In this update, Gynaecological Endocrinologist Dr Anna Fenton shares her insights into making informed choices when it comes to menopausal hormone therapy (MHT); we share some of the responses to a recent gynaecology Q&A with Janene Brown, John Short and Michael East; and our nursing team discusses natural ovulation tracking. We are also pleased to update you on some fascinating studies our clinicians are involved with.
Understanding menopausal hormone therapy
For people experiencing menopause or who are approaching this transition in life, menopausal hormone therapy (MHT), otherwise known as hormone replacement therapy, can be an important treatment option for managing difficult symptoms.
But as research into this area has continued to grow, many women are unsure if it is the right option for them, or which type of therapy would be most effective. Oxford Women’s Health Gynaecological Endocrinologist Dr Anna Fenton shares her insights into the therapy, and what people should know to help them make informed choices.
“MHT helps thousands of women get their quality of life back. It has been shown to dramatically improve symptoms; and also reduces the risk of some cancers, fractures, coronary artery disease and death from dementia,” Dr Fenton says.
“With that said, different types of MHT have been associated with different risks, depending on your particular circumstances, such as stroke or breast cancer, so having open discussions with your GP to understand what, if any, MHT would be most suitable for you, is really important. Not everyone is able to have MHT and there are other options you can explore,” she says.
MHT covers a range of hormonal treatments that are designed to reduce menopausal symptoms, such as hot flushes,
sleeping problems, mood changes, and discomfort during sex. It can include estrogen, progestogen, a combination of the two, and/or testosterone. “If you’ve had a hysterectomy, taking estrogen alone
Dr Anna Fenton
can be really effective, and it reduces your breast cancer risk. For women who still have their uterus, a progestogen is important for protecting your endometrium and in cases where you might still be able to get pregnant, some progestogens act as a contraceptive,” Dr Fenton says.
Testosterone can be prescribed if a woman is experiencing low libido or is struggling with arousal. Estrogen can be prescribed in a variety of ways, depending on the persons’ needs, such as a gel, tablet or patch.
“It’s important to let your doctor know which, if any menopausal symptoms are troubling you the most, as this helps inform the type of therapy you are prescribed,” Dr Fenton says.
Alternatives to MHT can include St. John’s wort, maca root, hypnosis, cognitive behavioural therapy (CBT), and mindfulness techniques. As always, dressing in layers that can easily be removed to regulate your temperature, reducing alcohol consumption, exercising, maintaining a healthy weight and quitting smoking are helpful ways of managing some symptoms.
Answering your gynaecology questions
Oxford Women’s Health Gynaecologists Janene Brown, John Short and Michael East recently came together to answer some common questions they have seen emerging in women’s health.
Should I trust content about women’s health that I see on social media?
The short answer? Be cautious of what you’re viewing. Social media is a powerful vehicle for sharing important information and raising awareness but it comes with some drawbacks. One of these is a proliferation of misinformation.
Dr East says the number of people coming into the Oxford Women’s Health clinic with questions or requests about gynaecological issues and treatments they have seen online has increased over the years, to the point that he now keeps a range of reputable resources printed in his consultation room.
“People naturally have questions about conditions they might be facing or are concerned about, so it’s important to have the right information available. As doctors, we always look to reputable sources to inform best practice, and we’re happy to share these with patients so they feel comfortable and informed as well.”
Credible sources such as Endometriosis New Zealand and International Association for Premenstrual Disorders are great organisations that people can look to for more information, rather than relying on social media content creators.
Dr Brown says, “When we look at many social media claims and their references, we can see straight away that they don’t stack up. It’s all about marketing. If what they were saying was true, your doctor would be saying the same thing and endorsing the claims,” she says.
Can a blood test show that I have polycystic ovary syndrome (PCOS) if I am using a hormonal contraceptive?This depends on the type of contraceptive you are using. The progesterone-only ‘mini pill’ and Mirena® intrauterine device are the only two that will allow blood tests to show useful information your doctor might need.
