ON THE COVER Dr Sarah Jarvis Menopause News
My Weekly’s favourite GP Dr Sarah Jarvis from TV and radio writes for you
Every woman goes through the menopause once she reaches her 50s. About 4 in 5 women have some symptoms, and some suffer much more than others. The term menopause refers to your last period, although you can’t be sure it’s happened until a year without periods. In the years leading up to the menopause, irregular bleeding and hot flushes are common. The average age is 51, though any time from 45 is normal.
The menopause happens because the follicles inside your ovaries that produce eggs become fewer and fewer. This affects your hormones, including the female hormone oe estrogen.
The best-known sy ymptoms are hot flu ushes and night sw weats, mostly driven by b dropping and fluctuating fl oestrogen le evels. Once these l evels bottom out, many m women find their hot h flushes tail off.
They can start a couple of years before your periods stop completely, as levels start to go up and down. They last much longer than most women imagine – more than half have symptoms for at least seven years. For just over 1 in 10 women, hot flushes never completely settle.
Another common symptom is vaginal dryness. This is down to low, rather than fluctuating, oestrogen levels, which means the lining of the vagina becomes thin and produces much less natural moisture. This can lead to soreness, painful sex, and an increased risk of cystitis.
The good news is vaginal dryness can be successfully treated with topical oestrogen cream. The dose absorbed into your system is tiny, so it’s perfectly safe to use long term and doesn’t carry increased risk of cancer. Alternatively, there are several nonhormonal vaginal moisturisers available either from your pharmacist or your GP.
HRT has been all over the news recently for two reasons. Firstly, there have been severe shortages of some forms. If you’re taking HRT, don’t panic – there are alternative brands available, although different versions have different effects and side effects. Speak to your pharmacist well before your current prescription runs out – they can advise on whether your brand is affected and what options are in stock.
Secondly, the risk of breast cancer linked to HRT has raised its head again. A recent study suggests that your risk of developing breast cancer in
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IF YOU GO THROUGH THE MENOPAUSE UNDER 45, DO SEE YOUR GP – THIS PUTS ’’ YOU AT HIGHER RISK OF OSTEOPOROSIS
your 50s or 60s is increased – 1 extra woman may get breast cancer for every 50-70 women who take combined HRT (the version offered unless you’ve had a hysterectomy) for 5 years in their 50s. And this study suggests that some extra risk of breast cancer persists for at least 10 years after you stop HRT, if you’ve taken it for more than a year or two.
This still means at least 98% of women won’t get breast cancer as a result, and the extra risk is no higher than that associated with being overweight. But it’s important to speak to your GP about your personal risks.
If you prefer not to consider HRT, there are “natural” alternatives available, although they’re not as effective. They include black cohosh (I recommend Menoherb from Schwabe) or
red clover isoflavone – speak to your pharmacist about a Traditional Herbal Registration version.
After the menopause, you still make some oestrogen in your fat cells. If you have breast cancer sensitive to oestrogen, blocking oestrogen production in these cells can cut the risk of it returning. Drugs used for this include tamoxifen and the “aromatase inhibitors”, including letrozole, anastrozole and exemestane.
The downside of blocking oestrogen is that menopausal symptoms can sometimes come back with a vengeance when you start one of these drugs. If you’re struggling, speak to your doctor – sometimes switching to another drug within the same “family” will help. NEXT WEEK: Fighting back against flu