'MonaLisa Touch' for women with menopausal symptoms

'MonaLisa Touch' for women with menopausal symptoms
A risk factor for breast cancer is prolonged exposure of the breasts to hormonal stimulation over many years. But doctors strongly recommend that women who hit menopause prematurely receive hormonal therapy till the average age when women reach menopause.

Menopause is a natural part of ageing but if the symptoms bother you, you can get help. Joyce Teo looks at the treatments available, including a new laser treatment.

Some clinics here have started using a relatively new method - a laser technology known as The MonaLisa Touch - to help women suffering from painful sex caused by vaginal atrophy.

This condition typically happens after menopause, when oestrogen levels decline, and causes the thinning and drying of the vagina walls, though it can hit younger breast cancer survivors as well.

This laser treatment offers an alternative for women who do not want to use hormone replacement therapy (HRT) for vaginal atrophy.

Apart from vaginal atrophy, other common menopausal symptoms are aches and pains, hot flushes, and mood disorders such as depressive moods, anxiety and insomnia.

"Menopause is a physiological process all women will go through, very much like puberty," said Dr Chua Yang, a consultant obstetrician and gynaecologist at A Clinic For Women, Mount Alvernia Hospital.

"The most important thing is to have an understanding of this process, the changes that occur and the possible symptoms associated with menopause."

Up to 80 per cent of women will be able to deal with menopause easily as they have no symptoms or very mild, transient ones, said Dr Chua, who is also the Asia Pacific Menopause Federation president.

Menopause takes place when a woman has not had her period for 12 consecutive months.

Here's a look at the treatments for menopausal symptoms.Hormone replacement therapy (HRT): The female hormones oestrogen and progesterone, or just oestrogen alone, are taken in various ways, including tablets, skin patches, gels or implants.

Doctors say women with moderate to severe menopausal symptoms can benefit from HRT.

Dr Susan Logan, a consultant at National University Hospital (NUH) Women's Centre, said "the only group that definitely needs HRT is women with premature menopause".

These women are at increased risk of health problems such as early onset of osteoporosis and cardiovascular disease.

On average, women in this region usually hit menopause around 50 years old. Dr Logan said women who have low bone mass or osteoporosis can also consider HRT to improve their bone mineral density and menopausal symptoms.

Side effects of HRT include bloating, headaches, mood changes and diarrhoea. It can also raise one's risk of getting breast cancer and other health problems such as stroke.

But HRT need not be lifelong. The dosage is usually gradually reduced and stopped after the symptoms are controlled, said Dr Chua.

Non-HRT options: These include self-management and complementary and alternative medicine.

Dr Chua said she may advise her clients who experience mild symptoms to make lifestyle changes, such as doing breathing and physical exercises to deal with mood changes and energy levels.

Alternative therapies include phytoestrogens, which are found in a variety of products like soya beans and soya-based products, sunflower seeds, oats and chickpeas.

Black cohosh, red clover and bee pollen have also shown variable effectiveness in addressing menopausal symptoms, said Dr Chua.

But they mostly lack large-scale research to confirm their safety or effectiveness, she added.

There is mixed evidence on using acupuncture to treat menopausal symptoms, but some women have found it helpful, said Dr Logan.

For vaginal atrophy, the options include lubricants and vaginal moisturisers, she said.

Laser treatment: The MonaLisa Touch therapy, which was developed in Italy and launched here last week, is used to treat vaginal atrophy. Laser treatments stimulate the production of collagen so that the vaginal tissue becomes firmer and more elastic, said Dr Logan.

Dr Christopher Chong, medical director of Chris Chong Women's and Urogynae Centre, said the MonaLisa Touch can "generally be completed in five minutes, producing benefits right from the first treatment".

"The recommended number of treatments is one to three, but you can go up to six, done one to two months apart, followed by an annual maintenance treatment. It varies from case to case," he said.

Preliminary results show that the therapy alleviates vaginal atrophy and painful sex, said Dr Chong.

However, the procedure comes at a cost of $2,500 for three sessions.

While relatively painless, some may not like the psychological discomfort.

"It's a procedure that's done in the vagina. It's something a lot of Asian women may not be comfortable with," said Dr Chua.

She said the MonaLisa Touch is for the sole purpose of dealing with vulvovaginal atrophy.

Similarly, there are also effective topical and oral medications that can address symptoms brought about by vulvovaginal atrophy.

Further research is needed on the safety and long-term efficacy of the MonaLisa Touch before recommending its use in multiple gynaecological conditions, said Dr Logan.

Hormonal therapy suitable for some

Many women are worried about taking hormones, thinking they cause breast cancer, said Dr Chua Yang, president of the Asia Pacific Menopause Federation.

A risk factor for breast cancer is prolonged exposure of the breasts to hormonal stimulation over many years. "So, if a girl starts menstruation (menarche) exceptionally early or end menstruation (menopause) particularly late in life, she would already have a slightly higher risk of getting breast cancer," said Dr Chua.

Therefore, if a woman hits menopause at the average age of 50 but chooses to take hormones for another 10 years, she would also increase her risk of getting breast cancer.

However, if a woman hits menopause prematurely at 40 and takes hormones for 10 years, she would not have increased her risk beyond the norm, said Dr Chua. "Her risk remains the same as the women who reach menopause naturally at 50."

Doctors worldwide strongly recommend that women who hit menopause prematurely or have premature ovarian failure receive hormonal therapy until the average age when women reach menopause, said Dr Chua.


This article was first published on January 29, 2016.
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