There is a mistaken impression in the community that women are psychologically unstable at menopause, facing sociological changes that they cannot cope with. But this applies equally to both sexes. The difference for women is that they suffer a hormonal imbalance as well. Adjust this and the rest usually falls into the place.
We see no point in our clinics in running group therapy sessions. This is not done for any other hormone deficiency condition such as diabetes or thyroid deficiency. We stabilise the women’s hormones, and if following relief of their oestrogen dependent symptoms, they still need help, we refer them to psychiatrists or other expert professionals. Those who still need help after their hormones are stabilised are shown to be unable to cope with the stresses of mid-life which are common to both men and women.
In any medical interview the doctor looks into the workload and stresses of the patient. It is not uncommon to find women in this age group working full time, running a home, coping with a partner facing increased stress at work or retirement, coping with teenagers with their problems, as well as often being a major source of support for old people who may live in the home. It is impossible to assess the problems of menopausal women without taking all this into account.
To assess this, a full general and gynaecological history is taken. The woman is examined including a smear test for cancer of the cervix and a breast examination. She is also instructed on breast self-examination (figure 4.1). The doctor then explains what treatment is available and in what way it can be expected to help, together with a full explanation of the therapy and why it is necessary.
Oestrogen replacement therapy is offered orally, locally or by implant and if this is contraindicated, or if the woman does not want to take this therapy then alternative therapy is made available to her. Those who are not suitable for treatment must be recognised.
• women with a history of cancer of oestrogen-sensitive tissues, for example cancer of the breast or lining of the uterus. This does not apply to the neck of the uterus or cervix
• women with a history of thrombosis or clotting. In some instances, if symptoms are incapacitating, small doses of oestrogen may be given, particularly certain oestrogens which are said not to affect the clotting mechanism of the blood.
Other treatment is available if oestrogen is unsuitable.
Of course any other medical or gynaecological conditions are treated as well. Advice is given on regular exercise; diet and correction of obesity, if necessary, are discussed. Counselling on general problems is given.