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I am having my menopause and am now 51 years old. My main problem has been with the hot flushes. I am keen to try something different to HRT and believe that anti-depressants are used with success.

Answer: A number of studies recently have shown that antidepressants can be effective in reducing hot flushes. The two drugs were venlafaxine and paroxetine and the flushes were reduced by over 50%. The drug clonidine (dixarit) which is used for treating high blood pressure can also be effective in reducing the severity of flushes in about one third of women.

I am 58 years old and have had few menopausal symptoms so decided not to take HRT. However, I do have problems with dryness and irritation of the vagina which also makes intercourse difficult and painful, which I understand is due to lack of oestrogen. What alternatives are there to manage this problem?

Answer: As you may know the cause of this problem is part of the aging process where the vaginal lining becomes thinner in the absence of oestrogen. You can be prescribed oestrogen vaginal cream or pessaries which act locally and are not usually absorbed systemically. This helps with the urogenital symptoms that some women experience and provides the additional oestrogen to the vagina that will ease the dryness and irritation problem. You may also wish to use a vaginal bioadhesive moisturising product such as Replens which helps with lubrication and can be bought from a pharmacy.

I have been experiencing headaches and sickness which seem to coincide with my periods. My doctor thinks I have migraine, but the anti-migraine tablets that I have been given make me feel ill. Is it possible that these headaches are connected to my hormones, and is there anything else I can do about them?

Answer: What you describe is known as “menstrual migraine”. The exact cause is not known, but it appears the migraine attacks are triggered by the falling oestrogen level that occurs just before or around the time your period starts. The best way to correct this problem is to use a “top-up” dose of oestrogen to prevent the levels falling too quickly. This is most easily achieved by applying a 40 or 50 mcg transdermal oestradiol patch a day or two before your period is due. You can remove this after three and a half days, or apply another patch if you get migraine more than a day or two into your period. Patches can also be used to help premenstrual symptoms such as depression or irritability. Again, they can be applied just before or when the symptoms arise, usually during the 5 – 7 days before menstruation, and continued for a day or two into the period.

My periods stopped finally about 6 months ago when I was 52years old and I have had no bleeding since. However, I am now presenting with some symptoms and wish to start Hormone Replacement Therapy. I have read about the benefits and the risks involved with HRT and before I discuss this with my doctor. I would like more information on the different types of HRT and which sort would be suitable for me.

Answer: During the perimenopausal period, women are still producing some of their own hormones but the levels fluctuate, often causing some of the most distressing symptoms. This can be relieved by taking Hormone Therapy which overrides the natural hormones, balancing them and creating a more stable situation. Initially treatment usually starts with cyclical hormones which mimic the cycle of early menopause and which consist of 14 days oestrogen only, followed by oestrogen and progesterone together, then usually followed with a bleed.

A continuous combined medication is offered to women usually after a cyclical medication has been used and with the combined product, a bleed will not occur.

The dose and effects will then be monitored regularly by your General Practitioner and , providing you are stable on the prescribed medication, this need not be changed. Should the menopausal symptoms not improve, an alternative may be suggested by your GP or Menopause Clinic Please note that this medication regime is one for women who have not had a hysterectomy.

I have been having some symptoms of the menopause over the past year and the most distressing is severe sleeplessness. My GP prescribed HRT a month ago but I am feeling no benefit How long should this take and should I take sleeping tablets in the meantime?

Answer: Sleeplessness is not an uncommon problem and many women complain of this together with disturbed sleep from night sweats. HRT will be beneficial for this but will not help the symptoms immediately. Remember it has taken some time for the body to change producing natural hormones which result in the onset of the menopause and it will take time for the therapy to start to be effective. You should have relief from hot flushes and night sweats within three months and any genito urinary symptoms may then start to improve and there should be considerable benefits within 6 months. However, in some situations this can take longer. In the meantime it is useful to practice some good habits to establish better sleeping patterns with relaxation and stress management, and some people find natural remedies useful

I am now 56 years old and nine years ago started on HRT – Premarin 0.625 mg – after surgery for a total hysterectomy and removal of both ovaries. My mother had osteoporosis and, following a fall which meant she was hospitalised, developed complications and died 18 months ago. I was distressed at the amount of pain my mother experienced and how disabling her osteoporosis was and would like to ensure that I take appropriate precautions to prevent this. Is HRT sufficient to protect my bones? Recent media statements have confused me. As I have been on HRT for 9 years should I stop and, if I do, how can I then prevent the onset of osteoporosis ?

