Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 129

Many women associate menstruation with femininity, fertility, and youth, which is in sharp contrast to the symbolism of menopause, which signals biological ageing triggering a new dynamic in self‐identity and sexuality. In the medical literature, the view that menopause is a deficient state is prolific. Some would argue this negative portrayal is a social construct based on the medicalization of menopause and failure to recognize it as a natural life transition.¹³ These debates aside, menopause is an individual experience derived from the interplay of physiological, psychological, and other factors. Natural menopause occurs in women at an average age of 52 years.

Numerous studies of ageing and menopausal transition demonstrate multiple health‐related changes, alterations to sexual response, and impacts on intimate relationships that lead women to seek support through either traditional or alternative medicine.¹⁴ The major symptoms of menopause are hot flashes and night sweats, also known as vasomotor symptoms (VMS), which occur in approximately 80% of women. The occurrence of VMS coincides with a decrease in endogenous oestrogen and an increase in follicle‐stimulating hormone. Although VMS lasts 7–9 years for most women, some women experience symptoms upwards of 10 years.¹⁵ In an older woman with persistent nocturnal VMS leading to disrupted sleep, it is important to investigate other potential causes for sleep disturbance, such as untreated obstructive sleep apnea.¹⁶

For many women, behavioural adaptations such as using fans, lowering the room temperature, wearing layered clothing, and avoiding triggers such as spicy food can help alleviate VMS. Hormone therapy, including oestrogen‐only and combined oestrogen‐progesterone therapies, has been shown to be highly effective in reducing hot flashes and night sweats. However, these are associated with increased risks of coronary events, venous thromboembolism, and stroke. There is also a well‐documented increased risk of endometrial cancer among those who take oestrogen‐only hormone therapy.^17,18 Selective serotonin reuptake inhibitors have been associated with some improvement in the severity and frequency of hot flashes, and cognitive behavioural therapy has also been shown to affect menopausal symptoms.^19,20 Reviews of the evidence on exercise, Chinese herbal medicines, and black cohosh have demonstrated insufficient evidence to support their use.^21‐23