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Forest Trees

Menopause FAQs

Thank you for submitting your questions during the Menopause Workshops.

 

As promised, our aim is to create further resources that will support you and other women during their menopausal journey. We have collated your questions into this Menopause FAQ page which will be an ongoing resource that you can refer to.

We hope you find the FAQ useful as it may contain answers to questions you have not yet considered or provide some insight into other aspects of the menopause journey.  Please note, as some questions were similar in nature, we have merged them where appropriate to avoid repetition, and did our best to ensure that each question was answered. 

Will there be a Menopause Workshop for men to attend to help them understand what menopause is and how they can support?

We intend to create further educational workshops. These may include a workshop for male partners, family members, friends, or colleagues. When the workshops are ready, we will invite the appropriate group of people to attend.

 

Will the workshop slides be available?

At present, there are no plans to make the menopause workshop slides available. However, we do have other support and resources in place including the following:

  • Menopause webpages and resource links. (https://www.healthandwellbeingwpcn.co.uk/menopause)

  • Educational workshops on the pillars of menopause wellness, covering: strategies, protocols and practises (to be advertised soon). Please note that you are welcome to take your own notes at any future workshops that we deliver.

  • Health and well-being coaching sessions, delivered by our health and well-being team.

  • Menopause clinic appointments, delivered by our clinical team & Women’s Wellness Coach.

 

Should I see a doctor for help with intermittent symptoms that are not constant e.g.  sleeping, night sweats, brain fog, as the NHS is so busy.

If you are experiencing intermittent menopausal symptoms that are difficult to manage with changes of habit and lifestyle medicine, or that are affecting the quality of your life, then it is suggested that you book an appointment with your GP or the nurse at the menopause clinic; this can be booked by your practice reception staff. You may be only just starting the menopause or feel that you have been going through it for a long time, but if you are struggling with symptoms then it is best to come in and discuss them.  The NHS is busy, but your health and wellbeing are very important.

If you decide that you would like HRT you need to have a discussion with a GP, either in your surgery or by referral to the menopause clinic (referral by GPs or the menopause nurse). There are lots of different kinds of HRT with different pros and cons, the doctor/nurse will discuss these with you and will refer you to some websites so that you can fully understand your choices.

Why is it so difficult to get an appointment with someone that has a good knowledge about the menopause and what medication to prescribe? 

GPs have to know a lot about a variety of topics, just as some know more about joint problems, others know more about menopause. All GPs understand the menopause and have experience prescribing HRT, but some will have had more experience and will have more confidence prescribing different treatments.

There are several professional guides that have been produced to help your GP offer you the right help and support when managing menopause.  These documents are written and reviewed by experts and have been produced to ensure that all women receive the same standard of care from the NHS.  These include NICE Guideline 23 Menopause: Diagnosis and Management, and the General Medical Council's 'Decision making and consent' guidelines.  GPs also have access to their local prescribing formularies, which list all the HRT products available along with prescribing guides.

Why don’t the NHS or local surgeries run menopause clinics?

There are NHS HRT clinics run by specialist gynaecologists. There is also a local menopause clinic run by a GP who has an interest in menopause.  For appointments at the local Menopause Clinic, you can book an appointment with your GP or the nurse at the menopause clinic, this can be booked by your practice reception staff.

How are women meant to get a diagnosis if the doctors will only allow you to discuss one symptom? When menopause is a combination of many symptoms?

A 10 minute appointment is for one problem, such as suspected menopause, even if this comes as a variety of symptoms. If you think your problems are very complicated it is best to book a double appointment.

Why isn’t it compulsory for tests to be completed before medication is prescribed to ensure you are getting the right one for you and the right dosage?

The National Institute for Health and Care Excellence (NICE) menopause guidance, first published in November 2015, states that perimenopause should be diagnosed on symptoms alone without blood tests in healthy women over the age of 45.  This is because during perimenopause your hormone levels can fluctuate and vary widely from week to week. So, a blood hormone profile on one day, may show very different levels to another day. Unless a blood hormone profile is taken on a regular basis over several months, it will not provide a clear and accurate indication of where your levels are. Currently, menopause is diagnosed symptomatically using the green climacteric scale to measure symptoms (in particular vasomotor symptoms e.g. hot flashes and night sweats), cross-referenced with your age (45yrs+) and changes to your menstrual cycle (irregularity). 

For those under the age of 45, a blood test may be appropriate, but again, if symptoms are clearly related to menopause, blood tests may not be needed. 

