Middle aged woman fanning herself

Surviving menopause interview by Clement Manyathela on 702 Talk Radio FM.

Menopause interview on Health For Mzansi Sisters Without Shame podcast.

For more on this conversation please see this article and check out their podcast.


Menopause, also known as the climacteric, is a time in women’s life when their menstrual periods stop permanently. The average age of menopause is 51 years and the age of menopause varies between 45 and 58.

Transition to menopause can take anything from 1-2 to 5-7 years. During the early transition to menopause, the levels of oestrogen and progesterone often rise which causes breast tenderness, bloating, fluid retention, mood swings and sleep problems.

Symptoms can include hot flushes, mood changes, difficulties sleeping, vaginal dryness, painful sexual intercourse and osteoporosis. Some women notice changes in their hair and skin as they get to menopause.

A new term ‘genitourinary syndrome of menopause (GSM) describes well the various symptoms of menopause-related to the genital area  (vaginal dryness, burning, and irritation), and sexual symptoms (lack of lubrication, discomfort or pain, and sexual dysfunction, and bladder symptoms (urgency, dysuria, and recurrent bladder infections). The previously used term of vaginal atrophy and atrophic vaginitis did not describe all symptoms and did not imply that the symptoms are caused by a decreased estrogen level in menopause.

Although irregular bleeding can be one of the “normal” signs of transition to menopause, it is necessary to contact your gynaecologist if you bleed more often than every 21 days, if your bleeding is very heavy, if your bleeding lasts for more than 8 days, or  if your bleeding occurs after 6 months without any bleeding. Such types of bleeding will require full doctors examination, gynaecological examination and pelvic ultrasound to exclude sinister causes of bleeding.

Dr Novikova is a highly experienced gynaecologist who can provide you with various Menopause Treatment options to combat specific symptoms or to advise on how to improve the overall quality of life when experiencing menopause.

There are a number of interventions available to prevent and treat menopausal symptoms. Menopause treatment may simply consist of adopting a healthy lifestyle through the reduction of stress factors, the practice of mindfulness, avoiding smoking and limiting alcohol (particularly avoiding red wine) and physical exercise. These are very important and work well in preventing and diminishing menopausal symptoms.

Aside from menopause treatment, it is important to have regular general check-ups including blood sugar, blood pressure, cholesterol, mammogram, bone density, cervical (Pap) smear. The doctor will also be able to make sure that the symptoms you are experiencing are related to menopause and not caused by any sinister illnesses.

Dietary changes suggested for reduction of menopausal symptoms include avoidance of processed food, refined sugars, red meat, increasing fibre, complex carbohydrates, vegetables. Supplementation with essential fatty acids, vitamin E and selenium for hot flushes, vitamin C for hot flushes, calcium, vitamin D, magnesium for bone health, vitamin B for dry skin and hair.

Hot flushes are usually caused by fluctuation of oestrogen levels. Some women experience no hot flushes at all, others may have a few, and some women experience hot flushes even through to their 80s or 90s. Hot flushes are only treated if they interfere with the quality of life and daily activities. The best treatment of hot flushes is the supplementation of oestrogen in the form of HRT (hormone replacement therapy). If you still have your uterus, oestrogen and progesterone will be prescribed together. If you don’t have a uterus, you can take oestrogen alone. Hormone therapy isn’t for everyone. Don’t take it if you’ve ever had breast cancer, uterine or “endometrial” cancer, blood clots, liver disease, or a stroke. There are other ways of treating hot flushes for women who cannot take hormonal treatment, but unfortunately, they are not as effective as oestrogen supplementation. Other ways of treating hot flushes include antidepressant medication or medication usually used to treat high blood pressure. Dietary changes may be helpful for some women.

Mood changes and sleep disturbances are also caused by changes in levels of hormones and the above-mentioned treatment for hot flushes will also work for mood swings.

Osteoporosis or thinning of bones is related to low oestrogen levels and the rate increases once women get to menopause. Taking calcium and doing weight-bearing exercises prevents osteoporosis.