But our panel of gynaecologists say don’t be too worried if you aren’t able to have a blood test, or the test isn’t informative: your doctor will still be able to focus on managing the PCOS symptoms you are experiencing.
“PCOS is a spectrum of insulin insensitivity that affects the ovaries and can result in a variety of different symptoms,” Dr Short says. "Our main consideration is making sure we are able to help a person manage their symptoms, whether that is irregular periods, excessive hair growth, fertility concerns, or other symptoms. This wouldn’t change simply because a blood test might or might not conclusively show that you are experiencing mild or severe PCOS.”
If you’re experiencing any symptoms that you are concerned about, make sure you talk to your doctor.
Is it worth asking for a blood test to measure my testosterone or estrogen levels?
More women are asking for their testosterone or estrogen levels to be measured but this information is not only difficult to identify, it can also be very unhelpful. That’s because these
Dr Michael East
Dr Janene Brown
Dr John Short
hormone levels in the blood are constantly fluctuating throughout the day and are very hard to glean anything useful from.
Testosterone, which can (but not always) have an impact on a woman’s libido, is sometimes considered as a way to increase a person’s level of sexual desire, especially after menopause. Meanwhile estrogen is one of the main hormones that supports women’s health, from menstrual cycles to bone health and pregnancy.
Dr Brown says there is no known ‘normal’ level of testosterone in women to know whether someone has enough or too much.
“We only really need to look at testosterone as part of the process for understanding and supporting sexual desire in postmenopausal women. Outside of this, it’s not helpful to try and learn how much your body is producing,” she says.
Estrogen levels are known to change as you age, but if you are still having periods, your body will be producing enough of it. Once your periods become sporadic or stop, that is a key sign you are beginning menopause.
If you have any questions or concerns about your sexual or reproductive health, book an appointment with your doctor.
Registered Nurse Melanie Gray (left) and Nurse Team Leader, Kate Davidson
Nursing team maximising chances of natural conception
If you’ve been trying to have a baby, ovulation tracking is a great starting point to help improve your chances of conceiving naturally. Sometimes it may be as simple as knowing the optimal time to have sex according to when you are ovulating. It could be that your cycle is irregular, and a few adjustments might make all the difference. Other people may require the support of medication to boost their chances.
While it’s normal for women under 35 years to take up to 12 months to get pregnant, some choose to start ovulation tracking after six months. For women aged over 35, it is recommended they seek expert support after six months of trying to have a baby. “Just because you’re not conceiving, doesn’t automatically mean you need IVF (In vitro fertilisation),” Oxford Women’s Health Nurse Team Leader Kate Davidson says. “Nearly half the people we work with become pregnant in six to twelve-months through natural cycle monitoring. If it doesn’t happen straight away, we can help identify issues and refer women for additional support early.”
People can self-refer to the Oxford Women’s Health service and natural cycle monitoring can all be arranged and coordinated over the phone and via email. It is a relatively simple process, involving the team remotely ordering blood tests to measure the levels of estradiol, luteinising hormone (LH), and progesterone. All you need to do is call or email the team on the first day of your period and they will arrange for you to have your first blood test. Based on this information, the team will advise on the best time to start having sex. A couple of other blood tests will follow to provide insight into your most fertile times, and to check the luteal phase and progesterone levels. “In most cases, we won’t find a problem and it provides reassurance there isn’t anything else going on, and the couple can keep trying when they are most fertile," Registered Nurse Melanie Gray says. “Sometimes we find that people aren’t ovulating, have a poor luteal phase, or aren’t ovulating when they think they are.”