 

Women under the age of 40 who have not had a period for four months or longer, or who have symptoms which suggest estrogen deficiency, need at least two blood tests, to be taken approximately four to six weeks apart, to provide a clear diagnosis.  This may be followed by further tests and referral to a specialist.

There are some occasions within the NHS, and indeed in some private clinics, where blood hormone profiles will be administered. This is usually offered on a case-by-case basis. If you feel that there is a need for your hormones to be tested, you can make that inquiry with your GP. 

Are all HRT options available on the NHS or are some not due to cost?

Most of the widely recommended HRT options are available on the NHS. These can be purchased at a reduced price by applying for a Prescription Prepayment Certificate, known as a HRT PPC , which is available in the UK.  You can buy this certificate from the NHS which will make the cost of your HRT prescriptions much cheaper. It does this by allowing you to pay one payment for an entire 12 months worth of prescriptions, with no limit on the number of different HRT prescription items that you can get within that 12 months.  When applying for the HRT PPC you will be able to see which HRT prescription items are included.

See the link for further details - https://www.gov.uk/get-a-ppc/hrt-ppc 

 

See the link below for a list of medicines covered by the HRT PPC. 

https://www.nhsbsa.nhs.uk/help-nhs-prescription-costs/nhs-hormone-replacement-therapy-prescription-prepayment-certificate-hrt-ppc/medicines-covered-hrt-ppc 

 

There are some medications that you may be prescribed for menopause that are not eligible as part of the HRT Medicine offer and for these, you can still receive them at a reduced price by applying for a standard Prescription Prepayment Certificate (PPC). 

What are pros and cons of HRT?

This is a big topic, please see our menopause page for more information or speak to a menopause nurse/GP. It is suggested that you book an appointment with your GP or the nurse at the menopause clinic, this can be booked by your practice reception staff 

Should you review or change your HRT if you’ve taken it for a long time? How do you know what’s right for you, and if you are taking the right amount?

After starting HRT you should have a review with a GP after 3 months, this is to assess if the HRT is controlling your symptoms as it can take a few months for symptoms to improve. Once you are stable on HRT you should aim to book an annual review with your GP; this is to check the treatment and dosage is still right for you and help you plan at what point you would like to stop.

 

I’ve been on HRT for 8 years and I was told it is best to come off after 10.  What is the process of coming off and what if your symptoms haven’t finished?   

If you reduce your HRT dose gradually, your symptoms will only return if you are still symptomatic.  Some women experience estrogen depletion symptoms for many years after menopause.  The caveat here is that almost all women will experience menopause symptoms again if they suddenly stop HRT, but this is just a withdrawal response.  If they remain symptomatic a month to six weeks later, then it is safe to assume that they are still truly symptomatic.

A good indicator when you could consider stopping HRT is if you have reached the average age of natural menopause at 51yrs. Once you decide you would like to stop HRT your GP will support you in doing this by gradually reducing the dose, minimising any side effects.  It is possible that some symptoms may return once you have stopped HRT. If this is the case, and they can't be managed through lifestyle medicine, then it may be an option to restart HRT on a low dose and see how you get on. 

 

If you have experienced premature ovarian insufficiency or early menopause. Then it would be advised that you continue to take HRT up until the average age of natural menopause, 51 years and thereafter reassess whether ongoing HRT is required. 

 

The amount of time that you are on HRT will vary from woman to woman as it is a personalised experience and prescription. However, general guidelines suggest that up to five years on HRT is the recommended amount of time. There currently isn't the research or guidelines to support a timeframe beyond five years.  However, there are differing schools of thought on this matter, with some menopause specialists advising that HRT can be taken long-term for the rest of life, or whether it should be taken for a short phase just while symptoms are most problematic.  At the end of the day, the amount of time that you take HRT will be a personalised decision based on your medical history, personal preferences and having an in depth and informed conversation with your GP. 

I have been experiencing menopause for years and must be near the end, is there any help? Can you still ask for HRT post menopause?

Menopause symptoms tend to start during perimenopause and last on average for 2-8yrs but can last between 2-10 years.
Once you have reached menopause, which is the one-year anniversary after the last day of your last period, we would expect that menopause symptoms start to subside, and will usually have settled within 1-2 years. However, for some women, menopause symptoms may continue for longer, for another 4 to 10 years, or the rest of your life.

Symptoms that may linger during the post menopause phase include hot flashes and night sweats, Genito Urinary Syndrome (GSM), low libido, weight gain, facial hair, and hair loss. If you are still experiencing post menopause symptoms, then you could apply lifestyle medicine or have a conversation with your GP about a possible prescription for HRT or vaginal estrogen therapy.

