GP and menopause expert Louise R Newson explains why your doctor may not be getting your treatment right What to do when hormones play up

ASK people what they know about menopause and they will often talk about hot flushes, night sweats and mood swings. Menopausal women are often the butt of many jokes.

“What’s the big fuss about?” my 14-year-old daughter recently asked me. “I would love to not have periods!” If only it was that simple. We see a glimpse of how complicated menopause can be in Allison Pearson’s new taboo-breaking book How Hard Can It Be?

In it, she revisits the life of her heroine Kate Reddy from I Don’t Know How She Does It, as she navigates the physical and emotional upheaval I see experienced by hundreds of women in my clinic.

All their stories share a common theme – they are struggling with the demands of life without receiving the right help. Often they blame themselves and see no way out.

Their relationships at home and work are impacted and they feel isolated.

As she wrote this book, I helped and advised Allison regarding the facts about perimenopause and menopause.

Reddy has so many typical symptoms that are still often not talked about (or misinterpreted) . . . but they are finally being talked about in a truthful way.

In my opinion, the only advantage of menopause is to no longer have periods. Many women find that their periods become less frequent, lighter and then stop all together. However, heavy and more frequent periods can also be a sign of changing hormone levels.

The experience that Allison describes of Reddy caught out by a very heavy period while in a meeting, will resonate with so many women – myself included.

I was caught out once on a family holiday in a Muslim country and I had to be bundled into a taxi with one of my daughter’s sweatshirts covering my trousers. A mortifying experience that my children (and me) will never forget!

But while we can laugh after the event, it is not so funny for millions of women as they go through menopausal symptoms.

Anxiety, low mood, irritability, loss of self-esteem, loss of confidence, memory problems, poor concentration, tiredness, headaches, palpitations, joint pains, muscle aches, brain fog, urinary symptoms, loss of libido and vaginal dryness do not make this an easy experience for most of us.

One lady told me “if I died it would be easier” and others say they have “turned into zombies” or feel like a completely different person who they can no longer control.

My menopause training at medical school and also in general practice training was non-existent. My mother has taken (hormone replacement therapy (HRT) for decades and I have always been inspired about how active, both physically and mentally, she is compared to so many of my patients of similar ages.

She has always extolled the virtues of HRT. My mother-in-law is the same.

Over the past 25 years of being a doctor, I have usually given HRT to women who have asked for it.

However, I am embarrassed to say that it is only in the past few years (since my interest in menopause has increased) that I have asked more direct questions to women about their symptoms.

The more I question, the more I realise how dreadfully many women are suffering yet are not seeking help. Even when they ask for help, often they are being given inaccurate information by their doctors.

I frequently see women who have seen various other specialists for (often expensive) investigations such as brain scans for migraines, heart scans for palpitations, bladder scans for urinary incontinence and numerous blood tests (all unnecessary – there is no “test” for menopause or perimenopause).

One of my patients had been to different GPs 15 times in the preceding two years with menopauserelated symptoms and came to see me worried that she had dementia, as her memory was so bad.

No one had talked to her about menopause and she thought it was insignificant to tell them about the hot flushes she was having as menopause is not “an illness”.

All of her symptoms have improved with taking HRT and she now only returns to the practice for an annual review, yet still, the majority of women that I see in my menopause clinic are still being offered anti-depressants by their GPs instead of HRT.

I admit that it can sometimes be hard to recognise symptoms as being related to changing hormones, as women are often pulled in different directions by children, parents, partners and work.

I am embarrassed to say I had symptoms for three months before one of my daughters asked me if my irritability was related to my hormones.

I had been putting extreme tiredness down to working too hard, the night sweats I thought could be due to lymphoma (doctors are notorious for thinking the worst of any symptoms) and the joint stiffness I thought was due to my age.

My brain fog and forgetfulness were blamed on taking on too much work. I never once thought that I could be perimenopausal, despite seeing women with similar symptoms in my clinic all the time.

It has been estimated that only about 10% of women who would benefit from HRT actually take it. The majority of women I talk to are too scared to take HRT, worrying about a breast cancer risk, but admitting they do not know enough about it.

Oestrogen is the most important female hormone and without it we have a greater risk of heart disease, osteoporosis and osteoarthritis.

Oestrogen also works to build collagen, a building protein, so a lack of oestrogen can affect our skin, causing dryness, itchiness, more wrinkles and loss of elasticity. It can also affect the quality of our hair and nails.

Many of these women live with symptoms (that can last for decades) but even those fortunate enough to have no or minimal symptoms (the minority) still have the negative effects of low oestrogen.

HRT is well-researched and is safe for the vast majority of women. More importantly, taking HRT reduces our future risk of heart disease (including heart attacks) and osteoporosis.

Many women say HRT has “given them their lives back” and find their sleep improves and that they are a “nicer person to live with”.

Taking the right type and strength of HRT can improve energy, motivation, concentration, mood, libido and improves the physical symptoms. I personally could not function as a doctor, wife or mother without taking HRT.

The facts about HRT and breast cancer are simple. Young women (those under 45 years old) who take HRT do not have an increased risk of breast cancer.

Women who have had a hysterectomy and only take oestrogen do not have an increased risk.

Women who take oestrogen and progestogen may have a small increased risk after taking HRT for five years, but this increase is less than the risk of being overweight, drinking a couple of glasses of wine each night or not exercising.

Most women I see in my clinic have put on weight as they are not exercising. They are either too tired, their joints are too painful, and they are drinking more alcohol to help them sleep at night. So they are increasing their future risk of breast cancer by their unhealthy lifestyles.

I feel passionately about helping women have clear advice, which is based on sound evidence.

Like Allison has done with her book, women need to engage more in open conversations about how menopause is affecting them.

Healthcare professionals need to be empowered with more knowledge to correctly manage menopause so women’s lives are not ruined by their symptoms.

For more on menopause, visit menopausedoctor.co.uk — The Daily Telegraph