100 LIFE- CHANGING-MEDICAL QUESTIONS ANSWERED

TODAY: LOVE, SEX ANDTHE MENOPAUSE

Can I get Viagra for my husband?

What’s the best remedy for hot flushes?

Can I stop my period to go on holiday?

Why’s my wife lost interest in sex?

THEY’RE some of the most common questions fielded by GPs every day. And in this must-read series, we reveal the answers given by experts. Starting today and continuing in the Mail all next week, it’s vital reading . . . MENOPAUSE 1 Why are myp eriods irregular/stopped— is it the menopause?

If you are aged between 44 to 55, then, yes, it’s likely you are entering the perimenopause, the time before you have your last period, says Dr Vanessa Mackay, a consultant obstetrician and gynaecologist at the Queen Elizabeth university Hospital in Glasgow and a spokesperson for the Royal College of obstetricians and Gynaecologists.

‘This process can take a number of years. your periods might gradually get lighter, but things can also really fluctuate — you might find you’re very heavy one month and light the next — then periods become more frequent or further apart.’

This means some women accidentally get pregnant, she warns. ‘If you’re still having periods, then you still have the potential to get pregnant — it’s more common than you imagine!

‘Menopause actually means “last period” and you are not considered postmenopausal until 18 months after your last period.’

If you’re under 45, note the dates of your periods and how irregular you are: this will help your GP if you seek advice. Stress can disrupt a cycle short-term, as can gaining or losing a lot of weight quickly.

‘If your periods are suddenly every two weeks, it may be that something like fibroids [benign growths in the womb] could be to blame,’ adds Dr Heather Currie, a gynaecologist in Dumfries, past chairwoman of the British Menopause Society.

In rare cases, increased bleeding can be due to cancer or changes which may lead to cancer, such as polyps, and should be investigated.

2 Will HRT give me breastcancer?

WORRIES about hormone replacement therapy (HRT) are centred on studies published in the early 2000s, which warned it dramatically increased women’s risk of heart problems and breast cancer.

‘However, these findings were later disproved because they were based on older women who had undergone the menopause — and most importantly because the findings were found not to be statistically significant,’ says Dr Currie, who runs the website Menopause Matters. ‘ The increased risk of breast cancer is now known to be small.

‘Basically, there is no evidence that it causes breast cancer. What research has shown is that some types of HRT may fuel the growth of cancer in cells that are already cancerous in some women. It’s seen as a promoter.’

figures from the National Institute for Health and Care Excellence (NICE) show that for every 1,000 women taking combined HRT (oestrogen and progestogen) for seven-and-ahalf years after 50, there may be around five extra cases of breast cancer. ‘Research has suggested the risk of breast cancer decreases when you stop taking it,’ says Dr Currie. ‘Also, taken long-term, HRT can be very beneficial for bones and probably for the heart as well.

‘overall, it’s a decision that each woman must take: what’s right for her? Some will be fine with those figures, others not.

‘for women with hormonesensitive cancers, such as some breast cancers, I would not advise HRT unless in exceptional circumstances under the guidance of a specialist.’

3 I can’t cope with hot flushes, but I don’t want to take HRT. What should I do?

‘DIET and lifestyle changes can have a huge impact on a woman’s symptoms,’ says gynaecologist Dr Currie. ‘Cutting right back on caffeine and alcohol can really help — both cause blood vessels to dilate and make the problem worse. So can being overweight and smoking.’

Meanwhile, being active raises endorphins and boosts mood, so it can help with how a woman deals with the menopause.

‘Another option is cognitive behavioural therapy ( CBT), which alters how we perceive symptoms,’ adds Dr Currie.

Research published in the journal Menopause in 2012 found that after just four CBT sessions, 65 per cent of women reported reductions in the number and severity of their hot flushes and night sweats — compared with 12 per cent in a group given no treatment.

follow-up research found the women who had been given CBT continued to experience fewer symptoms six months later.

In fact, the treatment has now been recommended by NICE — but its availability can depend on where you live.

There are also non-hormonal drug treatments that can work for hot flushes, but these have to be prescribed at the discretion of your GP and only in special cases, as they’re not licensed to treat the menopause.

A drug called clonidine, originally for high blood pressure, has been found to reduce hot

flushes and night sweats. Venlafaxine, an antidepressant, has been shown to reduce the average number of hot flushes by up to 61 per cent, according to research published in 2006 in the British Medical Journal.

‘Some women also find natural treatments such as isoflavones, plant- derived compounds that act in a similar way to oestrogen, and black cohosh, a traditional herbal remedy, can help,’ says Dr Currie. ‘But the scientific evidence is limited and they can be expensive.’

4 Why am I still having hot flush es 20 years after the menopause -ended?

‘When a woman goes through the menopause, her level of the hormone oestrogen falls, which is what causes the hot flushes, night sweats, mood swings and vaginal dryness,’ says gynaecologist Dr Currie.

‘however, there is no correlation between how much a woman’s oestrogen levels fall and the severity of her symptoms. One woman may have the same oestrogen level as another, but totally different symptoms. These can also be made worse by external factors — not least stress.’

She adds: ‘hot flushes occur because the fall in oestrogen can make the thermostat in the brain a bit wonky, causing overheating.

‘however, we know other chemicals are involved and it can also be about the reactivity of the blood vessels — generally in the upper body. Some women’s vessels react differently.

‘either way, for some women, hot flushes can unfortunately continue for a long time. Generally speaking, symptoms that start early, such as brain fog, flushes and sweats, do resolve. Unfortunately other symptoms are unlikely to get better over time — such as vaginal dryness and urinary incontinence or bladder issues.

‘We know that symptoms last on average for seven years, but they can continue into the 60s, 70s and 80s.’

Research published in the journal Menopause in 2015 reported that 42 per cent of women aged 60 to 65 were still experiencing symptoms.

5 Making love is uncomfortable —what can I do?

‘PAINFUL sex can be due to vaginal dryness and also due to the skin becoming thinner and less stretchy,’ says gynaecologist Dr Currie. She recommends using internal moisturisers.

These come as pessaries that slowly release a variety of soothing, moisturising ingredients such as aloe vera or probiotics over three days.

‘There are also various lubricants on the market, for a more immediate solution, to be used during sex,’ Dr Currie adds. ‘They can be bought over the counter, although some types can be prescribed.

‘HRT may also restore vaginal health. however, if the main menopausal symptom is vaginal dryness, the use of vaginal oestrogen can be more effective and, indeed, may be needed even if HRT is being taken for symptoms such as flushes.

‘Vaginal oestrogen is available as a pessary, a cream or an internal ring and can be prescribed by your GP.’

Dr Dawn harper, a GP in Gloucestershire, adds: ‘My first choice of treatment is Vagifem [a pessary containing oestrogen] — i prescribe it a lot. it helps to improve lubrication of the vagina by hydrating and “plumping” up the tissues.’