Dr C’s check-up:
A new billboard campaign is encouraging people to take the menopause more seriously. Dr C says women need to be listened to and supported, but everyone’s experience will be unique to them
“Please don’t fear the menopause”
Acampaign has been launched to challenge the sentiment that menopause isn’t a big deal. The posters include messages such as, “Lost your mind? 60 per cent of women suffer brain fog in menopause” and, “Lost Your Job? 10 per cent of women quit work due to menopause” – with sufferers pointed in the direction of The Menopause Charity for help. Menopause absolutely shouldn’t be shrugged off. We need to have conversations about it.
DON’T STRUGGLE
Although it happens to all women, it shouldn’t be dismissed as something you just get on with. It’s sometimes described as a “female hormone deficiency” and while that’s factually true, it makes it sound like a disease, when the menopause is an entirely natural and normal process. Some women don’t need help at all, while others have a very difficult experience and do. Just as some women struggle with their periods while others don’t – everyone responds differently. There are lots of things we can do to help with the symptoms of menopause, but not all women need medication.
CHECK BONE STRENGTH
The drop in oestrogen during menopause can cause changes to the mineralisation and strength of your bones and they can get weaker and more brittle. It’s to do with calcium and vitamin D metabolism. Women need to be aware of that risk, which can be picked up by a bone density scan. Ask your GP if you’re concerned, but be aware that if you carry on exercising, your bone strength ought to be maintained. Aim for 20 minutes a day of moderate exercise, so cycling or walking, as well as some weight-bearing exercises like squats and lunges. Also eat calcium from green, leafy veg, nuts, seeds, dried fruit and dairy products and take a vitamin D supplement. In the same way as some women struggle with blood pressure and cholesterol problems thanks to genetics, some will have weaker bones, but the idea that all women need to be on a hormone supplement for menopause is wrong.
MAINTAIN A HEALTHY WEIGHT
If you go through menopause at a healthy weight, that should set you up for a healthy old age, as being overweight makes symptoms worse, but also raises risks of things like breast cancer. Regular exercise can also help counter the changes that occur, and if that isn’t enough, we can prescribe things to help. If you can, ask your mum about her menopause, as that will give you a good indication of when yours will be and what it’s likely to be like. That way you can read up and decide what you want to do before you’re in the thick of it. Also ask how long it lasted – whether it dragged on for years or lasted six months. That will help you decide if you want HRT.
SEE YOUR GP IF YOU SUSPECT IT’S EARLY
Early menopause is more of a condition than menopause at the normal time, which is around the age of 50. Early menopause – in your 30s or early 40s – may be normal for your family, but because you’ll be post-menopausal for longer, the risks in terms of bone density go up and you should talk to your GP. Again, it doesn’t mean that you’ll need treatment – your doctor will be able to assess that and monitor you.
CHECK FAMILY HISTORY
As well as treating symptoms like brain fog, depression, sleep problems, hot sweats, low libido and vaginal dryness, HRT helps to stave off heart disease, osteoporosis and dementia – but it does carry some risks so your GP needs to look at those. All of the risks are tiny but if you have a strong family history of breast, ovarian or womb cancer, blood clots or liver disease, you may not be able to have HRT. There would be things we could do, though. We could consider an SSRI antidepressant, for example, which can help with mood problems, pain and brain fog. If you’re really struggling but only need to take HRT for six months, the raised risk of breast
cancer would be tiny and would return to normal once you stop taking it, so you may feel that’s a good decision for you. It’s an individual choice, based on individual circumstances. In terms of risks, eight more women per 10,000 would develop breast cancer if they had HRT – that risk is actually smaller than the increased risk associated with drinking two glasses of wine a night. If it’s delivered as a gel it’s not linked to breast cancer risk at all, because it’s applied locally so it tends to not affect your entire body. Similarly, there’s no increased risk of blood clots from HRT patches or gels, and only a very small one with tablets, while the increase in stroke risk is tiny. The use of unopposed oestrogen (oestrogen given alone, without progesterone) is the one associated with a slight increased cancer risk, but your GP will look at your symptoms to see what combination of hormones you might benefit from. For an obese woman who smokes and has a strong family history of heart disease, high cholesterol or breast cancer, HRT would carry risk, but for the majority of women, the risks are very low, and the benefits can be vast.
LOOK AFTER YOURSELF
There’s good evidence for wild yam extract and black cohosh, so there’s no harm in trying those, but also look after yourself; eat well, move regularly and find ways to deal with stress, because the menopause marks a turning point in life, which can be psychologically challenging.
OPEN UP AND TALK
Talking about menopause shouldn’t be seen as “brave”, it should be totally normal. TV presenter Davina McCall,
53, recently talked about her experience of menopause, which was a positive step. Women need to talk, and we all – men included – need to listen. Women have years of experience so we should be having these conversations, not struggling in silence. Menopause isn’t exceptional, it’s utterly normal and we doctors can help it pass comfortably if you need us to.