Many menopausal women complain of sleep problems. It is difficult to separate sleep problems that are due to low oestrogen from sleep problems that are due to the effects of ageing. If you were previously in good health and your sleep is now disturbed by night sweats, then HRT will almost certainly help. However, if you cannot link your insomnia or other sleep problems to the menopause, then HRT may not help, as the cause is probably not low oestrogen. (You might like to try HRT for, say, two months, and if you still can’t sleep after this time, then the insomnia has other causes.) As with hot flushes, some doctors still prescribe tranquillisers and sedatives to women whose sleep disturbance is the result of a deficiency of oestrogen, and this cannot be a good thing. If night sweats are disturbing your sleep, and if as a result of this you feel tired, lethargic, irritable, and find it difficult to concentrate or make decisions, ask your doctor about HRT.

‘My problems were mat I kept walking in the night drenched through with sweat, or just waking after only 2-3 hours’ sleep, and then remaining wide awake for some hours; also I started getting feelings of panic. HRT solved all these problems, although I had to increase the original dose before it really worked. I am now my normal self, and my husband gets a good night’s sleep now mat I do, so he’s happy.’

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No, it is unrealistic for every woman contemplating HRT to ask for a bone density scan as the procedure is offered by only a small number of centres and the cost to women varies from about $30 to over $100. The federal government is considering introducing a Medicare rebate for the procedure. What’s more important is that it’s not necessary for every woman.

Those for whom bone density scans are appropriate have one or more of the following characteristics:

- a family history of osteoporosis

- an experience of breaking a bone around the time of menopause with very little force applied

- strong risk factors for osteoporosis, such as a history of absent periods for six or more months, heavy smoking, excessive alcohol or caffeine consumption, prolonged immobilisation and a poor diet

- difficulty deciding whether or not to remain on HRT now that symptom control is no longer the purpose for it

There may also be some women without symptoms who are contemplating HRT, and the bone density measurement will help them make their decision.

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In attempting to put the presence or absence of sexual intimacy into some sort of general framework of midlife relationships, Hathorn and Bates identified a significant obstacle. ‘One of the major problems was that our interest was in both men and women, yet it seems that most of the well-known developmental theorists of the past have focused only on men. It is as if woman were an afterthought and had to be “fitted in” to men’s cycle of growth.’

Professor Marjorie Fiske, who initiated a long-term study of life changes among Californian adults, believes that developmental models based on men may be misleading where women are concerned. ‘The assumption that men and women undergo similar processes in terms of developing, coping, and “declining” has turned out to be fallacious. In nearly all ways of living, thinking and feeling, a young woman is far more likely to resemble an older woman than a young man her own age. Similarly, differences between groups of men in various periods of life are less significant than their differences from women in their own life stage.’

While women within male-female relationships have been largely overlooked by theorists, homosexual women and heterosexual women without partners have fared even worse, having had almost no attention paid to them in traditional analyses of sexuality after menopause. Simone de Beau voir made the point in her book The Coming of Age that enjoyment of sexual activities takes many forms, has many motivations, and is not necessarily extinguished with age. ‘It is understandable that a man or woman should be bitterly unwilling to give it up, whether the chief aim is pleasure, or the transfiguration of the world by desire, or the realisation of a certain image of oneself, or all this at the same time . . . The old person often desires to desire because she retains her longing for experiences that can never be replaced and because she is still attached to the erotic world she built up in her youth or maturity — desire will enable her to renew its fading colours.’

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LOWER URINARY TRACT PROBLEMS Urinary frequency (going to the toilet more often), the pressing urge to go (known as urgency), and bladder incontinence (escape of urine when the need to urinate is very strong or when coughing or sneezing occurs) are more likely with increasing age and may be accentuated at menopause. Studies indicate that up to 50 per cent of women attending menopause clinics have some lower urinary tract symptoms. Treatment with HRT may relieve some of these symptoms, including urinary incontinence, frequency and urgency, by increasing the collagen of the urethra and vagina, and by improving muscle tone in the pelvic floor.

PALPITATIONS AND HEADACHES You may be one of the many women who experience palpitations and headaches around the time of menopause. A Dutch study found that one in four women had palpitations at menopause, and headaches affect nearly a third of Australian-born women aged forty-five to fifty-five. For reasons that are not clear, some women have more frequent and severe tension-type headaches around menopause; for others, headaches, and particularly migraine, become less of a problem. Oestrogen appears to be effective in treating palpitations. It may alleviate migraine in some postmenopausal women too.

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Those on HRT are mainly women seeking help to reduce their menopause-related symptoms. In some cases the menopause has occurred naturally. In others menopause has been brought on by removal of or damage to the ovaries during surgery, chemotherapy or radiotherapy (see chapter i). The main user groups other than women with generalised menopausal symptoms are those who are at high risk of fractures and heart disease, and those already experiencing these health problems.

A study of Massachusetts women aged forty-five to fifty-five found that, of those on HRT after natural menopause, ewer than one-third continued the treatment for more than two years. Among those who had a hysterectomy, nearly two-thirds stayed on hormones for more than two years. Among women in the natural menopause group, those on hormones were different in some important ways from those not on it. Before they started treatment, these women were more likely to have reported hot flushes or menstrual problems than women who did not embark on hormone therapy. They were also more likely to regard their health as poor and to use health services. These women were better educated, too, and were more likely to have used oral contraceptives in the past.

Prescribing HRT for women who do not have clearly defined symptoms and are not at high risk of postmenopausal fractures or heart disease is quite a controversial matter. Fuelling the controversy are some medical specialists who advocate HRT for most women ‘from menopause to grave’. Supporters of this approach tend to equate menopause with ‘hormone deficiency’ or ‘ovarian failure’, often giving the impression that menopause is a time of dramatic and irreversible shutdown of sex hormone production: the start of a downhill road along which women become crumbling shadows of their former selves. This is a ridiculous generalisation, as the variability in sex hormone production after menopause is vast.

Studies of Australian women aged forty-five to fifty-five indicate that about one in two who have had their ovaries removed at the time of hysterectomy are on HRT, as also are one in three who have had a hysterectomy without removal of their ovaries, and about one in six who have had a natural menopause. In a comparable group of US women, the rate was about the same in the surgical menopause group and significantly lower in the natural menopause group. Rates seem to vary widely across Western Europe, but there are no comparable studies by which to assess this.

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Related Posts:

• THE SIGNS OF MENOPAUSE: INSOMNIA
• SHOULD ALL WOMEN CONTEMPLATING HRT HAVE A BONE DENSITY SCAN?
• SEXUALITY AND EMOTIONAL GROWTH: PUT THE PRESENCE OR ABSENCE OF SEXUAL INTIMACY
• HRT AND MENOPAUSAL SYMPTOM CONTROL:PALPITATIONS AND HEADACHES,LOWER URINARY TRACT PROBLEMS AND