When the doctor becomes the patient

KRISTY RAMNARINE

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Gynaecologist/Obstetrician Dr Sherene Kalloo has delivered over 11,000 babies—and she’s still going strong.

At 60, Dr Kalloo continues to guide women through pregnancies and the often-turbulent transition of menopause—a phase that can take a toll physically, emotionally, and socially. She has explained to countless patients the realities of mood swings and sleep disturbances, yet when menopause came for her, she found that medical knowledge alone could not shield her from the impact of hot flushes.

“Perimenopause started for me with the hot flushes. I became irritable and found myself snapping at my children and my husband—though not at work, which was always my happy place,” Dr Kalloo recalls.

“Having a good night’s sleep is crucial, but insomnia was a problem during menopause. With the hot flushes, you don’t sleep well—you’re flinging the sheets off because you feel hot, then pulling them back because you’re cold. It wakes you up repeatedly.”

Despite long working hours making her accustomed to exhaustion, menopause introduced a new cycle of sleepless nights. By morning, irritability would set in, making interactions with loved ones challenging.

Like many of her patients, Dr Kalloo initially believed she could manage her symptoms on her own. There was also the lingering uncertainty surrounding Hormonal Replacement Therapy (HRT) and its risks and benefits regarding chronic disease prevention and cancer risk.

“There was a study done about 20 years ago, which was conclusive but not conclusive,” she said.“We followed it for a while as doctors, but now we realize much of it has been reconsidered, which is why HRT has become an accepted option.”

Dr Kalloo reached menopause at 57.

“It took a while to stop seeing my period. Eleven months went by and then—bam—I got my period again. I had to start counting all over because menopause is defined as 12 consecutive months without a period. Last year, at 60, I decided to start HRT based on my research and what I believed would be beneficial for me.”

The National Institute of Health launched the Women’s Health Initiative (WHI) in 1991, concluding that menopausal hormone therapy has a complex pattern of risks and benefits. While appropriate for symptom management in some women, its use for chronic disease prevention was not supported by WHI randomized trials.

An updated study in May 2024 reported no increase in deaths from breast cancer or cardiovascular disease among participants. According to the WHI:

“Hormone therapy is effective for treating moderate to severe vasomotor and other menopausal symptoms. These benefits, combined with lower rates of adverse effects when initiated in early menopause, support starting hormone therapy before age 60 for women without contraindications who have bothersome symptoms.”

For Dr Kalloo, HRT has been transformative.

“My life has changed, and I can confidently recommend it to patients who will benefit,” she said.

However, she notes challenges with accessibility in T&T.

“Getting HRT here is very difficult. We mostly have tablets, sometimes vaginal creams, but the best option—the patches—aren’t available. They deliver a lower dose of estrogen and are safer. Perhaps the Minister of Health, being a gynaecologist himself, can ensure women in this country have access to them.”

HRT options explained

Tablets: Replace declining estrogen and progesterone to ease hot flashes, night sweats, vaginal dryness, and mood changes. They may also help prevent long-term health issues like osteoporosis.

Vaginal Creams: Provide localized estrogen to relieve vaginal dryness, itching, and painful intercourse. Generally safe, but may cause local irritation or burning.

Patches: Medicated adhesive patches deliver estrogen or a combination of estrogen and progestogen through the skin. They are highly effective for managing menopausal symptoms, particularly for women who cannot tolerate systemic HRT.

In Part 3, we explore menopause and relationship strain.