Expert Q&A: Menopause symptoms and remedies

From hot flushes to HRT, we know from our forums that so many women have queries about menopause and how to ease the symptoms. Whether it was about joint pain associated with this change or how to cope with differing moods, we asked you to leave your questions for Dr Anne Henderson to help you understand more about menopause. Here are her answers.

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I went through the menopause nine years ago. Can I still get hormone changes that affect my mood?

"Menopausal symptoms last for an average of five to seven years, however one in 10 women experience symptoms for up to 12 years. Oestrogen plays a fundamental role across many areas within the body, including the regulation of several hormones with mood boosting properties, such as dopamine and serotonin. Many milder symptoms can be managed through lifestyle changes, however if persistent or impacting your life or relationships, it may be worth speaking to your doctor who might recommend therapy or medications to help."

Why does it seem so much harder to lose and keep off weight after the menopause?

"During the menopause, declining oestrogen and testosterone levels cause a muscle mass reduction of around 2-4% per year. This in turn leads to a slowing of the metabolic rate which means that, even if women continue to eat and exercise as they have done previously, they will inevitably gain weight. Due to hormonal shifts this weight tends to be gained around the midriff, leading to what can be known as 'middle-aged spread'. HRT that replenishes oestrogen and or testosterone helps to reset this hormonal shift and enables women to maintain weight and muscle tone more effectively."

I had a hysterectomy over 20 years ago and went on HRT. Just an oestrogen gel and it worked well. Then I was taken off it because of some study on breast cancer which said HRT could cause it. The hot flushes and night sweats came back with a vengeance. I was then put back on the gel after about five years of misery, only for another ‘study’ to come along and was off it again with the same result. I’m still suffering from the hot flushes and night sweats at the age of 73. Is there any hope that they will go away or is that it?

"In this particular case, and for all women who have had a hysterectomy, there is no increased risk of breast cancer as these women are on oestrogen-only HRT without progestogens. Any increase in breast cancer risk is solely related to women on combined HRT including progestogen. Women who have had a hysterectomy can therefore continue on HRT without any risk for decades should they wish to do so.

"In fact, more recent studies have even indicated that there maybe a reduction in the risk of breast cancer on oestrogen-only HRT which makes it even safer than previously anticipated. However, simple lifestyle changes to your diet can play a really important part to managing menopausal symptoms so try and include a rich and varied mix of grains, fruits and vegetables. If you’re concerned with the duration of your symptoms it might be worth seeking specialist advice to rule out other potential causes."

Does taking HRT help prevent issues with joints? Since going through the menopause I have had many issues with my back, fingers, toes and now I think my hips. Lots of swelling, pain, herniated discs and stiffness, especially first thing in the morning. I remember my mum being the same as she got older and if it is so I would like to prevent the same happening to my daughter if possible.

"Oestrogen has a direct impact on the musculoskeletal system, particularly joints. It impacts on collagen which is found in muscles, tendons, ligaments and the joint itself, as well as helping the 'synovial buffering' fluid in joints such as the hip and shoulder. A reduction in oestrogen during the menopause helps to explain why women of this age are much more likely to suffer from musculoskeletal conditions. As HRT stabilizes hormonal changes across the menopause, it will help to regulate oestrogen levels and therefore fluid retention to protect joint tissues.

"Lifestyle changes such as exercise and a healthy diet should be a primary course of action in caring for joint health at all ages, alongside taking clinically backed supplements that are supported by robust research. Rosehip extracts have been studied in multiple scientific trials, mostly for their cartilage protecting properties. Similarly, ginger has a long history of use across both traditional and modern healthcare, helping to preserve joint mobility and flexibility whilst reducing inflammation – a common cause for aching joints. Incorporating vitamin D and vitamin C into your diet helps to support collagen production and can be easily incorporated into your diet."

Does the menopause really affect your memory or is that just an urban myth?

"Memory loss during the menopause is very common and studies have shown a decline in memory function and concentration during the menopause transition. It is no surprise that when oestrogen levels fall these areas begin to malfunction and symptoms arise. Fortunately, the impact is temporary and does appear to decline once the menopausal transition is complete. Getting lots of rest, eating well and regular exercise may help to reduce the impact in the meantime, as well as coping strategies such as writing yourself lists or setting alerts on your phone."

Can any particular diet or natural remedies help with menopausal symptoms, mainly hot flushes?

"Hot flushes are perhaps the most well-documented symptom and, as with most, the root cause lies with a fall in oestrogen. Oestrogen plays a role in the normal function of the brain’s thermostat; when levels drop the brain is tricked into thinking that it is overheating which causes the skin to ‘flush’ red as blood is moved closer to the skin’s surface and sweat glands spring into action. Some medicinal herbs and foods have been known to have properties similar to oestrogen, so adding them to your diet may help to reduce your symptoms. I would always recommend seeking advice from a herbal expert, such as an accredited member of the National Institute of Medical Herbalists (MIMH). You can find a nationwide list of these practitioners on the MIMH website."