Vaginal dryness, pain during sexual intercourse and frequent urinary and vaginal infection due to thinning of vaginal skin are all caused by low oestrogen levels. The treatment is the use of lubrication during intercourse, use of oestrogen cream vaginally.

Vaginal dryness is related to vaginal atrophy or thinning of vaginal skin due to low oestrogen levels. Although this condition is very common in menopausal women younger women also suffer from it occasionally. Low oestrogen levels can be related to the use of the contraceptive pill, heavy exercise, weight loss, chronic illnesses, ovarian failure of unknown cause and of course ageing. At times vaginal atrophy becomes so severe that women end up developing vaginismus, a condition where vaginal muscles contract at the fear of vaginal penetration. Vaginal atrophy leads to frequent vaginal infections and bladder infections.

The standard treatment for vaginal atrophy is vaginal oestrogen preparations – creams, tablets, vaginal moisturizers. About twenty per cent of women fail to respond to vaginal oestrogen. Some women have unpleasant side effects from vaginal oestrogen preparations. Although very little oestrogen is absorbed vaginally and is mostly safe to use, some women prefer to avoid hormonal preparations.

A new, very effective treatment for vaginal dryness is now available. Dr Novikova offers vaginal laser and vaginal radiofrequency treatment for vaginal dryness, painful intercourse and frequent infections. You can find the details of Femilift vaginal laser treatment on Dr Novikova’s website. 

Other options for vaginal dryness are following

  Vaginal laser Femilift

  Radiofrequency UltraFemma 360

  Genital treatment

  AQ serum


All of the treatments have similar effects. They have not been compared to be able to advise which one is beneficial. The choice could be based on the patient’s preference.

Vaginal Laser Femilift is more invasive, women who normally have spotting for a few days following treatment are advised to stay away from sexual intercourse for 3 days. The treatment is performed every 4-6 weeks and 3 sessions are recommended. The session can last around 15 minutes.

Radiofrequency UltraFemma 360 vaginal treatment has no downtime. It takes about 8 minutes. Three treatments every 1-2 weeks are recommended.

Genital treatment involves taking blood, spinning it to separate growth factors and injection into the vaginal wall and clitoris. There is no downtime. The effect lasts for 8-12 months.

AQ serum contains growth factors produced in the lab. It is used in home environments for 45 days. It can be repeated when needed.

Vsculpt is also a home used device, the treatment is about 10 minutes every 2nd for 45 days.

Once Dr Novikova assesses you. She will be able to give you advice on the treatment most beneficial to you. She has excellent results with all the above treatments. At times she has to try a few before she achieves the desired result.

Dr Novikova will discuss your symptoms, medical history, previous treatments and address your expectations from treatment when choosing menopausal hormonal treatment to suit your needs.
Bioidentical Hormones are made from plant estrogens such as an extract from soy and yams. They are body identical as they resemble hormones produced by the body.
Traditional menopausal hormonal treatment preparations are produced from the urine of pregnant horses and other synthetic hormones.
Bioidentical hormones are not approved by FDA, not tested, not regulated, not monitored, may have inaccurate dosage and have insufficient scientific evidence to support their safety or efficacy.
Traditional Hormones are approved by FDA, tested, monitored, have accurate dosage and have sufficient scientific evidence to support their usage.
The transdermal route of delivery of medication is the safest as it avoids liver metabolism.
Hence, either transdermal patches or cream.
Progesterone does not absorb in cream form and it’s prescribed either in tablet, vaginal suppository or intrauterine device (Kyleena IUD) form.
Women who still have uterus combinations of oestrogen and progesterone are indicated, for example, a patch containing both of these, or oestrogen gel in combination with progesterone tablet, suppository or intrauterine device.
Women who have undergone a hysterectomy in the past can use oestrogen in patch or gel form without progesterone.
Testosterone is often supplemented to improve energy levels and libido in women with testosterone deficiency. Testosterone is used in cream or implant form and levels are checked regularly in blood to monitor the correct dosage.
Several medications have been studied and have shown to have modest effects on improvement in hot flushes and mood swings. Blood pressure tablets, SSRI antidepressants are prescribed, but unfortunately are not as effective as hormonal treatment.

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