Menopause FAQ: A good menopause starts with being well informed. Here we present answers to some of the most common questions we get asked.
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Menopause is the time in a woman’s life when periods stop altogether. As we get older, the levels of the female hormones produced by our ovaries (oestrogen, progesterone and testosterone) drop to very low levels. Eventually, our ovaries no longer release eggs, periods stop and we can no longer become pregnant naturally.
80% of women will experience symptoms as a result of the changing hormone levels. These can vary in nature and severity. There are as many as 32 commonly recognised symptoms of menopause. Scientific studies have shown that a wide range of tissues of the body beyond the reproductive organs are sensitive to oestrogen including the brain, gut and skin. As a result, symptoms can be very varied. Some of the most troublesome can be changes in mood such as increases in anxiety, feelings of anger or tearfulness. Some women experience night sweats, hot flushes and trouble sleeping. However, symptoms can also include heart palpitations, itchy skin, poor concentration and joint pains. If you are wondering if your symptoms are due to menopause, take a look at this symptom checklist. Many symptoms of the menopause can also have other causes. If you are concerned, speak to a doctor. Check your symptoms here.
Menopause can usually diagnosed based on the symptoms you’re experiencing. This is a transition that happens over time. Early changes can be subtle, such as a change in the timing of your periods or their flow, or a worsening of PMS. This could be in your late 30s or early 40s. Later on, symptoms tend to become more obvious. It’s all of these symptoms, as well as cycle changes (if you’re having periods), that reveal a woman’s hormonal status and we focus on taking a thorough history, focussing on what matters to you.
It’s important to know that 1 in 20 women go through menopause before the age of 45, 1 in 100 before the age of 40 and 1 in 1000 before the age of 30. If you’re experiencing symptoms that could be due to the menopause, we recommend discussing them with a doctor.
For most women, blood tests are unhelpful and here’s why. The most important blood marker is Follicle Stimulating Hormone (FSH). This varies throughout the cycle in menstruating women and becomes persistently elevated after the menopause. This means that a positive result is reliably found in women who are already through the menopause, but by this time, the presence of other symptoms and signs, such as the cessation of periods, has already made that clear.
Blood tests can be helpful in diagnosing menopause in younger women, or determining whether women who are not having periods due to medicines such as the mini-pill are through the menopause and no longer need contraception.
In perimenopause, when most women are looking for the answer to this question, the FSH is variable and may well be within the normal range. If it is normal, it doesn’t rule out the hormonal fluctuation of perimenopause as the cause, therefore a blood test hasn’t helped. This is the reason listening to and understanding a woman’s story is so much more important.
Yes. In the UK, the average age for women to have their final period is 51 years old. However, for 1 in 20 women, this will happen before the age of 45. This is termed an early menopause. 1 in 100 will go through menopause before the age of 40 and 1 in 1000 before the age of 30. In both cases, this is called premature menopause or primary ovarian insufficiency (POI). Women who have had surgery to remove the ovaries will experience a sudden drop in their levels of female hormones and will therefore have what’s called a surgical menopause. Symptoms can be especially prominent for surgical menopause.
Women should be given the chance to discuss hormone replacement for the protection of their long term health, regardless of whether they are experiencing symptoms at that time. We know that women who go through any kind of early menopause have an increased risk of cardiovascular disease, osteoporosis, dementia and death due to all causes, which can be prevented with treatment. Furthermore, there is no increased risk of breast cancer for women taking replacement hormones up to the age of 51 since it is only replacing what could otherwise have been there naturally.
HRT stands for Hormone Replacement Therapy. It is sometimes also called Menopausal Hormone Therapy (MHT). Women going through perimenopause and menopause experience fluctuating levels of the female hormones oestrogen and progesterone. This causes the wide range of symptoms women can experience. For more information on symptoms click here.
HRT tops up or replaces these hormones, evening out their levels. This brings beneficial effects in terms of symptom relief and also some long term health benefits. There may also be some potential risks and these will be discussed with you on an individual basis.
Body identical HRT consists of replica hormones, with the same chemical structure as those that exist naturally in the female body. Some HRT products contain synthetic hormones which are made chemically in the way other medicines are made and exert an effect within the body but are not identical in structure to those hormones that exist naturally. Modern hormone replacement medicines are derived from the vegetable the yam.
Preparations may contain lactose, soy or gelatin. Check with your doctor or pharmacist if you have allergies, intolerances or are vegan.