In some cases, medications such as Clomiphene and Letrozole are options that can be considered. They both work in different ways to induce ovulation and are prescribed to suit the individual. Patients start on a low dose that may be increased slowly to lower the chance of multiple births, which brings increased risks to mothers and babies. Blood tests will be monitored throughout, and a scan will be performed at Oxford Women’s Health to check the lining of the uterus. There is a cost involved with both natural and medicated cycle monitoring. “Through ovulation tracking, women generally become pregnant pretty quickly, and if not, we can refer them on for additional support early,” Mel says. Some people also opt for ovulation tracking before they start trying to have a baby to boost their chances of success.
Kate and Mel’s best piece of advice is to get on to things sooner rather than later. It’s also important to keep in mind that while many celebrities may be having babies a lot later in life, what isn’t reported is that they are often using donor eggs, or their own younger, frozen eggs. “Many people think their chances of having a baby naturally are higher than they actually are,” Kate says. “By the time you reach 40, there’s a five to 10 per cent chance of becoming pregnant with everything going perfectly.”
They also suggest taking a more cautious approach when using popular phone apps. “They have their place,” Kate says. “Some people with regular cycles will conceive quickly using the information the apps can provide. However, they are not as helpful for people with less regular cycles, and they give people a sense of security when they are not ovulating but have regular periods.”
Booking an appointment to discuss ovulation tracking with the Oxford Women’s Health team is a great starting point if you want to learn more about getting pregnant and trying a natural approach before being referred for support if you need it. “We see so many amazing and special stories,” says Kate. “For the last three years, close to 50 per cent of women using cycle monitoring achieved a pregnancy without having to go down the track of having IVF.”
Canines reveal ‘milestone’ score in cancer detection
Oxford Women’s Health is about to contribute to a groundbreaking clinical trial where medical detection dogs have been trained to seek out early ovarian cancers. In advanced testing, prior to the trial getting underway, they are achieving 100 per cent success rates.
K9 Medical Detection New Zealand (K9MD) is a Dunedin-based Charitable Trust using specially trained dogs as an additional diagnostic tool in a controlled clinical environment. Trained to detect ovarian cancer, Labrador Hogan, achieved a perfect specificity* and sensitivity* rate of 100 per cent in identifying cancerous samples during a blind randomised trial.
Another dog trained to detect ovarian cancer is German Shepherd Hunter who achieved 100 per cent specificity and 96 per cent sensitivity. The testing is possible because many diseases and disease-causing agents give off odours, known as volatiles. A dog’s sense of smell is so sensitive it can detect a teaspoon of sugar in two Olympic-sized swimming pools of water. Using medical detection dogs to identify volatile organic compounds (VOC) released from tumours could become an alternative to molecular and physical screening techniques.
K9 Medical Detection New Zealand CEO Pauline Blomfield said the milestone marked “a significant step forward in our mission to revolutionise cancer detection".
“We are one step closer to offering
Ovarian cancer detection dog Hogan “reading” samples
non-invasive diagnostic options that could improve cancer outcomes for New Zealanders."
"By training dogs to detect these specific odours, it is possible to minimise the spread of the disease and identify at-risk patients sooner. This enables earlier commencement of treatment, potentially leading to improved patient outcomes.”
Waitaha CGO and Gynaecological Oncologist Dr Bryony Simcock says ovarian cancer is widely known as the silent killer as it frequently presents at an advanced stage when it is very hard to cure.
“Oxford Women’s Health and Christchurch Women’s Hospital are really excited by this research which has shown such promise in the early stages.”
“Research is hope for a better future and supporting such research into better outcomes for women is one of our priorities," Dr Simcock says.
To support this work, click HERE
* Specificity is correctly ignoring all samples that do not have cancer
* Sensitivity is correctly alerting to all samples that do have cancer
Merry Christmas from Oxford Women's Health
The Oxford Women’s Health team wish you a very happy Christmas and New Year.
We hope you and your families have a wonderful holiday, and we look forward to seeing you again in 2025.
Oxford Women’s Health will close for the Christmas break at 12.30pm on 20 December. We will be back to start the New Year at 8am on Monday 6 January 2025.
