Lifestyle changes following early menopause

The other thing of course, one very important, is the lifestyle issue. Anything you can improve in reducing the risks of the long-term issues, I think that’s where you have to look into it. So if you’re talking about lifestyle issue, about the cardiovascular, you want to make sure they’re not overweight, you want to make sure their cholesterol and everything is okay, they’re not a diabetic and everything else. The calcium itself, the vitamin D, the exercise they’re doing, stop smoking. You know, within range, alcohol, those kinds of things is important.

At the end of the day, the person, the patient, have to do the exercise themselves. But it’s lovely when they know that there is an exercise custom-made for them, with all their limitation, and all the things they can do, and then do it. Because if you can give somebody something that they can do it, then they will do it. But if you give somebody based on what, you know, just generic things, then you know, you may not be able to do all those things, and you don’t see the result of it, so you don’t do it.

I usually get them to start monitoring their hot flushes. So I’ve got a diary thing that I give them and so what we’re interested to find out is whether there are any triggers that exacerbate their hot flushes, make them more frequent or make them more intense we find that some of the things that will impact on women’s hot flushes are things like – in terms of diet, caffeine, alcohol, spicy foods, smoking, non-diet things like stress, you know, if you’ve had a fight with your partner, you might find your hot flushes are worse for a while. Immediately after exercise, women find that their flushes are more frequent or whilst exercising, they can be more frequent.

So we sort of have to talk about that because we obviously want them to keep exercising because that also helps. Yeah, so the monitoring exercise is really useful and as a result of that, we then start to talk about, well, obviously what changes they might make in their lifestyle. Now, a lot of women don’t want to give up their glass of wine that they have each day and so it’s generally then around, “Well, how can we make this work so that it’s still enjoyable for you?” and, you know, I remember one woman talking about setting herself up each afternoon with her fan beside her that’s going and she’s got her glass of wine and she still continued to enjoy it very much indeed. So she found a great way to still be able to manage it.

Things like hot flushes whilst you’re trying to sleep, that’s really, really difficult for women. So we talk about things like, you know, what they’re wearing to bed, so wearing natural fibres, cotton things, cotton sheets, trying to avoid anything synthetic, blankets rather than a heavy doona, piling the blanket towards the centre of the bed rather than at the foot of the bed, so going to bed a little bit cooler rather than getting into a warm bed, so avoiding the use of the electric blanket, so getting in under the sheet first and seeing if you can tolerate the temperature as it is before putting the blankets on you.

I say, “Keep the blankets towards the centre of the bed rather than the end of the bed” because when women wake up during the night because they’ve had a hot flush, it’s easier to just throw it to your side and then pull it back over you. If you start tossing your blanket down the end of your bed, you’ve actually got to sit up and drag it up and that wakes you up more fully. So the idea is to try not to wake up too much, so the quick toss to the side and then back again.

So, I start with the simple things, so the simple things often work. So, wearing cotton underwear rather than nylon underwear, using a non-soap cleanser because soap is an astringent okay. Then using a vaginal moisturiser. So, they’re moisturisers and I differentiate between a moisturiser and a lubricant okay, so the patients understand. The moisturiser has to be used every day because your vagina is stratified squamous epithelium – same as your face – so you know if you’re wanting to make a difference it needs to be a regular application.

So, then the other things that you can utilise, there are some pelvic floor physiotherapists, so they use biofeedback, they use desensitisation techniques to gradually reintroduce comfort with intercourse and try and overcome the dyspareunia. Because that becomes psychological as well, it hurts when you’re having sex because you’re dry, so then your brain thinks it hurts to have sex so then you tense up and it goes in a circle. So, there’s some good value from that as well.

So a lot of the work about osteoporosis and HRT, there’s been a fair bit of work to say that if you have a physical programme where you do weights and you keep fit your risk of falls and balancing and coordination go down and strength goes up. So osteoporotic falls are lower by keeping active, yeah.

So sport’s good. And I think, you know, in the future, you know, programs at gyms, there’s might even be coordinated falls and balances coordination programs with a bit of funding, and Pilates type things and a bit of extra stuff added to it. It’s very appropriate stuff – way to be treating things.

And generally when women, let’s say they haven’t been very physically active and, you know, their lifestyle’s a bit sedentary.

And they’re not confident about it. Then Pilates type approaches are great for a start. If someone’s well trained in it there can be group sessions with Pilates where they actually get core strength. And core strength in their gait improves, and posture improves, and confidence improves, and then, I mean, if they’ve got joint issues they might not want to take up sport. But some bike riding and some swimming and Pilates type things is a great way to be able to keep people healthy. And I think that there’s a bit of work to show that cognition improves with physical activity too.

I think that it’s very difficult to get people to exercise but it’s our job to tell them so I often tell them about weight bearing exercises for example to increase bone strength, vitamin D and calcium is becoming fairly regular. I think monitoring of osteopenia and osteoporosis is getting much better so yes, I think there’s, in general, fairly good awareness of bone health issues. I think weight gain is something that a lot of women complain about, but again, it is something that women are often made to feel that it’s a minor price to pay for having cancer and getting cancer treatment, and I think women really struggle with that and if affects self-esteem it affects a lot of things.

Ideally, we refer women to anywhere from their local gyms to physiotherapists. Not everybody needs to see an exercise physiologist to just get walking and to get moving so we will do that. Dietician, sometimes I think that there is so much to discuss in an oncology clinic that that is probably not every oncologist’s priority and a patient would have to identify weight as her primary problem for us to say, “Look maybe it’s worth going and seeing someone about this,” I would think.

I think it would be fair to say, although many people would benefit from targeted dietetics advice, they don’t get it.

What we find sometimes is the menopause clinic will see them and offer them something like EFEXOR [venlafaxine], but the patients have had so much medication, they don’t want medication. So, one of the things that we look at when we do survivorship are what other supports are available, what non-medical stuff can we advise them. So, there’s lots of organisations out there, NGOs that provide support. Sometimes just talking through with someone who is having similar problems does help, it sorts of normalises the experience.

For patients that are experiencing a lot of joint pains when they are on anti-hormone therapy, a lot of these cancer rehab programs do water exercises. So, it allows them to do exercise without it being painful. And, we’ve had a few people that have done the programs and really enjoyed it. It’s important that the patient has a good rapport with their GP so that they can provide support and also refer to the rehabilitation programs because there is a rebate that the patient can get if they are referred by their own GP, because they can be quite expensive.