than age 60 years, there may be a slightly reduced coronary heart disease risk.
With this background I would like to introduce Dr Sugandha Kumar. Dr Kumar is an Obstetrician and Gynaecologist committed to providing comprehensive women’s health care in the south-eastern suburbs of Melbourne.
Sugandha did her early specialist training at a prestigious medical institute in India (PGIMER, Chandigarh) and completed her advance training in Obstetrics and Gynaecology in Australia (Monash and Eastern Health). She holds specialist appointments at Box Hill Hospital and has a strong focus on improving outcomes for her patients by offering up-to-date and evidence-based treatment options. She provides obstetric and gynaecological and is expert in advanced laparoscopic surgery including laparoscopic hysterectomy and endometriosis surgery as well as having specialist interest in menopausal hormone therapy. Please welcome Sugandha to the podcast which we will present in two parts.
References:
Dr Sugandha Kumar : Create Fertility: www.createfertility.com.au
https://www.thelancet.com/series/menopause
Swan Study : JAMA 2015;175:531–39