Menopause - NICE guidelines

Thank you for this. As someone who suffered eight years of misery after being told by my GP to stop (oestrogen only) HRT after three years, I can only say that I wish that this guidance had been available then.
I have urogenital atrophy and found that section very clear and helpful.
I particularly appreciate the clear non-judgemental language of the report. In my experience one of the hardest things to bear was the frequently expressed view that suggested that a positive attitude / brisk walk / alternative health remedy was all that was required.
I hope that the guidance will help to ensure that future generations of women do not have to experience the same difficulties in getting help, support and effective treatment.

I have posted about HRT previously but find it interesting that it is stated so clearly above that oestrogen only HRT is associated with little or no increase in the risk of breast cancer. My (very good) GP still tells me I am at risk and would prefer me to come off it. I am on the lowest dose oestrogen only patch and this keeps me almost sane and hot flush free.

I had such horrendous problems when I was younger that it was a relief to have my ovaries removed and be put on a high dose of oestrogen when I was in my forties. I remember thinking at the time that it was wonderful to feel the same all the time and not have to calendar watch and prepare OH for mood swings! Even when I told him that I was due to be unreasonable the next day and to take no notice he use to stupidly react every time.

As a long - term user of HRT (15 years) I welcome the reassurance. My GP is wonderful. She appreciates that I have tried to cease taking HRT but that 12 months later my symptoms were just as bad. So I feel confident in continuing, I use Tibolone. However, how do these recommendations fit with findings that HRT increases uterine cancer risk?

I asked for HRT as a remedy for tiredness, at age 60 the doctor told me I was too old for that kind of thing. So I gave up work and go to sleep when I feel like it. I take thyroxin 75mg one day and 50mg the next still feel exhausted, any suggestions?

I went through the menopause with no problems whatsoever. I put this down to my vegetarian diet. I eat lots of fruit, vegetables and pulses and I also walk three or four miles every day. Maybe I was just lucky but if anyone is having a bad time, it may be worth trying.

Have you had a thyroid function test recently? My dosage went up gradually to its current level of 100mcg daily, over a period of about 15 years. Sleepiness can also be a symptom of type2 diabetes - or so I have been told.

My experience of the menopause is a long one. I have now been having hot flushes severely for 20 yrs, having had a hysterectomy 22 yrs ago, leaving one ovary. I tried HRT for nearly 8 yrs, and practically every other remedy. The female doctor I went to in year 15 just said as a throwaway remark, Oh, bad luck. That is the only 'help' I have had so far from GPs. However, magic has been happening lately, as I tried acupuncture, and this has helped enormously. It's expensive though. Any other advice will be appreciated.

I was on HRT for five years when my GP refused to give me anymore my symptoms quickly returned I consulted a homeopath who successfully treated the hot flushes and made a huge difference to my insomnia

I feel my menopause is endless. I started peri-menopausal symptoms at age 45 (hot flushes, muzzy head and bouts of extreme fatigue) but due to family history of breast cancer and having benign breast disease, my consultant advised me never to take HRT. I had to struggle on with no help as I was a single parent at the time and holding down a full-time job. Now at age 63 I still have hot flushes and bouts of low energy, but my GP prescribed low-dose antidepressants five years ago to help with the symptoms. I also take Menopace tablets and have noticed an increase in hot flushes if I stop taking them at any time. The menopause is a particularly difficult time in a woman's life I think, and nobody warns you!

Judie123 - could you be diabetic? Before my husband was diagnosed with Type 2 about 6 years ago, he was permanently exhausted.

When I was being treated at the local hospital for post menopausal troubles (hot flushes etc.) one of the things I found most doctors, including my practice G.P.s, were completely unconcerned about, or even interested in, was the psychological effects. Yes - it was great not to have to worry about contraception, but I really went through a grieving process. I couldn't have a baby any more (not that I was desperate for one) but that process was 'dead' to me and it took me quite a while to come to terms with that.

It must be significant that the menopause occurs at a time when other great changes are taking place in a woman's and her family's life. For one thing, bereavement becomes more prevalent and as her parents die, she finds herself to be the older generation; for another, it may be the 'empty nest' time when her children leave home for work or study and she may become a MiL and/or a grandmother. In my case, it was also the time when my OH started to 'look elsewhere' and finally left for a slightly younger model. However, I was spared the physical symptoms (apart from some sweaty nights in what was, in any case, a hot summer) of the menopause for which I am profoundly thankful.