 

What exactly is the perimenopause? How do I know what stage of menopause I am in?

Menopause consists of several different stages as outlined below.

  • Pre-menopause: normal levels of estrogen & progesterone. Periods + no symptoms.

  • Perimenopause: fluctuating estrogen and declining progesterone. Transitional phase. Periods + symptoms, lasts 2-10yrs, onset age 35-40yrs, end age 45-50+ (average 51yrs).

  • Menopause: 1 day in your life when you have not had a period bleed for 1 year. It is the 1-year anniversary of the last day of your last menstrual bleed (period). Average age 51yrs.

  • Post menopause: low estrogen and low progesterone, usually resulting in symptom decline. Rest of your life.

 

How do you know if you have reached menopause if HRT causes small bleed each month?

When starting or altering any HRT prescription it is not unusual to experience erratic bleeding (breakthrough bleeding).  This is common if you are taking cyclical HRT and should be predictable, occurring at the same time each month, usually at the end of the progesterone phase. This should settle within the first three to six months, but if you are concerned by unpredictable, prolonged or very heavy bleeding, please seek medical advice.

​Unexpected bleeding that occurs after the first six months of starting a continuous HRT regimen (both estrogen and progesterone every day) should be reported to your GP and investigated for other causes. This is because the continuous combined HRT is designed to eliminate vaginal bleeding.

If you are on a hormonal contraceptive or HRT, it will be difficult to know when you have reached menopause because the hormone medication will affect your natural periods and symptoms. Age, hormones changes, menstrual cycle changes and symptoms are the indicators of reaching perimenopause and the final period is the indicator of reaching menopause. The only way to know, would be to stop taking the hormones and see whether your period returns over a period of 12 months. If you are well beyond the average age of menopause then you could presume that you have reached menopause.

Breakthrough bleeding within the first 6 months after your last period (not yet reached the 1 year anniversary ‘Menopause’) is quite common and does not necessarily require investigation unless the bleeding is unusually heavy.

​Once you are postmenopausal (12 months without a period) and not on HRT, any bleeding should be reported to your GP.  It is usual to be referred for investigation on a 'two-week pathway' so that any problem can be found and dealt with promptly.

 

What category does surgical, chemical or early menopause come under?

Surgical menopause occurs immediately when you have had your ovaries removed. As the ovaries are no longer present to produce estrogen and progesterone you enter hormone deficiency relative to your life stage. This sudden drop-off of hormones may result in a more severe onset of menopausal symptoms.

If you were pre-menopausal or perimenopausal and have undergone surgical menopause (ovaries removed), then you should have received some guidance and the option to discuss HRT or vaginal hormone therapy to help replace the estrogen and progesterone that can no longer be produced by your ovaries.

I have been on HRT for 23 years after a hysterectomy. Had increased symptoms in last few years but now getting less often. When I can stop taking the HRT?

If you have had a hysterectomy wherein your uterus was removed but your ovaries are still intact. Then your ovaries will still be doing their job of producing the sex hormones in amounts natural for your age and life phase. Hence you will still experience cyclical symptoms but won’t have a menstrual bleed. You may not need to take HRT immediately following your surgery, unless your symptoms become unmanageable.

If you have had a hysterectomy with an oophorectomy (ovaries removed), and are under the age of 50yrs then you will enter menopause immediately following your surgery. It is advised that you start HRT immediately so you can receive the sex hormones that your ovaries would have otherwise produced at this age. This will help to prevent you from plummeting into immediate symptoms of menopause.  

 

For both scenarios, it would generally be advised that you continue to take your HRT up until the age where your ovaries would have naturally stopped producing hormones.  Thereafter you could stop taking HRT when your symptoms have subsided, as you will likely no longer require it.

 

If you have had a hysterectomy after you have reached menopause, then you will likely not require HRT at all, especially if you are not symptomatic. However, you may benefit from local estrogen therapy if you are experiencing genitourinary symptoms.  

How do you manage late onset menopause?

Late onset menopause is where you have reached the one-year anniversary after your last day of your last period at a later age than would normally be expected. If you have had regular menstrual cycles before reaching this late menopause, then you will have received the benefits of your body producing estrogen and progesterone for a longer period than usually expected. This is because both hormones provide health benefits and protection against the risk of developing certain conditions or diseases e.g. heart disease and osteoporosis. Hence late onset menopause is considered to be beneficial. If symptoms start to arise at this later age, then you can still apply lifestyle medicine, HRT or vaginal hormone therapy if needed.

