What if HRT isn’t right for me? And is coldwater swimming really the answer to everything? Your menopause questions answered
Q: I have difficulty concentrating and suffer from anxiety, and I can feel I am losing my confidence. What can I do?
A: ProfAimee Spector is professor of clinical psychology of ageing at UCL Most studies of menopause symptom management focus on hormonal replacement therapy (HRT) and physiological symptoms. This restricts treatment options for women who are concerned about the risks of HRT and overlooks the wellbeing of women with non-physiological symptoms, such as brain fog and mood problems, which are highly prevalent. We have just published in the Journal of Affective Disorders the most up-to-date study of its kind, providing a meta-analysis of 30 studies involving 3,501 women who were going through menopause in 14 countries. The researchers found that women showed statistically significant improvements in anxiety and depression following cognitive behavioural therapy (CBT) and mindfulness-based interventions (MBI) when compared to no or alternative treatments. This equates to small to medium changes in everyday life. Evidence showed that CBT could help reduce symptoms such as hot flushes, brain fog and night sweats, depressive symptoms and problems sleeping. You don’t have to suffer.
Q: What can I do about my insomnia?
A: Dr Zoe Schaedel is a GP with expertise in menopause care and sleep problems In perimenopause, both oestrogen and progesterone production are chaotic and affect sleep. In menopause, you can also suffer all sorts of sleep problems due to symptoms such as hot flushes or night sweats, where you wake up drenched in sweat. You can choose to stabilise those hormones with HRT, but you can also help yourself holistically, too. Make sure you are active enough in the day to really build up something called “sleep pressure” by building up a neurotransmitter called adenosine, which helps you fall asleep and stay asleep throughout the night. Get physically and mentally active in daylight hours. Keep caffeine to the morning hours, as it can make palpitations and anxiety worse. Limit alcohol, which can reduce sleep quality significantly. It may appear to help you fall asleep, but it will cause micro awakenings during the night. Evidence shows that breathing techniques can help to get you back to sleep and reduce anxiety. CBT has also been proven to help with menopausal insomnia.
Q: How can I support my partner who’s going through menopause?
A: Dr Olivia Hum is a GP. She specialises in perimenopause and menopause, hormonal health and sexual health If your partner is going through menopause, it helps to educate yourself about the symptoms – read articles, watch documentaries, listen to podcasts, do your research. It’s important to talk to your partner about menopause. However, many of our patients say they feel embarrassed and have conflicting feelings about getting older, losing their fertility and not feeling attractive any more, and don’t want to talk about it. Try bringing it up in the third person: “I was watching this documentary/Jo at work was struggling with anxiety,” so it doesn’t feel confrontational and your partner can choose to talk about it if they want to. Lifestyle is important. We know, for example, that being more active, eating healthily, and cutting down on alcohol and smoking will help symptoms of menopause. Support your partner by joining them and cleaning up your lifestyles together. Confidence can be an issue – they may be feeling that they’ve changed, that they’re not the same person, their bodies have changed, and their personalities. Show your partner that you still love her, that you still find her sexually attractive. Listening and communicating are key.
Q: I have had breast cancer – how do I get through menopause without HRT?
A: Dr Kristyn Manley is consultant gynaecologist and menopause lead at Bristol UniversityThe first question I ask patients is – what symptoms are affecting the quality of your daily life the most – hot flushes, anxiety, insomnia? Once you identify this, you can create your own treatment plan. For example, studies show that Pilates can decrease fatigue, tai chi can have an impact on sleep, quality of life and physical performance, yoga has been shown to help with psychological effects of menopause, such as low mood. Recent surveys show that women experienced a significant improvement in anxiety, mood swings, low mood and hot flushes with cold-water swimming. Recent research on mindfulness and CBT also shows that these can help with stress and anxiety. There is evidence that eating a plant-based, non-processed, low-sugar diet with low caffeine and low alcohol will reduce inflammation in the body and ease symptoms such as aching joints. It’s holistic care. It’s learning how to interpret what your body is saying. But do reach out for help – you don’t need to do this alone.
Q: My GP recommended antidepressants, is that what I need?
A: Dr Olivia Hum I remember being taught at medical school 20 years ago that anxiety was not a symptom of menopause. We used to think menopause was just about hot flushes. We believed perimenopause was the year before your period stopped. So this idea that perimenopause could start much earlier and can start with mental health symptoms is still quite new. There’s been a massive learning curve for the medical profession. When women came into the GP’s surgery in their 40s, who were anxious or depressed, in the recent past we’d have given them antidepressants. I have been a GP for 18 years and I know antidepressants can be life-changing. But now there is a realisation that, for some women, emotional changes are actually due to hormone changes, and not due to primary mental-health disorder. We try to look holistically at a woman’s life – stress management, sleep, good nutrition – but if depression or anxiety is being caused by low hormones, then HRT is going to help enormously. But HRT is not for everyone. As a doctor, I would advise the obvious lifestyle changes – exercise, good nutrition, limit alcohol – and if you do still suffer from low mood, discuss antidepressants with your doctor.
