Menopause Specialist

A really common question, especially for the many women who are using contraception that stops their periods. The answer is that there is no way of telling ‘where you are’ in the process or how long your symptoms will last for. Hormone levels go up and down in the peri-menopause so a blood test to check hormone levels does not give any useful information if you are in your 40s. Menopause specialists tend to treat on symptoms rather than test results.  

Oestrogen receptors are all over the body so as your oestrogen level drops you can get a variety of symptoms. Most people think of hot flushes or night sweats when they think about menopause, but many women do not have these, or do not find them distressing. Some of the common symptoms are irritability and anxiety, joint pains, tiredness, insomnia, brain fog, memory loss, palpitations, headaches and lack of libido.   

 Not many good quality trials are ever done on supplements, so it is difficult to conclude whether one is any better than another. Women tell me that they find soy useful for hot flushes, magnesium for sleep and feverfew for headaches.  There is good evidence that CBT (cognitive behavioural therapy) can help for low mood, hot flushes, sleep disturbance and anxiety.  St John’s Wort can help relieve anxiety and mood changes but interacts with many medications, so check with your specialist provider.  Plant based oestrogens, like soy, have been shown to help relieve symptoms but cannot unfortunately be taken if you have had breast cancer.  

  HRT stands for ‘hormone replacement therapy’. The main component is oestrogen which can be given as a patch, gel or tablet. This will help with menopausal symptoms. If you have a womb then you will need to take progesterone as well. This protects your womb against the oestrogen. If you are still having periods this is taken ‘sequentially’ for half of every month. If you are post menopausal you need it every day. A Mirena coil can provide progesterone for HRT, control heavy periods, and provide contraception. 

  Some women are lucky enough not to get symptoms when their oestrogen levels drop. For other women their entire life is destroyed for years by their menopause symptoms, which affect their work, relationships and sleep. If you have symptoms that are affecting your life then, for most women, the benefits of HRT far exceed the risks. In the past, there was huge pressure not to take HRT and some women still experience judgement from others. Common worries are that HRT is ‘not natural’, or that taking it means that you are ‘not coping’ and that you are somehow ‘less of a woman’. Every woman is different. The best person to talk to is a GP or menopause specialist who can help you work out what is right for you. 

 Is there an age limit to start taking HRT? 

Many women in their 60s are now asking to try HRT. Starting HRT in your 60s does carry some risks. It is worth having a good discussion with a GP or menopause specialist about the risk benefit balance for you.  Guidelines in the past told doctors that HRT could only be offered for 5 years. Recent evidence shows that, as long as women are aware of the risks, there is no limit to how long you can take HRT for.   

  This is a really common problem during the perimenopause and post menopause. I would say that about 90 per cent of the women I see feel that their libido has been affected.  

Libido is really complex and affected by a lot of things. HRT often helps by improving sleep, mood and energy. It is really important to make sure that sex is comfortable and not painful, and vaginal oestrogen is really good for this.  If HRT has helped with all your other symptoms but not libido then this is when testosterone can be tried.