 

How can I get a good night's sleep and not feel completely exhausted all of the time?

Sleep disruption is a common symptom of menopause. It can be caused by the decline in estrogen and progesterone as well as changes to the thermoregulatory system.


Some of the ways that you can improve your sleep during the menopause journey include HRT and sleep hygiene as listed below:

  • Estrogen or progesterone HRT

  • Create a bedtime and wake up time that fits your natural chronotype

  • Create a safe and comfortable sleep environment

  • Consider night time disturbances: noise, presence of pets, trips to the toilet

  • Establish a calming and relaxing bedtime routine

  • Early morning exposure to daylight

  • Reduce exposure to blue light in the evening

  • Reduce consumption of alcohol and caffeine

  • Consider a low histamine diet

  • Eat foods that contain enough protein to balance blood sugar

  • Eat enough carbohydrate to calm your nervous system

  • Ensure that you are well nourished or supplement with: iron, magnesium, glycine and taurine

  • Melatonin is another option that helps. Making changes to your sleep routine is also a useful method so that you coincide with your natural circadian rhythm

If I haven't had a period for three years, not on contraception and menopausal symptoms are minimal. Am I post-menopausal? Could I still get pregnant?

You are considered to be post-menopausal once you have reached the one-year anniversary after the last day of your last period.

It is considered that you may still be fertile, and could possibly become pregnant, if you are having unprotected penetrative sex, for up to 1-2 years after that menopause date.  It is recommended that you continue to use some form of contraception for two years after you have reached menopause.

 

Does not having any children impact when you will start the menopause?

If you have not been pregnant or birthed children, you may be at a higher risk of entering early menopause. This means that you may enter menopause before the age of 40, or earlier than the average woman who has been pregnant.


Menopause tends to start later in women who have had pregnancies/children, and progressively later as the number of pregnancies/children increases up to three, but no further beyond that. This is because there are certain protective benefits that occur from having been pregnant, and/or given birth, and it is shown to delay the onset of menopause. Therefore, having children may be beneficial by enabling longer-term production of estrogen and progesterone and the resulting health benefits that are associated with these hormones.

 

Does IVF affect the stages of menopause? Will it start sooner due to the number of eggs collected?

The general consensus is that having IVF treatment will not cause your menopause to start sooner, as it does not deplete your ovary’s ability to produce estrogen or progesterone and therefore has no significant impact on the onset of menopause or menopausal symptoms.

 

Does the menopause affect memory and what can you do to help restore it?

The decline of estrogen can cause symptoms of temporary cognitive decline e.g. memory loss, trouble concentrating, lack of focus and brain fog. These are usually temporary and subside once hormone levels stabilise and the brain has adapted to the lower levels.

 

There are lots of things you can do to help restore cognitive function as detailed below:

  • Making sure you get enough sleep and rest

  • Reduce stress

  • Improve insulin resistance

  • Consume an anti-inflammatory diet

  • Consuming less sugar

  • Consume or supplement with: vitamin B12, coenzyme Q10, choline, magnesium and taurine

  • Build muscle via strength or resistance training

  • Stimulating your brain with activities or by learning something new

  • Estrogen HRT

 

How can I replace lost estrogen?

Localised or systemic HRT is an option for replacing low estrogen. It’s a good idea to start with the lowest dose possible, wait and see what effect it has and then increase it gradually if required. During perimenopause your levels of estrogen may actually be 20 to 30% higher than they used to be as they may fluctuate for years before eventually declining. So you may not actually need to replace any estrogen during the early phase of perimenopause, and if your levels are high then additional estrogen via HRT may actually exacerbates or increase menopause symptoms.

If you have reached the phase where estrogen is declining in later perimenopause or post menopause, then estrogen may be beneficial at this time because you will have your lower or lowest levels of estrogen being naturally produced. You can also replace lost estrogen by consuming phytoestrogens (plant estrogen) from lignans (fruits, vegetables, seeds, legumes, wholegrains), which can potentially be useful to top-up small amounts of estrogen in the post-menopause phase.

 

Is HRT prescribed during perimenopause?

HRT is often prescribed during perimenopause to help ease symptoms. However if you are in early menopause you may not need it (see above). It can also be prescribed during post-menopause (often alongside progesterone) if a woman is still symptomatic. It can also be prescribed to women who have entered early onset menopause, or for women who have been diagnosed with osteoporosis who are under the age of 60yrs.

 

I have heard that menopause never ends. Do the symptoms finish, or can they go on beyond into your 60s?

