Some Menopause Questions Answered

Living Through the Menopause: from HRT to poor memory, your questions answered. Specialist Dr Louise Newson gives her expert advice.

It’s for good reason that the Countess of Wessex said this week that there should be more support for women during the menopause. Research suggests that one woman in four has considered leaving her job because of it. The symptoms associated with it include heart palpitations, feeling tense, having difficulty sleeping and concentrating, anxiety attacks, a lack of energy, feeling depressed, joint pains, hot flushes, sweating at night and loss of libido.

The countess, 56, who is the patron of the charity Wellbeing of Women, described her own experience: “You know in the middle of a presentation when you suddenly can’t remember what you were talking about? Try being on an engagement when that happens — your words just go.”

The menopause occurs when the hormones that are associated with egg production (oestrogen, progesterone and testosterone) decline. Not only are these hormones important for a woman’s long-term health, they have receptors in cells all over your body that respond to them, which is why the impact on a woman’s body can be dramatic. But often they don’t get the information they need to cope. Here are some of the most common questions women ask.

At what age should I start to worry about the menopause?

The menopause officially starts when you have not had a period for one year, and the average age in the UK for that is 51. But what a lot of people don’t realise is that you can begin to experience symptoms before this — known as the perimenopause — when your periods start to change in nature or frequency before they have stopped altogether.

I have started to feel angry and depressed, but my periods are still regular. Is this common?

I’ve found that irritability, reduced self-esteem and short-temperedness can be very common during the menopause thanks to hormonal shifts. Levels of these hormones often begin to deplete during the perimenopause, so you may feel like this even if your periods are still regular.

I have started to have sweats in meetings. What can I do?

In some cases hot flushes and sweats can occur every 30 minutes during the day and night. Many women I see find that this can quickly impinge on working life. These symptoms are caused by low oestrogen levels, so if you are really suffering, it’s worth considering taking oestrogen. Avoiding spicy foods, alcohol and stopping smoking have also been known to help.

I am 54 and forget people’s names. Will I ever get my memory back?

As the countess pointed out, the effects of hormone levels on the brain can be one of the most difficult aspects of the menopause. Many women worry that they have dementia because they constantly forget things. Brain fog is also very common and women often describe their brains feeling like “cotton wool”. Replacing the hormones with the right dose of oestrogen and often testosterone can really improve these symptoms. Some women find that the forgetfulness lifts with time, but most do not improve without hormone replacement.

How safe is it to take HRT?

All types of hormone replacement therapy (HRT) contain an oestrogen hormone, which will replace the oestrogen that your ovaries no longer make. HRT is actually much safer than most people realise. Some much-discussed studies have shown that women taking some types of older HRT may have a higher risk of breast cancer, but many of these studies are flawed. Any risk is very low, and lower than the risk of breast cancer in women who are overweight or drink moderate amounts.

Taking body-identical HRT has not been shown in studies to increase the risk of breast cancer. Indeed, for the vast majority of women the benefits outweigh any risks. If you still have a womb it is important that a type of progestogen (a synthetic type of progesterone) is combined with the oestrogen. When you take oestrogen the lining of your womb can build up, which can increase your risk of womb cancer. However, taking progestogen reverses this risk

What are body-identical hormones?

The best type of oestrogen to take is called 17 beta-oestradiol. This is a “body-identical” oestrogen, which means that it has the same molecular structure as the oestrogen in your body. It is usually taken as a patch, gel or spray. The optimal type of progesterone to take is called micronised progesterone, which is an oral capsule. This is a “body-identical” progesterone because it has the same molecular structure as the progesterone in our bodies. Both are available on the NHS and are commonly offered to women.

What are ‘bioidentical hormones’ sold by private clinics?

Recently there has been a trend for women to turn to private “hormone clinics” to get what they call bioidentical hormones, which are touted as being more natural. These hormones are “compounded” in special pharmacies and are not subject to the same tests for safety, efficacy or dosing consistency as those for regulated HRT. There is no evidence that they are safe or even as effective as body-identical HRT, which you get from your GP. They are often very expensive too.

Is it OK to buy ‘natural’ progesterone creams online?

No, because they do not absorb into the body well and many contain insufficient amounts of hormone to be effective. Similarly, they have not been shown to protect the womb lining from the effects of taking oestrogen, which is potentially dangerous for some women.

How long can I take HRT for?

Most women can take HRT for ever to replace their missing hormones, but their treatment should be reviewed annually to ensure benefits outweigh any risks. A study recently reported a link between taking HRT for more than three years and dementia but this looked at older types of HRT, and it was an observational study, which is not a study to prove cause and effect.

What are the natural treatments for the menopause?

There are no “natural” treatments that replace missing hormones. Some women use acupuncture with some success. Others find drinking herbal teas such as camomile can lead to a better night’s sleep, while some find that the use of aromatherapy oils, especially lavender, helps to relax and improve symptoms of anxiety or depression. Any therapy that allows you to relax is an investment in yourself and can help you to cope better. I would advise against the “natural” supplement black cohosh, often promoted for the menopause. Some types have been shown to be associated with liver toxicity

Can my diet help?

There is evidence that women who eat a plant-based diet may suffer fewer menopausal symptoms. A diet with adequate calcium is also really important for your bone health. Ideally you should aim to include at least ten types of vegetable in your meals each week. Leafy greens and dark-coloured berries are particularly beneficial. Avoid processed carbohydrates, junk food, alcohol and caffeine.

What exercise should I do?

Weight-bearing exercise is important to improve bone health. And strength training to maintain muscle and bone density.

Have I said goodbye to my libido?

Reduced libido is very common during the menopause. For some women it can be related to the way they feel about themselves, such as weight gain, low energy, irritability, fatigue and reduced self-esteem. Many women experience vaginal dryness, which makes sex painful. For others, reduced libido is related to low testosterone levels. Seek help and receive the right treatments for these. It may not improve without help.

I can cope with a few hot flushes, but is HRT worth taking for other health reasons?
Low levels of oestrogen result in an increased risk of heart disease, osteoporosis, type 2 diabetes, obesity, osteoarthritis, osteoporosis and dementia. Women who take HRT have a lower future risk of all these conditions. Heart disease is the most common cause of death in women in the UK, so lowering the risk by taking HRT can save many lives.

Is there such a thing as an easy ride?

Every woman’s experience is different and symptoms can vary between women and at different times.

I am suffering from low mood. My GP has recommended antidepressants. Will this help?

These feelings are very common symptoms of the menopause and perimenopause, especially if you have had postnatal depression, or a history of PMS (premenstrual syndrome). These symptoms can be mistaken for depression. There is no evidence that antidepressants improve the low mood associated with the menopause, so they should not be given to women for this reason.

How will I know when the menopause has passed?

Menopausal symptoms can vary in duration. Some women have symptoms that last only a few years, but many women find that their symptoms last for many years, or even decades. In addition, symptoms can vary with time, which means that many symptoms change after several years. Even if symptoms disappear, low hormone levels are associated with health risks, so this is why it is really important that women receive individual advice and treatment for their menopause, regardless of their age.

Dr Louise Newson is a GP and founder of the Newson Health Menopause and Wellbeing Centre, Stratford-upon-Avon. She is the author of the Haynes Menopause Manual and Preparing for the Perimenopause and Menopause.

Reference
The Times  Saturday 9th October 2021: Dr Louise Newson