Menopause: Empowering women to recognise and manage symptoms

Most people know that the menopause refers to when a woman stops having periods and is no longer able to get pregnant naturally. But many question marks still remain about the menopause – when can women expect to go through it, what are the symptoms and can HRT make a difference? Dr Dorota Urbaniak, Private General Practitioner at Parkside, answers some of the frequently asked questions.

 What is the difference between perimenopause and menopause?

The menopause refers to the last period, while ‘perimenopause’ is a term used to describe the time before menopause, which can last for months or even years. The average age of menopause in women in the UK is 51 years – however the symptoms of menopause can start as early as age 45.

How will I know I am going through the menopause?

Menopause symptoms may not be very obvious at the beginning. During perimenopause, the levels of hormones, in particular estrogen, start to fluctuate. The imbalance of hormones may result in irregular periods and may cause hot flushes and night sweats, so-called ‘vasomotor symptoms’. However long before periods become irregular, women may experience more subtle symptoms like tiredness, poor concentration, irritability, low mood, anxiety, sleep problems as well as vaginal dryness, painful sex, low libido, and bladder issues.

Do I need a blood test to check if I am going through menopause?

As the hormone levels fluctuate during perimenopause, a blood test is not usually required in women over the age of 45, and the diagnosis is often based on symptoms.

Should I consider hormone replacement therapy (HRT)?

Every woman who experiences troublesome menopausal symptoms should consider HRT. For the majority of women, providing there are no contraindications (condition that serves as a reason to not take a certain medical treatment due to the harm that it would cause), the benefits of HRT outweigh the risks.

HRT is the most effective treatment for vasomotor symptoms – hot flushes and night sweats are usually improved within four weeks of starting the treatment and maximum benefit is gained by three months. HRT can also improve sleep, muscle aches and pains as well as general quality of life in symptomatic women.

Can HRT help with low mood and anxiety?

HRT can improve mood and depressive symptoms, and is often considered to alleviate low mood that arises as a result of menopause. Cognitive-behavioral therapy may also be beneficial.

I have lost my sex drive and sex is painful – what can I do?

A drop in testosterone that accompanies menopause is the cause of loss of libido, and testosterone therapy can help. In addition, a low level of estrogen during menopause may cause vaginal dryness and painful sex. Vaginal estrogen tablets or vaginal estrogen creams can be used to alleviate the symptoms of vaginal dryness.

My migraines are really bad during menopause – what can help?

Women who suffer with migraines often find their migraines worsen during their menopause. The hormonal fluctuations, which are attributable to this, can be stabilized with HRT, often leading to improvement in migraine symptoms. Transdermal HRT preparations (most commonly available as a patch or gel that is applied directly to the skin) are often preferable for these women.

I’ve heard HRT increases the risk of breast cancer – is this true?

The data regarding the true effect of HRT on the incidence of breast cancer are still contentious. Combined HRT increases the risk of breast cancer however the absolute risk is small at around one extra case of breast cancer per 1,000 women each year. Every woman on HRT is recommended to have regular mammograms while taking HRT and there is no increased risk of dying from breast cancer as a result of taking HRT. Interestingly, drinking two to three units of alcohol daily or being overweight increases the risk of breast cancer in a similar way.

Are bioidentical HRT available on prescription?

Yes, conventional regulated bioidentical HRT preparations are prescribed by doctors in both NHS and private clinics. The term bioidentical is often misunderstood. ‘Bioidentical hormones’ (body-identical) are precise duplicates of hormones naturally produced by the human body. However ‘bioidentical’ is often used as a marketing term by some private clinics offering compounded bioidentical HRT. Compounded bioidentical hormone replacement therapies are manufactured as creams, lozenges and vaginal preparations by ‘Specialist Pharmacies’. They are not regulated in the same way as conventional HRT, the efficacy and safety of unregulated compounded bioidentical hormones are unknown.

How long shall I take HRT?

The duration of HRT use should be made on an individual basis after discussing the risks and benefits with a doctor and no arbitrary limit should be set on duration of use. The long-term benefits of HRT must not be overlooked. Life expectancy for women in the UK is now 89 so effectively women spend well over 35 years of their lives deprived of estrogen. The effect of estrogen on bone mineral density is well documented; it prevents osteoporosis even at lower doses. There is evidence to support the beneficial effects of HRT on the maintenance of muscle mass, strength and connective tissue in women. In addition, estrogen has positive effects on hormonal aging, increasing skin collagen content, thickness, elasticity and hydration. There is also a possible reduction in risk of Alzheimer’s and dementia in those women who take HRT but more trials are on the way.

To summarise:

Menopause can be a time of liberation from periods, cyclical moods and the need for contraception. It can bring the feeling of confidence empowering women to positively move forward. However, there are symptoms of the menopause to bear in mind. If you need support or further advice regarding menopause and HRT please contact GP Services at Parkside Private Hospital.