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Menopause management – your questions answered

Menopause management – your questions answered

Menopause – or ‘The Change’ – is a natural process and one that all women go through. It brings with it a range of symptoms, which can affect people in varying degrees or not at all. And because everyone’s experience is unique to them, there’s no one size fits all solution. Furthermore, in 2015, NICE published renewed guidelines for health professionals and members of the public regarding menopause management. This included revised guidance on the safety of HRT in the face of new research and suggestions for the types of complementary treatments available.

Here, nurse Nikki Porges answers your questions about the menopause and peri menopause, some common symptoms and what options are available to help those who are suffering continue to live life to the fullest.

Q. I’ve just turned 50 and was told to come off the pill I’ve been on since I was 17. I had dreadful night sweats, hot flushes, mood swings and tight stiff hands. Also no sleep for 4 months! I tried all the natural remedies - herbs, acupuncture, homeopathy - nothing worked. I’m now back on the pill (Microgynon) for 3 months so I can go on holiday to Japan, but about what will happen when I get back? Any help in getting through this would be appreciated.

The pill isn’t a conventional treatment for menopausal symptoms, which you do seem to be experiencing quite badly. Given your age you could be eligible for HRT and I suggest speaking to your doctor about this treatment for your symptoms.

According to current guidelines HRT doesn’t increase your risk of heart disease, as previously thought, if you’re under 60 and start the treatment within ten years of the natural menopause. If you’re already at increased risk cardiovascular disease it may still be possible for you to take HRT but it will depend on your individual circumstances. Your GP will take into account your overall health and any possible side effects, to help identify the best treatment options for you.

It’s still possible to conceive in spite of menopausal symptoms, so contraception is a good idea and should be continued for at least one year after your last period if your periods stop after the age of 50, and for two years if they stop before then.

Discuss your symptoms with your GP who may refer you to a local menopause clinic where there are specialists who can help.

Q. I came off the pill and started to experience symptoms including headaches, hot flushes and low mood, so I started HRT. Unfortunately my temperature went even higher and after four days I was so uncomfortable I went back on the pill. Can you suggest why this happened and is it worth me trying again?

There are over 50 different combinations of HRT available and the one that’s right for you will depend on several factors, such as what stage of the menopause process you’re at, and whether you’ve had a hysterectomy.

Doctors will usually start you at the lowest possible dose but you may have to do a bit of to-ing and fro-ing with your GP to find the right medication and dose for you.

Alternatively, it might be worth trying a specialist menopause clinic to fast track this process. They would perform blood tests and assess how well you’re absorbing the medication and what level of circulating oestrogen is in your blood. If it’s still too low to resolve your symptoms then they will alter your dose accordingly.

HRT is considered by many to be the most effective treatment of menopausal symptoms but it’s a good idea to look at all the options available.

Q. I’m 51 and have been experiencing acute joint pain in my upper arms-could this be part of the peri-menopause?

Joint pains are not unusual in women experiencing menopausal symptoms or whose oestrogen has dropped. However there may equally be another cause. Start by asking your doctor to check your bone health and perform an assessment of the areas where you have pain.

If no cause is found, ask for them to look more closely at your hormone status, which involves a quick and simple blood test. Often GPs will check for circulating levels of oestrogen. However, to get a full picture it is helpful to screen for the following: FSH (follicle stimulating hormone), LH (luteinizing hormone), oestradiol (oestrogen) and progesterone if possible to determine your hormonal status. If it shows FSH rising and LH and oestradiol dropping then the pain could be related to the peri-menopause.

Either way, finding out what’s really behind the pain you’ve been experiencing will enable you and your GP to identify the most appropriate way to manage your symptoms going forward.

Q. I saw my GP the other day and explained that I was having flushes and at times waking up in a sweat. I also have drier skin. I had a hysterectomy 6 years ago- ovaries still in place. He told me I’m menopausal without doing tests. Is this right?

Sorry to hear about your problems. In fact menopause can frequently be diagnosed on a history of symptoms and it does sound as though this is what you may now be experiencing.

Hysterectomy can cause a slightly earlier menopause to occur in women whose ovaries are left in place. If you’d like confirmation you can ask your doctor to check your oestrogen level.

Q. Is it best to start treatment at the first signs of menopause or wait until the symptoms become more problematic?

I think that's a personal decision based on how well you are coping and the severity of your symptoms.

Some people find that getting regular exercise and practicing yoga or similar relaxation exercises helps to alleviate symptoms. Increasing your calcium and vitamin D intake is also a good idea to help preserve your bone health.

If you do find that your symptoms are affecting your quality of life talk to your doctor about other options available, and the benefits and risks of each.

HRT can help to improve hot flushes and skin dryness, and advocates say that it can improve mood, memory and concentration, vaginal dryness and quality of sleep.

In the meantime, there is plenty of helpful information about methods of managing the types of symptoms. See further reading below.

Answered by the Health at Hand nurses  

Sources and further reading

Menopause and mental health – Ask the Expert

Menopause and weight gain – Ask the Expert

Memory and the menopause – Ask the Expert

Menopause – NHS Factsheet

Useful resources

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