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Going through the menopause? Some questions answered

All women go through it and some are affected more than others but this natural process we call the menopause (or ‘the change’) is something we are all talking more openly about.

As every woman’s experience of the menopause is different it is difficult to find one definitive way of managing symptoms and guidelines change as new research is being undertaken.  In 2015, NICE published renewed guidelines for managing menopausal symptoms which included revised thinking around the safety of taking HRT and the use of complementary treatments.

AXA PPP Healthcare’s nurse, Nikki Porges, answers a few general questions concerning the menopause and perimenopause.  Nikki takes us through some of the usual symptoms and gives advice on options available so we can carry on living as we would wish through the menopause and beyond.

“I’ve been on the pill since I was 17 and have been told to come off as I am now 50.  But I’ve been experiencing mood swings, hot flushes, awful night sweats and my hands are tight and stiff.  I’ve not been able to sleep properly for four months either.  The natural remedies like acupuncture, homeopathy, herbs – none of them have worked!  I want to go on holiday to Japan so I put myself back on the pill (Microgynon) for three months but I’m worried about how I will feel when I get home and come off it again.  Can you help?”

You do seem to be experiencing some severe menopausal symptoms so I would suggest speaking to your GP as the pill is not an orthodox treatment for this.  Your GP may recommend taking HRT as you fall within the recommended age bracket.

Contrary to previous thinking, current guidelines state that HRT will not increase your risk of heart disease, especially if you are under 60 and it is started within ten years of the natural menopause.  It may still be possible for you to take HRT even if you are deemed to have an increased risk of heart disease but your GP is best placed to advise, as he will look at your general health and recommend options that are best for you.

Even if you are experiencing menopausal symptoms it is still possible to conceive so it may be wise to use contraception for at least one year after your last period (if you were over 50) and for two years after your last period (if you were under 50).

Your GP will be able to help and may even refer you to a clinic local to you, specialising in menopause.

“I started HRT after I came off the pill as I was having hot flushes, headaches and experiencing low moods. However, I only lasted 4 days as my temperature rose even more and I couldn’t cope, so I went back on the pill.  Why do you think this happened and do you think I should give HRT another go?”

Finding the HRT treatment that is right for you may take some time as it will depend on where you are in the menopause if you’ve had a hysterectomy and your medical history.  There are in fact over 50 different combinations of HRT available.

Women are usually offered a fairly low dose to begin so it is worth going back to your GP as this may have to be adjusted for you.

There are also specialist menopause clinics which may be able to help more quickly as they can take blood to test how your body is absorbing the treatment and how low your levels of oestrogen actually are.  If your oestrogen is very low then your dose can be altered to suit.

It is a good idea to look at all the options to treat menopausal symptoms but HRT is considered to be the most effective.

“I have a sharp pain in my joints particularly in my upper arms, I am wondering if this could be due to perimenopause as I am now 51?”

It is possible that your pain is due to menopausal symptoms as joint pain is not unusual in women going through menopause. But there may be other reasons for the pain so it is best to see your GP and ask for a bone health check and a full assessment of the areas.

If after assessment your GP cannot find a cause then ask for a blood test to check your hormone levels.  GPs often just check oestrogen levels but in order to determine your hormone status more fully it is a good idea to ask for the following to be checked: follicle stimulating hormone (FSH), luteinizing hormone (LH), oestrogen (oestradiol) and progresterone.  If it is found FSH rising and LH and oestradiol dropping then the pain you are experiencing could well be due to the perimenopause.

It is very important, whatever the result, for you to find out why you have been suffering joint pain, so a visit to your GP is the best place to start so the most appropriate treatment can be given.

“Six years ago I had a hysterectomy (ovaries still in place) but I have been experiencing hot flushes and waking up in bed covered in sweat.  My skin has also become drier than it was.  I went to my GP who told me that I am going through the menopause but didn’t do any tests.  Do you think this is the case?”

GPs do not necessarily diagnose menopause through blood tests but base their conclusion on a history of symptoms instead.  It is unfortunate that you are experiencing these problems but it does seem like you may be going through the menopause.

Women who undergo a hysterectomy, whose ovaries are left in place, may result in slightly earlier menopause.  However, your GP can check your oestrogen level if you would like to have this confirmed.

“When should women start treatment?  Should it be at the first signs of menopausal symptoms or should it be when the symptoms really start to kick in?”

When (or if) to start treatment for symptoms of menopause will directly relate to how well you can cope with the symptoms and how severe they are.  It is definitely a personal decision and will differ from woman to woman.

Taking regular exercise or practising yoga or other relaxation exercises help some women to manage their symptoms.  It is also beneficial to preserve your bone health by increasing your intake of calcium and vitamin D.

However, if your menopausal symptoms are adversely affecting you then speak to your GP and explore the options available to you – but do ask about the risks as well as the benefits.

Women who take HRT say that it improves memory, concentration, mood, vaginal dryness and quality of sleep along with the commonplace hot flushes and skin dryness.

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