It has been suggested-I have read- that the best menopausal body is a little plump because the fat cells can convert hormones into oestrogens and offset the natural fall in these.

Sorry Anno, but I don't buy into that hypothesis. Menopause is a physical process caused by changes in hormone levels. To suggest that it has to do with external events implies that there is an emotional / psychological process which at its worst (not accusing you of this) smacks of the "keep fit and have a positive attitude" remark that I found so unhelpful. In my case there were no major lifestyle changes and the only thing that happened was that the menopause symptoms (particularly hot flushes causing broken nights) got in the way of my doing my very demanding job at the height of my career.
What I like about this guidance is that it doesn't go down that line, recognising that different women have different experiences.
If you didn't suffer palpitations, panic attacks, endless hot flushes, mood swings then you were lucky. Mine came out of a clear blue sky and caused years of misery. It was a hormonal problem that needed medical intervention.
I sailed through pregnancy and childbirth and I was lucky. Fibroids, hysterectomy and a ten year menopause were the downside of my reproductive system.
Now it is over, I feel ten years younger.

I am very puzzled. Surely the menopause is the relatively brief change part, when you stop ovulating and having periods. Then you become post-meopausal. I am amazed that women can be menopausal for so many years. In my case, the menopause was about three and a half years – now I am post-menopusal with no symptoms.

suzieb, your comment about grieving is interesting. I hadn't thought of that before. I had my last child, gloriously and happily, in my mid forties and thought of her as my "last good egg". I suppose my experience made acceptance of the loss of my fertility very easy.

I wonder if, in the past when there was no contraception, most women who got as far as the menopause were actually glad when it happened. Most of them will have been sick to the back teeth of producing babies, I would imagine, and glad that it had stopped. Most of us don't have this natural lead-in any more, which must affect the psychological aspect, as you say. I hope you eventually found peace from your grieving process

Sorry, Mamie, I had no intention of playing down the very real physical effects of the menopause which I acknowledge I was very fortunate to escape. However, it is true to say that it often coincides with times of stress in one's life and this doesn't make things any easier. My GP put me on a short-term course of anti-depressants after my mother's death and difficulties with OH, for which I was very grateful. It is quite possible that this depression was exacerpated by the concurrent hormonal changes.

Anno, no, I know you weren't. I don't doubt that stressful life events exacerbate the hormonal problems either!
Absent, I think the NICE draft guidance above says that about 10% of women have symptoms for ten years. If you have had a hysterectomy but kept your ovaries you have no idea when it has started. I have no idea if this is likely to change the pattern of the menopause.
I can honestly say I never gave the loss of fertility at 42 a second thought. Done that, now get on with the career!

I didn't give the loss of fertility a second thought either, but I know a few friends who did. Menopause symptoms affected me for around eight years, I know it can be even longer.

Thanks for your message thatbags. I still (at the age of 70!) feel sadness occasionally, but I think the women who have hormone therapy in their 60s in order to have a child are very odd! And about a month ago I dreamt that I was going to have another baby! Maybe some of all this comes from the fact that, at the moment, we only have two grandchildren who are 16 and 14. I do miss the weight and the breathing of a sleeping baby on my shoulder. Crikey, if I go on like this I shall start crying!

I have begged ( and I mean begged) various GP's within my practise for HRT, all of whom have refused. I guess that once the first one said no the rest just went along with his decision, yet none have been able ( or willing) to give me a good reason for their refusal except that they have it on record, from me,that my mum was diagnosed with breast cancer aged 59. At 53 the menopause is ruining life and I am not exaggerating. I am permanently tired, irritable, suffering from hair loss, mood swings,re-occurring water infections, insomnia and horrendous hot flushes and night sweats. I would do anything to feel normal again.

Gillybob I thought of you when I read this draft guidance. I would show it to your doctor. The bit in green above about breast cancer seems clear enough to me. Then I would ask for a referral to a specialist if they still don't agree. You should not have to suffer like this.

Also read the bit about UTIs and vaginal oestrogen!

Judi123 there was a thread recently about hypothyroidism and still feeling total exhaustion even when on medication. I'll see if I can find it and post the link for you.

It was very helpful.