At One Woman Health we specialise in the use of body-identical HRT. Body identical HRT is recognised and recommended by the leading professional and regulatory bodies in the UK including the British Menopause Society and National Institute for Health and Clinical Excellence. Body identical HRT consists of preparations of hormones that match those in the female body, namely oestrogen (estradiol), progesterone and testosterone. These are produced under the strict safety conditions applied to other prescription medicines. Furthermore, they have been subjected to rigorous clinical trials and have met the safety and efficacy requirements of the MHRA, the national regulatory body for medicines in the UK. Bio-identical HRT on the other hand, is made in ‘specialist’ compounding pharmacies and the National Institute for Health and Clinical Excellence has stated ‘the efficacy and safety of unregulated compounded bioidentical hormones are unknown’. You can read more about this here.
The benefits of HRT can be summarised under three headings:
1. Symptom control: Symptoms of the menopause can be inconvenient, but for some women they can be devastating, ruining quality of life. Many symptoms can be treated effectively, restoring quality of life.
2. Local treatment: As well as gels, tablets or patches to replace hormones for the whole body, there are additional preparations that treat the vagina alone. These are particularly helpful for dryness, itching, soreness, painful sex or recurrent urinary tract infections. When applied to the vagina in recommended doses, the oestrigen doesn’t into the rest of the body so vaginal oestrogens can be used by women who can’t or don’t want to take whole body HRT. Some women use vaginal oestrogen as well as whole body HRT.
3. Long-term health benefits: After the menopause the risk of a variety of health problems increases for women. The risk of cardiovascular disease (including heart attacks) increases, bone density decreases increasing the risk of osteoporosis and fractures, and change to our metabolism occurs such that we are at increased risk of type 2 diabetes, high blood pressure and weight gain. Hormone replacement therapy may help with all of the above.
This is particularly important for women who have had premature, early or surgical menopause.
HRT is not really one treatment. It is a term that describes a group of different medicines that act on receptors for oestrogen, progesterone and testosterone in the body. Your doctor will work with you to identify the right treatment or combination of treatments for you.
Women without a womb (eg following hysterectomy) can use oestrogen alone. However, in women with a womb, oestrogen will stimulate the lining of the womb to build up. We give progesterone as well to keep it thin. Without progesterone there is a risk that the lining of the womb with grow too much which could cause bleeding or even some abnormal cells to develop. Progesterone stops this happening and prevents erratic bleeding too, which can be a nuisance.
Some studies have shown that HRT causes an increased risk of breast cancer in some women, although the risk is much less than that caused by drinking alcohol regularly (2 units per day), smoking, or being overweight. Studies have not shown an increased risk of dying from breast cancer. The risk seems to be related to the progesterone (see above) as analysis of data on women taking oestrogen alone show a slight decrease in breast cancer risk.
Many of the large studies we are still referring to today have been performed on older medications that we do not use anymore. A study of body-identical progesterone, which wasn’t available until recently, has shown no increased breast cancer risk after 5 years of use.
Women who have a history of blood clots may have been told they cannot have the contraceptive pill. This is because taking oestrogen by mouth can increase the risk of clots. However, oestrogen given for HRT is most often given through the skin as a patch or gel, and studies have shown when given in this way, there is no increased risk of blood clots and women who have not been able to take the pill for this reason can often still have HRT.
Possibly. Breast cancer is a common condition and as a result, many women will have a family history of breast cancer. Whether your family history affects your own risk depends on which relatives, how many and at what age they were diagnosed. It is worth identifying the pattern of breast cancer in your family so that you can discuss it with your doctor.
Many women with a single relative with breast cancer will not be at higher risk than the general population and understanding this can help women feel confident in any treatment choices they make.
Some women with inherited genetic mutations that put them at higher risk may have been advised not to take HRT and in many cases this may make sense, but every woman deserves the opportunity to be heard, receive information and make an informed decision regarding their own health. The decision may not be straightforward and may require input from additional specialists e.g. cancer specialists.
Yes, studies show that oestrogen delivered through the skin in doses appropriate for HRT do not increase the likelihood of clots. Some synthetic progestagens can increase the risk of blood clots (eg norethisterone) however others such as body identical progesterone do not.
Yes. Migraine, especially menstrual migraine (migraine associated with periods) can get worse in the perimenopause due to changing hormone levels. Smoothing out the hormone levels over the course of the cycle can improve things. For women with migraine, it is much safer to have the oestrogen treatment through the skin, and add in a migraine-safe progesterone if you still have your womb.