Menopause? Here's to you, Mrs. Robinson

In the 1967 movie The Graduate, an older, married woman named Mrs. Robinson, played by Anne Bancroft, seduces the character of a young college graduate played by Dustin Hoffman. The situation depicts the concept that while a male’s sexual urges peak when he is young, a woman experiences renewed sexual drive when as she approaches menopause in her 40s. A scientific explanation may bear this out. As a woman approaches menopause that signals the end of her childbearing years, the hormonal levels in her system are altered. But while an increase in androgens may cause a concomitant rise in libido or sexual drive, a decrease in estrogen levels may lead to a host of physical symptoms in others. For some women, this includes vaginal atrophy that makes sexual contact painful. And thus, the myth of the “Mrs. Robinson complex” does not apply at all.

Is menopause a natural life event? Or is it a disease?

“It depends on how you look at it,” says climacteric medicine expert and International Menopause Society board member Dr. Delfin Tan.

Dr. Tan explains that accelerated disappearance of ovarian follicles begins at an average 37.5 years old, and the early symptoms of reproductive aging are hot flushes, sweating, insomnia, menstrual irregularity, and psychological symptoms. Although these may be initially bearable, the effects later on in life may be more serious. Intermediate effects of estrogen deficiency include vaginal atrophy (dryness and thinning of the vaginal wall), dyspareunia (pain during sex), skin atrophy, and urge stress incontinence (impaired bladder control). In addition, Dr. Tan lists osteoporosis, atherosclerosis (accumulation of plaque in blood vessels), coronary heart disease, cerebrovascular disease, and Alzheimer’s disease as the late effects of estrogen deficiency.

“Estrogen affects many target organs through a variety of estrogen receptors in diverse tissues,” he says. “This causes changes in the brain, eyes, heart, breast, vasomotor system, colon, and urogenital tract.”

To prevent degeneration and improve quality of life, experts recommend hormone replacement therapy (HRT) as an option that aims to replace the estrogen that has been lost.

“Clinicians who interact with women at the time of menopause have a wonderful opportunity and therefore a significant obligation,” says Dr. Tan. “Medical intervention at this point of life offers a women years of benefit from preventive health care and this should be seized.”

Together with lifestyle changes (smoking cessation, nutrition, and exercise) and phytoestrogens (from cohosh, flaxseed oil, soy, and other foods), HRT plays a key role in menopause management.

Despite the benefits of HRT, however, it is not as widely used because of perceived safety issues that link it to breast cancer and blood clots. At a recent forum, however, Dr. Delfin Tan and Drs. Eileen Manalo and Joan Tan-Garcia, former president and incoming president, respectively, of the Philippine Society of Climacteric Medicine, belied the perception that HRT use is dangerous. They cited the results of a Women’s Health Initiative study that showed that the benefits of HRT far outweigh its risks. They agreed that natural estrogen (estradiol) is a well-studied treatment that has undergone many stringent trials.

Current evidence suggests that HRT, when properly supervised, poses little risk to a woman’s health.  Estrogen therapy has been proven to reduce post-menopausal osteoporosis. By starting estrogen therapy soon after menopause, loss of bone mass is reduced, thus reducing fracture incidence.

It should be noted that calcium absorption is impeded significantly in menopausal women, rendering the benefits of various calcium preparations, milk, and other calcium-rich foods (such as malunggay, saluyot, sigarilyas) useless. “Bone loss is accelerated in the first four to eight years following the cessation of menses,” says Dr.Tan. “Preventing bone loss in these early postmenopausal years may be an important strategy in reducing the risk of osteoporosis.”

Most interesting is the link between estrogen use and the prevention of Alzheimer’s dementia. Estrogen protects neurons from oxidative stress and glutamate toxicity, thus keeping neuronal function intact. Moreover, estrogen seems to be important in protecting women against the deterioration of blood vessels. Cardiovascular disease is the most common cause of death in women after menopause. Decreasing estrogen levels likewise affect the appearance of skin and hair. Skin becomes thin, dry, and loses suppleness, while reduced estrogen is linked to poor hair texture and reduced hair growth. Atrophy of the dermis after menopause is due to a decrease in collagen content and these deficiencies in skin collagen can be corrected by estrogen treatment. 

Dr. Eileen Manalo is quick to clarify that HRT does not slow down aging or delay menopause. “Although replacement of estrogen can influence the changes that its lack brings about and may make a woman look and feel healthier, it cannot affect the natural aging process. Menopause is not delayed and the declining function of the ovaries is neither slowed down nor accelerated by HRT.”

Dr. Joan Tan-Garcia agrees: “Estrogen is a protector. It is not therapeutic. Currently, the consensus is that there is a medical need for menopausal HRT in women requiring menopausal symptom relief. However, treatment should be tailor-fit to suit an individual’s particular needs.”

She suggests that menopausal women discuss the option of HRT with their doctors. “Discuss your problems with your own doctor. If you and your physician opt for HRT, a thorough examination is necessary to determine that you are otherwise healthy; and that hormones are the best alternative for you.”

Middle age is when most women should enjoy the fruits of their labor — often having successful careers and grown-up children. The symptoms associated with menopause should not impede their enjoyment of life. The principle by which they live at this stage in their lives should be: “For me, no pause.”

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Ask your doctor about the low-dose HRT preparation manufactured by Bayer Health Care.