Dr Sarah Jarvis

My Weekly’s favourite GP from TV and ra­dio writes for you

My Weekly - - Contents - DR SARAH JARVIS

Hot flushes and night sweats af­fect 4 in 5 women around the menopause. For some, they’re a mi­nor in­con­ve­nience. For oth­ers, they can make every day a mis­ery. HRT is very ef­fec­tive – but what are the al­ter­na­tives?

Hot flushes and night sweats can start a cou­ple of years be­fore your menopause and may last sev­eral years. Usu­ally (not al­ways) they go away on their own. Lots of women who take HRT com­plain of a “sec­ond menopause” when they stop, but this usu­ally lasts only months. Tail­ing off the dose slowly may help pre­vent this.

There’s no ques­tion that the sin­gle best way to re­lieve menopausal flushes, sweats and vagi­nal dry­ness is HRT. The jury is out on whether it helps with the mood swings so com­mon around the menopause, but it won’t do any harm. It may cut your risk of “cog­ni­tive de­cline”, linked to de­men­tia, and some stud­ies show it may re­duce the risk of colon can­cer. It also pro­tects against os­teo­poro­sis or thin­ning of the bones.

So far, so promis­ing. But why are so many women wor­ried about tak­ing HRT?

It all went hor­ri­bly wrong for HRT about 15 years ago. A study in Amer­ica sug­gested HRT could in­crease risk of heart at­tack. Hot on its heels came a UK study sug­gest­ing it in­creased breast can­cer risk. Doc­tors were flooded with wor­ried pa­tients and the num­ber of women tak­ing HRT plum­meted.

Some of these con­cerns turned out to be non­sense. The US study in­volved giv­ing very high doses of HRT to women in their 60s or 70s,

SOYA IN ALL ITS FORMS – SOYA MILK OR YO­GURT, TOFU, EDAMAME BEANS – MAY HELP WITH MENOPAUSAL SYMP­TOMS, AND IT’S HEALTHY TOO!

years af­ter they went through the menopause. We now know that if you start HRT in your 40s or 50s, the time most women go through the menopause, it doesn’t in­crease your risk at all.

As for breast can­cer, the ev­i­dence is less clear. Some stud­ies have shown that for every 200 women who take HRT for 7.5 years, one will get breast can­cer as a re­sult. Other stud­ies sug­gest the fig­ure is closer to 1 in 50. We do know that the longer you take HRT, the higher the risk – and that the risk drops off when you stop HRT. We also know women who’ve had a hys­terec­tomy, who can take “oe­stro­gen only” HRT, don’t have the same risk.

The type of HRT may also af­fect your risk. Oe­stro­gen HRT in patch or gel form isn’t linked to a small in­crease in deep vein throm­bo­sis, as tablet forms are. The breast can­cer risk may be lower with “body-iden­ti­cal” kinds of HRT, such as Utro­ges­tan.

With all this con­cern, there has been keen in­ter­est in “nat­u­ral” al­ter­na­tives. The big­gest is­sue has been if they ac­tu­ally work, or if women feel bet­ter be­cause they ex­pect to.

“Isoflavones” may have nat­u­ral oe­stro­gen-like ef­fects, and it’s fall­ing oe­stro­gen that causes menopausal symp­toms. Soya and red clover isoflavones (60-80mg a day, from your phar­ma­cist) may help. Black co­hosh such as Meno­herb also does the trick for many. There’s lit­tle ev­i­dence that evening prim­rose oil, ginkgo biloba or gin­seng make a dif­fer­ence.

Life­style changes can make a real dif­fer­ence. It’s worth try­ing cut­ting out caf­feine and al­co­hol. Wear lay­ers of loose cloth­ing in nat­u­ral fi­bres and in­vest in twin du­vets for your dou­ble bed (his warm, yours not!). You might think ex­er­cise would make you more sweaty, but there’s good ev­i­dence that jog­ging, cy­cling or swim­ming can re­lieve hot flushes. Next Week: Look­ing at Lyme Dis­ease

TOP­I­CAL HRT RE­LIEVES VAGI­NAL DRY­NESS, BUT SO CAN NON-HOR­MONAL VAGI­NAL MOIS­TURIS­ERS LIKE REPLENS (FROM YOUR PHAR­MA­CIST OR ON PRE­SCRIP­TION)

IT’S MOST DEF­I­NITELY WORTH TRY­ING CUT­TING OUT CAF­FEINE AND AL­CO­HOL TO SEE IF HELPS’’ THAT

There’s a range of treat­ment avail­able

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