Once you have reached menopause (which is the 1 year anniversary since the last day of your last period) you will be classified as post-menopausal. Usually within one to two years of this date, we would expect that most symptoms will have subsided e.g. heavy periods, breast pain, mood problems, migraines, hot flashes and sleep disturbances, so you may be less affected.  However, it has been noted that certain symptoms can persist long-term. These include hot flashes, which can last on average from 4 to 10 years, and sleep disruption or disturbances, which can last on average for four years. Symptoms that may last for the rest of your life can include Genito Urinary Syndrome (GSM), stress incontinence, bladder infections, UTI’s, low libido, pelvic floor problems, weight gain, facial hair and head hair loss, osteoporosis and risk of prolapse may persist for the rest of your life. These can be managed or improved with various lifestyle medicine and/or a vaginal hormone therapy or topical DHEA for GSM.

 

Are muscle and joint pains a symptom of menopause? If so, what can I do to help? 

As estrogen and progesterone decline the body may lose some of its anti-inflammatory status. This can cause musculoskeletal aches and pains. They can also be caused by lack of sleep, which increases the tendency to feel and register pain.

Some options to reduce generalised aches and pains and manage pain are as follows:

  • Estrogen plus progesterone HRT

  • Pain relief medication can be used

  • Myofascial stretch and release routines

  • Gentle movement and exercise 

  • Soft tissue therapy (massage)

  • Soothing your nervous system

  • Adequate rest and relaxation

 

Does the menopause cause you to wee more often or have a weak bladder and urinary incontinence?

During menopause the decline in estrogen can cause thinning of the lining of the urethra and weakening of the pelvic floor muscles. This can result in lack of control over urinary function, causing stress incontinence or urge incontinence.

There are lots of things you can do to improve symptoms, as follows:

  • Isolated Pelvic floor exercises

  • Integrated pelvic floor exercises

  • Postural correction

  • Correcting dysfunctional breathing patterns

  • Vaginal estrogen therapy

 

If you have concerns about the function of your pelvic floor or urinary incontinence, you are advised to book an appointment with your GP and request a referral to a Women's Health physiotherapist or pelvic health physiotherapist for a thorough assessment to determine whether your pelvic floor muscles are overactive or under active, whether there are any other underlying issues and prescribe a treatment plan.

 

Does the menopause cause weight gain and is it harder to lose or maintain weight?

Weight gain, especially around the midriff, is common during the menopausal journey mainly due to the decline in estrogen and progesterone which causes several metabolic shifts to occur. These include the following:

  • Reduction in muscle mass

  • Reduction in your metabolic rate

  • Increased likelihood of developing insulin resistance

  • Relative androgen excess

  • Increased stress

  • Sleep disruption

  • Inappropriate nutrition

  • Sedentary lifestyle

 

There are lots of things that you can do to improve your weight management during the menopause such as:

  • Cleaning up the diet

  • Reducing consumption of sugars, alcohol, processed foods and simple carbohydrates. Consume more protein, fibre and healthy fats

  • Ensuring you are in calorie deficit

  • Exercising regularly: steady state cardio, interval cardio and strength training

  • Reducing stress and cortisol levels

  • Optimise quantity and quality of sleep

 

HRT in the form of estrogen or progesterone is not usually prescribed to help manage weight during the menopausal years.

 

The health implications and risks are higher than I expected. Why then, do women generally live longer than men?

Women tend to live longer than men due to several factors and trends as detailed below:

  • Genetics: men have a Y chromosome, which is linked to more chronic diseases.

  • Men also have higher levels of testosterone, which can weaken heart muscles and contribute towards cardiovascular diseases.

  • Men tend to store more visceral fat around their organs, which is a risk factor for heart disease.

  • Men have a tendency to engage in more risky behaviours or develop lifestyle habits that increases their likelihood of developing diseases and conditions.

  • Men are likely to suffer in silence when experiencing mental health struggles and conditions.

  • Men are less likely to have developed healthy stress management strategies and coping mechanisms and support networks.

  • Men are less likely to visit the doctor when they are unwell or symptomatic.

 

How do I track cycles and menopause symptoms if I have had an IUD fitted e.g. the Mirena Coil or copper coil?

If you are on a hormonal IUD, for example the Mirena Coil, this will be providing a contraceptive drug, alongside localised synthetic progesterone. This means that it may reduce menstrual bleeding or cause it to stop. However, it does not usually stop ovulation, so you may still have an ovulatory cycle and a normal shift in production of hormones for you at this stage. This means that you should be able to track perimenopausal symptoms - hot flashes and vaginal dryness will be good indicators to track.

