Menopause Q&A with Dr Rosemary Leonard

PamelaJ1

I always said I'd be on HRT till I died but then the manufacturer stopped producing my pill. I was prescribed a different one, started bleeding so had a go at going cold turkey. I got really dry then, bought something called sylk but it didn't seem to work very well.
Next step was Evorel conti patches. Are they the same as yours Liz? Can't see 25 on the pack. I have been on them about a year but I started feeling nauseous so thought it may be the patches so I'm off again. Hello hot flushes almost immediately but the dryness hasn't really got going yet. When it does what can I do?
I am 64, been on hrt since I was 53 no other health problems at all. As I have sailed through life without any medical concerns I AM TAKING THIS PERSONALLY AND AM VERY CROSS?

Use of HRT fell quite dramatically in just before after the millennium, and quite a few brands were discontinued. Though some women managed to
find a suitable alternative, others, like you, have struggled to find one that works well for them and have given up. Now you are 64, I wouldn’t suggest you start trying HRT again, but rather find a solution to your vaginal dryness. This is caused by lack of oestrogen, which means the genital tissues lose a lot of their moisture. This means that not only is sex uncomfortable, but the area can sometimes feel slightly itchy as well. The most effective treatment is to replace the oestrogen using either a cream or pessaries, that are just used in the genital area. I usually prescribe oestradiol pessaries, which initially are inserted into the vagina every day for 2 weeks, then twice a week. They really can make a big difference, and don’t carry any of the risks ( such as breast cancer or build up of the lining of the womb ) associated with HRT. They are available on prescription from your GP. If despite using this you still feel a little dry, then you could try in addition a non-hormonal treatment, such as Replens, which is available from chemists.

newnanny

I am 55 years old haven't had period now for about 17 months. I have had a few hot flushes but as over winter not too bad. My problem is my sex drive is nil. I use gel but just don't feel any desire for sex. I used to have amazing orgasms but now nothing. I also feel very tired and fall asleep for about 40 mins on days I don't work. My hair and skin is also much drier but I can manage this with Dove and moisturizer. I have never tried HRT but should i go to doc and ask to try it. DH thinks i should.

It sounds like you went through the menopause over a year ago, and that
means that production of hormones from your ovaries will have stopped then.

Though oestrogen is generally the most important of these, a small amount of testosterone is also produced while the ovaries are functioning, and both of these play an important role in libido. Many women also notice that their hair and skin become more dry after the menopause, but your extreme tiredness is slightly unusual, and it would be worthwhile having your thyroid hormone levels checked, to be sure they are not low. If they are normal, then going on HRT may be helpful for you, and improve your hair skin, and energy levels a little, as well as restore some of your libido. The hormone that works best for improving libido is testosterone, but unfortunately no specific product is made for women, and the best option is to use a tiny amount of the gel made for men. However, this is not licensed for women, and not many GP’s are willing to prescribe it. You also have to weigh up the pros and cons of going on HRT – is a boost to your sex drive worth the very slight increased risk of breast cancer and stroke? This is something only you can decide.

gettingonabit

Hi Dr Rosemary.

I was refused HRT six years ago. I was getting severe hot flushes and very fatigued all the time. The Doc (male) said I should "put up with it". I feel better now on the whole, the flushes have pretty much gone away, but I'm still lacking in energy and have overactive bladder, which is a nuisance.

I'm wondering whether to approach the doc again. Is it too late now, though? I'm 57, in good health, normal weight and fairly active.

Thanks in advance.

HRT may help a little with your fatigue, but it won’t help with your overactive bladder.

If you find you are constantly having to dash to the loo with very little warning, and your bladder capacity is less than that of your friends, the first thing you need to do is have a test to rule out a bladder infection. The symptoms of this can be different, and more subtle, than the ‘peeing glass’ scenario that women get when they are younger.

If you haven’t got an infection, then other treatments are available, such as medicines that relax the bladder muscle, and bladder re-training – where you teach your bladder to gradually hold more urine. So yes, I would suggest you do approach your doctor again, but not with a view to HRT, but rather a referral to a bladder specialist. It may also be worthwhile having some tests done to check for other possible causes of your fatigue, including thyroid hormone, iron and blood sugar levels, along with a check of your vitamin D status – which in many people in the UK is incredibly low at this time of year.

Dyffryn

I would like to know how long you can stay on HRTI am 61. I am on Premarin which suits me very well, I have 1 and a half tablets a day. I have been on HRT for about 15 years following a hysterectomy at 40. I did try coming off it a couple of years ago. I could cope with the hot flushes but I became very anxious and did not feel myself so I went back on it. Even on HRT I have terrible dryness. A friend recently died of a DVT at 55 and it has made me question whether I should continue to take it. Any advice greatfully received.

I’m often asked ‘how long can I stay on HRT’ and the answer is a bit similar to ‘how long is a piece of string”! There’s no simple easy answer. The official recommendation is that HRT is taken just long enough to get a woman through the troubling symptoms of the menopause, which many experts reckon is a couple of years. However, in women who are at risk of osteoporosis, and in their fifties, it makes sense to take it for a bit longer than this, and many women find they feel so well on it that they don’t want to stop. Not only that, but many, like you, have terrible problems when they stop it. If you stop it suddenly, then oestrogen levels plummet, and hot flushes and sweats nearly always start up all over again. Certainly the longer you stay on it for more than 5 years after the age of 50, then the risks of both breast cancer and stroke do begin to climb. However, in your case, you are only taking oestrogen, which is less risky, breast cancer wise, then taking oestrogen and progesterone. I suggest to all my patients that they try stopping HRT once they have turned 60, but that they do so slowly. In your case, this would mean first of all cutting down to 1 tablet a day, and letting your body adjust to this, which may take a couple of months. Then cut down to half a tablet, then a quarter of a tablet. You may get a few
flushes and sweats during this process, but they won’t be so bad as suddenly going ‘cold turkey’ from the fairly high dose you are currently taking.