Q: Do I have thrush? Since menopause, my vagina feels itchy and sore.
A: Dr Katherine Kearley-Shiers works in an NHS menopause clinic for women with complex medical conditions The skin around the vulva and vagina can become more delicate when you go through menopause. This can cause a feeling of dryness, soreness or irritation. Patients can sometimes mistake this for thrush, but it may in fact be due to falling oestrogen levels. As the skin around the vagina becomes thinner, the area can be more sensitive to soap and other chemicals, which can worsen irritation and soreness. When washing, try to use water only or a plain emollient such as E45, rather than soap or shower gels. Water-based vaginal moisturisers can help dryness and can be used at night. Use waterbased lubricants during sex such as Yes and Sylk. Hyaluronic acid (a gel that releases water molecules into the skin) can also have similar benefits to vaginal oestrogens. Vitamin E is a powerful antioxidant, which has been shown to protect cell membranes. Studies suggest vitamin E pessaries can reduce soreness and decrease dryness. It is important to see your GP if your symptoms aren’t improving so they can check for other skin conditions and check you are on the right treatment. Often women are embarrassed to talk about their symptoms, but it is much more common than people think and there are lots of effective treatment options to try.
Q: I keep getting urinary infections. Should I just keep taking antibiotics?
A: Dr Claire Phipps is a GP and British Menopause Society menopause specialist Urinary tract infections (UTIs) are really common in periand postmenopause. It’s harder to treat with a standard course of antibiotics because the bugs can really take hold. Vaginal oestrogen – which is not HRT – can help reduce the frequency of infections, but also can help prevent them as well. Vaginal oestrogen is a really low dose so it can be used alongside HRT safely. Studies have shown it’s safe for those who can’t use HRT because of a breast cancer diagnosis. It can be used internally as a pessary and externally as a cream – and it can be a game-changer. For older women who have been having recurrent UTIs and who’ve been admitted to hospital numerous times, it can be life-changing.
Q: What supplements should I be taking?
A: Nicki Williams is a nutritionist and author of It’s Not You, It’s Your HormonesI always recommend a good quality multivitamin that has the right levels and forms of all the B vitamins and key minerals (unfortunately, cheaper mass-market brands use forms that the body finds hard to absorb). Additionally, we need vitamin D3, especially through the winter, to support our bones, brain and immune system; ideally taken with vitamin K2, which helps bones absorb calcium. I generally recommend magnesium, which has a key role in energy production, muscle relaxation, sleep and adrenal function – among more than 300 other jobs. It’s hard to get enough in our diet, and it’s commonly depleted by stress.
Q. What alternative methods
might help with hot flushes?
A: Dr Avanti Kumar-Singh is a medical doctor and Ayurveda wellness expert Ayurveda is an ancient health system which invites you to live in harmony with nature. In Ayurveda, we use techniques that will help to eliminate excess heat in the body. Breath work can help with hot flushes. Sitali pranayama is a cooling breath technique that cools the body and adds moisture into the system. (Inhale as if you’re sucking through a straw; exhale with longer breaths through the nose. Try a few rounds when you feel a hot flush coming on.) Lifestyle recommendations also include going for walks in nature, or trying slower, gentler yoga practices so you can tap into your parasympathetic nervous system, which switches on when you are relaxed. Studies show that quality of life in menopausal women can be greatly improved after 18 weeks of yoga practice.
Q: How do I know if HRT, or which HRT, is right for me?
A: Dr Louise Newson, GP and director of the Newson Health Wellbeing and Menopause Centre
HRT is a treatment that has more benefits than risks, can improve your future health and reduce your risk of heart disease, osteoporosis, diabetes and dementia. Everyone should have the knowledge: what are the benefits and risks of taking it, but what are the benefits and risks of not taking it as well?
It’s not a simple HRT or no HRT question; there are different types and different doses. Thirty-eight per cent of women who come to our clinic are on HRT already. We spend a lot of time working out the right absorption for the woman, the right dose, the right type, whether it’s oestrogen, progesterone, testosterone or a combination – and then waiting. The waiting bit is important because it’s not always a quick fix. HRT alone won’t keep you in optimum health through menopause, either. We talk a lot about nutrition and exercise, lifestyle and sleep, and wellbeing.
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