I'm curious about any recent research on the possible causes of premature menopause? I started mine aged 30 and my last period was aged 32. Tests confirmed I was post-menopausal at 33 but my GP couldn't give me any reason at the time. I've still no idea what caused such an early menopause.

"1 in 100 women experience the menopause before the age of 40, which is known as Premature Ovarian Insufficiency. The changes that occur during a premature menopause are largely due to the fact that the ovaries have run out of follicles which subsequently develop into mature eggs responsible for oestrogen production, and when this supply is completely exhausted, the ovarian function ceases and the menopause occurs. The exact causes are often unknown but maybe from a genetic condition, autoimmune disease, infection or as a result of surgery. It is worth seeking specialist help to investigate potential causes, as well as reaching out to support networks such as the Daisy Network."



I'm 54. What are the body's mechanisms for why night sweats occur at night? They also seem to go in sync with my chronic pelvic pain, and when I can get the pain to calm the sweats do too. Perhaps it's just the body in stress, and if cortisol goes down at night then there is less natural pain relief around - does that relate to night sweats? Any natural remedies that work for this and especially the insomnia (which the pain doesn't help) are greatly appreciated.

"Night sweats are simply a hot flush experienced at night, but because they disturb your sleep they are noticeable. It’s not uncommon for women to wake up with their night clothes drenched in sweat, which can be distressing and contribute to poor quality sleep. Simple actions include keeping your bedroom as cool as possible, staying well hydrated and creating a calming bedtime routine may help. It’s best to avoid drinking caffeine and alcohol before bedtime as these can trigger hot flushes and play a part in disturbing your sleep. If you’re looking for something herbal, Valerian root has a long-standing history as a relaxing sleep aid, whilst mint and fennel have cooling properties and are often available as tea bags which can be made from cold water. It is always worth seeking the tailored advice of a NIMH registered herbalist."

What is the average age that women start going through the menopause and what are the early signs?

"In the UK, the average age of women reaching the menopause is 51.7 years, with a common range between 45 and 55 years. The time preceding your final period is known as the perimenopause, which is typically identified by increasingly irregular periods, trouble sleeping, stiff joints, night sweats and mood swings."

I had a hysterectomy aged 25 years (due to life-threatening growths of endometriosis and fibroids wrapped around all my internal organs). I was then on HRT for 25 years but my doctor took me off after constantly nagging me about breast cancer risks. Since stopping HRT I have been in agony with joint pain and now been confirmed with osteoarthritis - the oestrogen in the HRT would have stopped that whilst taking them. I need advice about joint pain please.

"Menopausal joint pain is commonly mistaken as an inevitable part of the ageing process and whilst women may seek help for other symptoms, they struggle on with aching and painful joints. Commonly affected joints include the hands, shoulders, knees and hips, although all joints can be impacted. It is important to consider a full spectrum of treatment options including lifestyle changes, diet and exercise, but also herbal medicine and supplements that are backed by scientific evidence. The active compounds found in rosehip, known as galactolipids, have been shown to have anti-inflammatory properties which may relieve pain, whilst some clinical studies show it to be as effective as taking paracetamol.

"Drinking plenty of water helps to retain joint flexibility, whilst staying active strengthens supporting muscles and keeps excess weight at bay – reducing the impact on load-bearing joints. As mentioned previously, women who have had a hysterectomy are on oestrogen-only HRT and therefore have no increased risk of breast cancer, so there is no reason to not continue with HRT for as long as you wish to do so."

If you are one of the many women who lose interest in sex following the menopause, is there any way back to a normal healthy sex life... or is this the new normal?

"A reduction in oestrogen and testosterone levels can make it harder to become aroused, as well as vaginal dryness and thinning of the vaginal wall, which can cause discomfort during sex. Combined with mood swings, lack of sleep and potential weight gain, it is no surprise that menopausal women may feel at odds with themselves and their partner. However, all hope is not lost. Exercise can improve your mood and combat weight gain, helping to put you in positive headspace, while using lubricant and regular Kegel exercises can help to combat some of the physical changes. It might be also worth discussing local oestrogen replacement with your doctor. Women can take this successfully without the need for additional progesterone, even if they have not had a hysterectomy, and it is suitable for long-term use for decades, if necessary."

Is hair loss a sign of menopause and if so are there any supplements that can help?

"Hair loss and hair thinning is another common symptom of the menopause. When hormone levels drop, hair growth slows and your hair falls out more frequently. Ensure that you are eating a balanced diet rich in nutrients including iron, as iron deficiency is one of the most common causes of poor hair quality in women of all ages. You may also wish to seek professional advice from a specialist trichologist, which is a professional specifically trained in the management of hair problems."

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Disclaimer: The information on our health pages is only intended as an informal guide and should not be treated as a substitute for medical advice. Gransnet would urge you to consult your GP before you begin any diet if you're concerned about your weight, have existing health conditions and/or are taking medication.