Wednesday 22 January 2020

Dear Dr Nina: I need help getting to grips with menopause & HRT?

Nina Byrnes

I am 52 years of age, menopausal and about to start taking HRT. There has been a lot of bad press recently about the therapy and I am a bit nervous, even though I am really looking forward to some alleviation of my symptoms.

Can you explain the therapy to me? What are the hormones that are being replaced and how long should I take the therapy for? And how will I know when to stop? When I do stop, will I start experiencing symptoms?

Dr Nina replies: Menopause is, by definition, the end of menstruation, but the process itself may start many years before, and extend for many after. Premenopause can start up to 10 years prior to the final menstrual period. The phase of actual menopause starts with the last menstrual period and lasts officially 12 months from that date. 

Symptoms vary hugely among women, with some cruising through this time symptom-free while others suffer prolonged disabling symptoms.

Hot flushes may occur - these are episodes of an intense feeling of heat and redness that passes from the chest up to the face and can be associated with profuse sweating. These may come about quite frequently and can cause night sweats, which disrupt sleep. Other common symptoms include passing urine more often, episodes of cystitis or urinary infections, vaginal dryness, skin changes, weight gain and mood changes.

Once a year has passed since the last menstrual period, the phase becomes postmenopause and this lasts the rest of a woman's life.

Menopausal symptoms last, on average, from six months to five years, but a small percentage of women (about 15pc) may carry on much longer than that. HRT halts symptoms. They do return in some women on ceasing treatment, but weaning slowly helps to counteract this.

Relief from menopausal symptoms can become a bit of a crusade for those affected. For many years, hormone replacement therapy (HRT) was routinely prescribed, but two large studies in 2002 showed that it significantly increased the chance of stroke, heart attack and breast cancer, and prescriptions dramatically reduced. The use of HRT fell off by almost two-thirds after these studies were published.

More recent studies seem to contradict some of the previous study results. The risk of cancer previously associated seems to be lower than thought and oestrogen-containing HRT may actually protect against cardiovascular disease.

HRT started within 10 years of menopause is thought to be safest. Starting it over the age of 60 is not advised. HRT should still only be prescribed in those with disabling symptoms and at the lowest dose effective for the shortest time possible.

HRT is effective for hot flushes and vaginal and urinary symptoms, but its benefit in other symptoms is mixed. Annual health checks are advised.

Other medical remedies include Clonidine (a blood pressure tablet), Gabapentin (a neurological medication not licensed for menopause), antidepressants and oestrogen creams and pessaries.

Lifestyle measures include wearing loose cotton layers, using fans, avoiding spicy foods and taking a cold drink to manage hot flushes. Studies have shown that women who partake in regular moderate exercise have less troubling menopausal symptoms. Maintaining a normal BMI and keeping alcohol to less than 11 units a week also helps.

Disabling and major mood and memory changes are not a normal part of menopause. However, about one-third of women may notice some mild or moderate mood change.

Women today can expect to live over 30 years into menopause. Remedies can help reduce symptoms, but even untreated, the symptoms will pass.

How does exercise help symptoms of menopause?

There are lots of studies that have documented the benefits of exercise in the menopausal period. Menopause can be a difficult time for some. The physical changes — including hot flushes, reduced skin turgor and tone, vaginal dryness and possible mood changes — may leave many feeling less than happy with their physical state.

Exercise doesn’t alter the menopausal state per se, but it benefits can alter how we feel and counteract some menopausal change.

Weight gain is common in menopause. Studies have shown that women who exercise, especially from their 40s, are less likely to gain weight through menopause and have less menopausal symptoms.Those who are obese or sedentary are more likely to experience problematic menopausal symptoms.

Exercise can also counteract mood change of menopause. Major mood change is not a normal part of menopause, but up to one-third of women experience some level of altered mood. Exercise releases lots of natural feel-good hormones, including endorphins and serotonin, and may counteract this change.

Those who exercise regularly will have better circulation and better muscle tone and this may help reverse some of the visible skin and muscle changes that occur during menopause, making skin seem more toned and elastic.

Bone density reduces significantly as oestrogen levels fall. Exercising will help keep bones strong, protecting the skeleton and reducing the risk of developing osteoporosis.

Leading a healthy lifestyle is important throughout life. Health habits started early on will stand as menopause approaches, but it is never too late to start.

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