Frequently asked questions about menopause

How is the menopause diagnosed?
Why is osteoporosis mostly associated with ageing?
Why do women seem to be affected more by osteoporosis than men?
How can osteoporosis be prevented?
What should be my daily dose of calcium?
Which foods and drinks provide calcium?
What are sources for vitamin D?
Is HRT a life-long treatment?
I have had a hysterectomy, so my uterus is gone. What will be my HRT?

How is the menopause diagnosed?

You suffer from hot flushes now and then, but your menstrual cycle is still very regular. Is this your menopause starting? When you consult your doctor, a blood sample will be analysed to detect its level of FSH (follicle stimulating hormone). FSH is a hormone that, during the fertile period, stimulates the follicles to mature and secrete oestrogen. If the level of oestrogen is sufficiently high, the synthesis of FSH will be stopped. Due to lack of oestrogen, FSH levels rise. High levels of FSH may indicate that you are approaching your menopause.

Why is osteoporosis mostly associated with ageing?

Strong and healthy bones require calcium and vitamin D. The latter stimulates the uptake of calcium out of your food and helps it to be built into your bones. Physical exercise also contributes to keeping your bones in good condition.
Vitamin D synthesis occurs inside your body and under your skin in response to sunlight. People who spend most part of their day inside the house, produce less vitamin D. Furthermore, vitamin D synthesis is less efficient in elderly people. Let’s summarise the causes of osteoporosis in the elderly:

• Bad eating habits, thus less intake of calcium.
• Decreased production of vitamin D.
• Poor physical exercise.
• Living indoors, compromising vitamin D synthesis even more.
• Decreased production of oestrogen in women.

Why do women seem to be affected more by osteoporosis than men?

Osteoporosis can also affect men, but far less frequently than in women. This can be attributed to the loss of oestrogen production in menopause. Of course, there are other factors than can cause osteoporosis, like long-term steroid therapy or some types of cancer, and these affect women as well as men.

How can osteoporosis be prevented?

Bone decalcification can be prevented in many ways, but only partially, since it is impossible to stop the process of calcium loss completely. It is important to start early in life:

• Before the age of 30: supply your bones with as much calcium as possible. Eat food products rich in calcium and make sure you produce enough vitamin D by taking part in outdoor activities.
• After the age of 30: try to keep the calcium inside your bones. There are things you can do to help maintain a health calcium level in your bones such as following a healthy, varied diet and taking regular excercise.

What should be my daily dose of calcium?

The advised daily dose depends on your age:

Which foods and drinks provide calcium?

What are sources for vitamin D?

Is HRT a life-long treatment?

Until a few years ago, the use of HRT was common practice in the treatment of menopausal symptoms. The effects on the woman’s well-being were substantial, and the treatment was usually well tolerated. Therefore, treatment was often continued for years and even decades, merely to prevent the long-term effects of oestrogen-deficiency, like osteoporosis and cardiovascular disease. Since the publishing of the results obtained from the Million Women Study, gynaecologists and other physicians have changed their attitude towards HRT. Nowadays, HRT is still the most effective and best tolerated treatment for peri-menopausal complaints, like hot flushes, palpitations and vaginal atrophy. But, instead of continuing therapy without periodical assessment of its benefits and risks, these days your therapy will be evaluated regularly, e.g. every year. Therapy should only be continued as long as the benefits outweigh the risks. Your gynaecologist or family doctor may also advise you to interrupt your treatment to see if symptoms return. If so, you’ll restart HRT. If not, you can abandon treatment. If necessary, other treatments will be initiated to prevent the long-term effects caused by a lack of oestrogen.

I have had a hysterectomy, so my uterus is gone. What will be my HRT?

Contrary to women who still have their womb, you will be prescribed oestrogen alone. There is no need to add progestagene, as there is no risk for building up mucous layers in the uterus.

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