You could also ask to be tested for Follicle Stimulating Hormone (FSH), to indicate whether you have entered the phase of menopause. However, FSH levels can fluctuate widely, so it can only offer an indication. If you are on the copper IUD, it does not contain a contraceptive drug and it does not contain estrogen or progesterone, so it does not interfere with your normal ovulation, menstrual cycles, or production of hormones. This means that if you are on the copper or IUD, you should still be able to track the cycle of your periods and menstrual blood flow, as well as any symptoms that may occur. However, one side effect of the copper IUD is that it may increase blood flow, and so it is not always the best option during perimenopause. However, if you have light periods, it may be a suitable option for you.

 

I had the copper coil removed months ago and have no periods, but I still have symptoms. How do I know what stage I am at?

If you have not had a period for one full year, then it is likely that you have entered menopause, so it’s a good idea to recall or track your menstrual cycle dates. You can still be symptomatic during perimenopause and the post menopause phase. We would expect that your symptoms would subside and reduce within one to two years after menopause, but they can continue for longer, potentially up from four years or even up to 10 years. Symptoms of GSM affecting the vagina and the urethra can last for the rest of your life if untreated.

 

How do you know what stage of menopause you are at if you have had an ablation and don't bleed in monthly cycles?

If you have had an endometrial ablation (which involves the destruction of the uterine lining), then you may bleed lightly during your menstrual cycles, or not bleed at all. This means that it can be difficult or impossible to use your menstrual bleeds to track and gauge what stage of menopause you are at. However, because an ablation does not affect your ovaries or their production of estrogen and progesterone, then you will still be able to track the usual menopausal symptoms.

 

If I'm having heavier or erratic periods and I'm concerned about weight gain, is progesterone or estrogen better?

High levels of estrogen relative to progesterone (known as east region dominance) can cause the uterine lining to become thicker during each menstrual cycle. When it sheds, during menstruation, it can therefore result in a much heavier cycle, flooding or passing large blood clots. For this reason, progesterone would be the recommended HRT option, rather than estrogen, if you are experiencing heavy or painful periods. However, it should be noted that though progesterone does not directly increase weight gain, it can increase fluid retention and stimulate the hunger hormone ghrelin.  This may increase your appetite, if it causes you to eat more food than your metabolic rate requires this may result in weight gain.

 

Do the menopause health risks and implications such as cardiovascular disease or stroke happen during perimenopause or post menopause?

Due to the decline in estrogen and progesterone you will have lost some of the shielding and protection that those two hormones provided against certain diseases and conditions such as cardiovascular disease, heart disease and stroke. Before you reached menopause your risk of heart attack would have been lower. Once you have reached menopause and estrogen and progesterone levels are low, your risk of heart disease will greatly increase, and by 10 years after you've reached menopause, your risk will be much higher and actually in line with those of men. This increased risk is due to the relative excess of androgens because there is less estrogen and progesterone to buffer the effects of the androgens.


Estrogen HRT may reduce the risk of developing heart disease. However, research has shown that it is only effective if it is started within the first ten years of reaching menopause. The safest form of HRT, for cardiovascular protection, is transdermal estrogen combined with oral micronized progesterone.

 

If we are shift workers, how do we regulate our nervous system?

If you work a regular night time or variable night time shift pattern, you may experience shift work sleep disorder (SWSD) you can minimise the effects and regulate your nervous system by doing the following:

  • identify your chronotype and change your sleep pattern to support your natural chronotype as much as possible on shift days and on days off

  • Take 20 minute power naps during your shift, ask your employer to provide a safe nap area

  • Aim to get to get 7 to 9 hours of uninterrupted sleep whether that's in the daytime or night-time

  • Sticking to a pattern as much as possible, so that your body can adapt

  • Getting regular exercise

  • Eat a well-balanced, nutrient dense diet

  • Eat less processed foods and lower GI foods

  • Avoiding large meals two hours before you sleep

  • Consuming your meals at the beginning or at the end of a shift (rather than throughout the night shift)

  • Considering using light therapy

  • Minimise light exposure in the day after a night shift if you are intending to sleep

  • Try cognitive behavioural therapy to help manage symptoms of SWSD anxiety, low mood, etc

  • Reduce physical, mental and emotional stress

  • Engaging in activities that calm your nervous system e.g. such as breathwork, mindfulness, meditation, somatic release, joyful movement, time in nature, nurturing social time or quiet me time

 

What changes can be made to nutrition to relieve symptoms of hot flashes and night sweats?