Answer: It has been well researched and documented that HRT has positive effect on bone and this protection is there for as long as you are taking the medication. After that the risk associated with osteoporosis would then be equal to the risk factors associated specifically with you – that is your age, being female, your family history and your surgical menopause. As you have been taking HRT for nine years your bones will have benefited from the exposure to its oestrogen whilst your own natural oestrogen levels have been declining. You should now discuss the route forward with your GP who will make a medical assessment to review whether the risk of developing osteoporosis is more of a factor in your particular case. This will influence whether you continue with HRT or change to one of the bone sparing products. Your GP may decide to send you for a scan to help you come to an informed decision. Lifestyle also plays a very important role in bone health so be sure to look at your diet’s calcium content as well as watching your weight, do not smoke and ensure you keep up a good weight-bearing exercise programme. If you are addressing all of these issues, then you are doing the best you possibly can for yourself.

I am 50 years old and had a hysterectomy and removal of ovaries 10 years ago. At the time I was given HRT oestrogen only and since feel really well. I was told then that I could continue on into my 60’s with HRT but now my GP wants me to stop. I am in good health,. Had a clear mammogram and my blood pressure is fine, so I need to be able to convince him that I wish to continue.

Answer: This is a difficult situation to be in and one that is sadly not unusual. At 50 women can still be having monthly cycles and producing hormones, but because of your surgery your menopause has occurred 10 years earlier Since you have been taking HRT, your hormonal status has been maintained as it would have been for a woman of 50 had you not had surgery, so in your case it is possible to take HRT for another 5 to 10 years, providing all risk factors have been assessed. Please see our leaflet on ‘The HRT Controversy’ and you can then discuss this with your GP next time you go. Ask your doctor why he/she feels it is necessary for you to stop taking HRT. With the information from both your Doctor and from our leaflet, you should then be able to make a more informed mutual decision. Do also continue having regular mammography.

I have had no periods since I was 54 (two years ago) and have had few menopausal symptoms but I do find that I am more moody and depressed and that my sexual drive has all but gone. This is putting a strain on my marriage, which had previously been a very fulfilling relationship.

Answer: This quite often happens and it is the partner who usually notices things before you do. You are right to consider that this may in part be menopausal symptoms but do consider all other aspects of your life too, as stress may be a major contributor. Some people feel that the ‘change of life’ is as difficult as adolescence both physically and emotionally and can be a very difficult experience with a lot of issues that have to be addressed as women change and move onto a different stage in their lives. Stress will also worsen any symptoms that women have, so it is recommended that you reassess your lifestyle and make some positive adjustments as necessary. You may find that you need also to consider taking HRT and Tibolone, which is a no-bleed preparation, which is often quite effective for the problems you describe.

I’m a 42 year old woman and I haven’t had a period for over six months. I assume I am going through the menopause – especially as I was told four years ago I was not fertile enough to have another baby. I’ve had a bone scan and have a slight bone deficiency in my spine for which I take calcium tablets.
I’m worried about any other health problems which could arise from having an early menopause. I’ve asked my doctor but she was quite dismissive. I’m experiencing hot flushes and am finding my memory is becoming terrible which is having a detrimental effect on my self esteem. I was wondering if you had any ideas for boosting my system via supplements which could help.

Answer: Hot flushes and difficulty with memory and concentration are well recognised menopausal symptoms. It does seem likely that you are experiencing a premature menopause, although it might be worth asking your GP to check your oestradiol and FSH levels to confirm this. (These blood tests are however not 100% reliable at your age.)

There are no supplements that are proven to be of true benefit for menopausal symptoms but HRT would help anyone undergoing premature menopause. Premature menopause can result in premature osteoporosis and premature coronary heart disease, and we would recommend HRT be taken until at least you have reached the usual age of menopause, around 51 years old.  

Do discuss this with your own GP, who knows your medical history, and jointly decide on a course of action.