CassieJ

I started going through the menopause when I was 46, I am now 58.
I must admit I haven't had many problems. In the early days I had a few hot flushes and night sweats, and did get irritable. But on the whole these were manageable.

My doctor did put me on HRT, but it doesn't work for me. It makes me bleed constantly! I have tried various ones and they all do the same. I then gave it up and haven't been on it for over 10 years.

I would like to know why this is as I have never come across anyone else that has this problem. The doctors don't seem to know the answer either.

The main hormone in HRT is oestrogen, and this can stimulate a build up in the lining of the womb. This can be counterbalanced by a second hormone
progesterone. If HRT is started before your periods finish, or within a year of your last period, when there still may be a little hormone production from the ovaries, the hormones are given cyclically – 2 weeks of just oestrogen, followed by 2 weeks of oestrogen with progesterone, then back to just oestrogen again. When you stop the progesterone, the lining of the womb is shed, as a sort of ‘artificial’ period. When the ovaries are assumed not to be working at all, then the two hormones are given together, all the time. However, getting the balance between the two can be difficult, and some women seem to naturally have a womb lining that is a bit unstable, and tends to bleed quite easily with just a little stimulation from oestrogen. The problem can usually be solved by switching the types of both hormones, and also tweaking the doses. It is also important to try and keep going with each different regime for at least 3 months, to give the body, and especially the womb, time to adjust. If bleeding persists despite trying several
different hormone regimes, and a woman is keen to stay on HRT, then I usually arrange an ultrasound scan to check that there isn’t an abnormality in the womb, such as a small polyp. But if a woman is happy to stop HRT, and once she does this the bleeding stops, then a scan isn’t necessary.

suzi15

I am 52 and not yet menopausal. I've noticed some sleep disturbance and the odd memory lapse but otherwise nothing at all. That's fine of course, but I have started to become increasingly panicky about what will happen when I do finally reach that point. The experience of most of my friends has not been positive and the worry has really started to get to me. I realise this is a bit silly but would love some reassurance and also tips on anything i might be able to do to 'prepare' myself

One of the weird things about life experiences is that people tend to be much more vocal about bed ones than good ones. That means that it's common to hear stories about women having a terrible time when they go through the change, but you don’t hear about those that sail through it with no problems at all. There really are lots of women who only have an occasional sweat or flush, and only a few disturbed nights. You seem to have got yourself into a spiral of negative thinking, worrying and panicking about something that may not happen. Try and get your self into a more positive frame of mind – there really is every chance that you are going to be one of the lucky ones who have an easy menopause! The best way of preparing yourself for whatever is to come is to lose excess weight – having extra insulation (and that is what fat is!) can make flushes and sweats worse, eat healthily, and take plenty of exercise.

fmonson

When can you tell it is safe to stop using contraception?

The official guidance on this is that women should continue to use contraception till a year after their last period. It’s reckoned that by this time, the ovaries will have stopped working, and that no more eggs are going to be released. But of course, it's not always that straightforward, especially for women who are taking the combined contraceptive pill. This completely over-rides the natural cycle, and as long as you are taking it, you will continue to have periods. The only way to know if you are
menopausal or not is to stop it, and wait and see what happens, and very importantly, use an alternative method of contraception, such as a diaphragm or condoms.

sophie56

I have been having hot flushes for 10 years and take sage and Isoflavones which seem to help a bit. My mother is in her late 70s and sill has flushes and knows a number of women, also in their 70s who still have them. Has anyone properly investigated menopausal symptoms that endure long after the last period? My second question is every time I have a flush at night I get really thirsty and need to wee - do other women experience this and why?

The exact cause of flushes and sweats that occur at the menopause is not known, but is thought to be due to a change in the sensitivity of the ‘body thermostat’ inside the brain. Sweating is the body's own cooling mechanism, and it seems that a much smaller change in temperature can set this off. In most women the system re-adapts after a couple of years, but in a few, flushes and sweats continue for 10 or 20 years.

Others find that though spontaneous flushes and sweats stop, they sweat much more easily when doing exercise, or in a hot climate. Why this is no-one really knows, though women who are overweight seem to be more at risk of suffering in this way.

Flushing and especially sweating make the body loose a little water, and this may account for your thirst at night, especially if you do not drink a lot of water before you go to bed. And if you a lot of water during the night then you are likely to need to go for a wee. It’s also quite common to feel the need to go to the loo once you are awake.

However, feeling thirsty can be a sign of diabetes, so it would be sensible to see either your doctor or nurse at your surgery and have a blood test for this.

Hi I started taking HRT Premarin 0.625g at age 38 after a Hysterectomy but still have ovaries I am now 71 and am taking just 3 tabs a week do you think this is ok or do you think there is still a risk of strokes, cancer etc?