There are lots that can be done to improve or manage hot flashes and night sweats as detailed below:

  • Identify whether you have insulin resistance and make dietary changes to help reduce this

  • Eating well balanced meals containing protein, healthy fats and fibre at every meal

  • Reducing the consumption of processed foods, added sugars and starchy processed carbohydrates

  • Achieve better blood sugar balance and insulin sensitivity

  • Reduce or avoid alcohol

  • Reduce or avoid foods that trigger thermoregulatory responses e.g. spicy foods

  • Track what you eat alongside your symptoms for a 1-2 weeks and identify correlating patterns

  • Staying well hydrated with water and electrolytes

  • Drink less caffeine (or caffeine no later than midday)

  • Supplement with magnesium or taurine

  • Engage in activities that promote thermoregulation and improve to heat sensitivity

  • Sleep in cool bedroom

  • Expose yourself to heat whilst soothing nervous system e.g. sauna, steam room, hot yoga

  • Try contrasting cool (not cold) showers

  • Improve gut microbiome and regular bowel movements

  • Test and optimise thyroid, cortisol and estrogen levels

 

What can I take to reduce hot flashes if I have had cancer or am taking letrozole?

If you have had breast cancer that is estrogen receptor positive cancer, then you may have been advised that you cannot take HRT, soya, red clover or black cohosh. If you are looking for an option that does not require any of these substances, then please see the lifestyle options listed above, which are considered safe for estrogen receptor positive cancer and can be taken alongside letrozole.

If you have had breast cancer that is not estrogen or progesterone sensitive, then you may still be able to take some forms of HRT to treat hot flashes. Progesterone HRT alone can be useful to treat hot flashes, and estrogen can be useful to treat hot flashes, if combined alongside progesterone.

If you've had breast cancer that was estrogen sensitive what suitable alternatives are available to estrogen based HRT?

Can you have HRT of any kind with a family history from another close relative dying of breast cancer?

Is there a site which can tell me which natural remedies & supplements are safe with tamoxifen & other breast cancer treatments?

Prescribing HRT to patients who have had cancer is a tricky topic and may require specialist advice, speak to your GP to start with.

This is a good source of information about non-HRT treatments that are available on prescription: https://www.menopausematters.co.uk/prescribed.php

 

There is some information here on natural and non-prescribed remedies: https://www.menopausematters.co.uk/remedies.php

Should all women at age 45 be taking calcium and vitamin D supplements as a standard protocol?

It is recommended that you consume a daily dose of approximately 600mg of dietary calcium. This can be obtained from a well-balanced wholefoods diet containing: leafy green vegetables, seeds, dairy and bony fish etc. Though calcium supplements are often recommended or advertised, there is very little evidence that they actually end up in bone, so you may be better off obtaining your calcium from a well-balanced whole food diet.

Vitamin D can promote the healthy absorption of calcium. However, it needs to be combined with vitamin K2. When combined, these two vitamins help calcium be absorbed and placed into the bones where it is needed, rather than in the blood vessels, where it can cause calcification and increase the risk of cardiovascular disease. In order to get a good source of vitamin D, it is recommended that you consume 1000 - 3000 IU per day and 200 mcg of MK7. You can get your vitamin D from natural food sources, including: sunlight, egg yokes, hard cheese, oily fish, yogurt, mushrooms etc. You can get vitamin K2 from natural sources such as kale, spinach, cabbage, blueberries, egg yolk, sauerkraut or kimchi, hard cheese.

 

There are lots of supplements advertised for menopausal women. Do these supplements work, and if so, is there a suggested one or key ingredient that we should be looking for?

A key strategy is to ensure that your body is receiving ample amounts of essential macro nutrients and micronutrients to help support physiological function and hormone production. Most of these can be obtained through a well-balanced, nutrient dense whole foods diet that contains ample protein, fibre, healthy fats and complex carbohydrates, as well as a wide variety of vitamins, minerals, phytonutrients and antioxidants. Adequate hydration is also vital.

There are many supplements that can be taken to help during the menopause. Which supplements will depend on whether you are looking to treat a particular symptom, or support a physiological system. There are dozens of supplements that may be useful for particular symptoms. However the main supplements that cover the widest range of menopausal symptoms are:

  • Magnesium

  • Zinc,

  • Vitamins B2, B6 and B12.

 

When taking any supplements, ensure that you purchase a quality product, adhere to the recommended dose, be mindful of contraindications, track your symptoms and response and consult your GP if you are unsure if you experience any adverse reactions.

Supermarket shelves are full of an ever-increasing range of menopause supplements, but if you are considering trying a supplement to treat your symptoms, it is recommended that you consult a registered medical herbalist for personalised advice and only buy products that are on the Traditional Herbal Medicine Scheme Register (THR).  It's important to check with your GP that any other medication you are using will not be affected or cause an adverse reaction when used alongside supplements.

 

What are the best things to eat to help gut health?

Optimising your gut health and microbiome can help to promote the balance and clearing of excess estrogen. It can also improve hormone health, immune health, brain health and emotional health. There are lots of foods that you can eat to help promote gut health, including probiotics, which are fermented foods providing good bacteria that helps to breakdown other foods and support healthy gut wellness.


These include foods such as: live yoghurt, kefir, kombucha, tempeh, live apple cider vinegar, sourdough bread, sauerkraut and non-pasteurised pickled vegetables etc. You can also increase your consumption of prebiotics, which are foods containing fibre that feed the probiotic microorganisms living in the gut. These include fruit, vegetables and seeds such as leafy greens, asparagus, leeks, raw cabbage, beetroot, apples, bananas, blueberries, barley, flax seeds, oats, ginger, spirulina etc. All of which can be obtained from a healthy, well-balanced diet.

You could also consume a probiotic supplement. These contain different strains of bacteria in varying quantities. However, with regards to gut health, it can be difficult to know which particular strain you are deficient in, unless you have had tests carried out.

Therefore, you should consider choosing a supplement that has a wide variety of different micro biotic strains, or simply rely on consuming a well-balanced diet to support your gut microbiome.

 

Where is the best place to look for nutrition advice during perimenopause?

It has been agreed by most researchers that the Mediterranean diet is an optimal diet for perimenopause and post menopause. If you start with this as your initial resource, it will give you a good foundation for creating a well-balanced whole foods based diet that supports hormone health, physiological functions and reduce some risk factors linked to dietary choices.

There are many dietary options that you can apply to optimising your nutrition for menopause and mid-life, which also include but are not limited to the following protocols:

  • Balancing blood sugar

  • Reduce insulin resistance

  • Helping the body become fat adapted (to burn fat)

  • Improving gut health and bowel movements

  • Support adrenal health

  • Supporting thyroid health

  • Supporting liver health

  • Supporting brain health

 

You can search for nutrition guidance relating to any of the topics listed above.

A useful source to get you started is: https://www.themenopausecharity.org/2021/06/12/healthy-eating-during-menopause/

 

What is the surgeries view on Testosterone, especially in light of our local practices refusal to do blood tests? How are women supposed to get access to it? Men can get instant help with libido why is there nothing suitable for women? Is there anything you can take to help low libido?

Libido can go down or up during menopause. Low libido can be caused by several factors including: changes to self-perception and self-intimacy, disconnection to our bodies and our somatic felt-sense, changes/problems in a relationship, lack of intimacy with a partner, GSM, stress, sleep disruption, fatigue and lethargy, medication and thyroid disease. There are many lifestyle options that can be applied to help boost libido.

Low libido in menopausal women is first treated by giving adequate levels of estrogen, if a doctor experienced in treating menopause believes that enough estrogen is being given, they may consider using testosterone, depending on the situation. Testosterone is not licensed for use in women, this is because there is limited evidence for its use and the long term risks associated with it, but some doctors will prescribe it in certain circumstances. If you think you might benefit from testosterone then speak to your GP first of all.

I don’t want to take HRT, what are the alternatives?

If you are not interested in taking HRT, there are lots of things you can do to improve your experience and symptoms of your menopausal journey. These would include taking a look at natural and holistic lifestyle medicine strategies that you can apply to improve your habits, behaviours and mindset.

You could start by looking at the following areas: Mindset, nutrition, exercise, stress management, sleep, pelvic health, hormone balancing.

Supermarket shelves are full of an ever-increasing range of menopause supplements, but if you are considering trying a supplement to treat your symptoms, it is recommended that you consult a registered medical herbalist for personalised advice and only buy products that are on the Traditional Herbal Medicine Scheme Register (THR).  It's important to check with your GP that any other medication you are using will not be affected or cause an adverse reaction when used alongside supplements.

There have been some small studies that show that acupuncture can be helpful for the vasomotor symptoms of menopause - the hot flashes and night sweats.  As with any treatment, it is important to check the credentials of the person treating you, if you decide to try complementary therapies to help to manage your menopause symptoms.

 

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