Friendly advice – the menopause

Cissie and Ada

Les Dawson’s Ada mouthed the words “the change” to Cissie. That’s the last time I recall seeing anything about the menopause on TV. So I took the opportunity to quiz my GP friend about what to expect.

Cissie and Ada

Cissie and Ada

Me: When will I know it’s happening to me?

My friend the GP: It’s actually difficult to know for sure. Some women come to the surgery with soft symptoms, such as feeling low or tired. But these simply can be due to their time of life. Maybe the kids have left home and they have a bit of depression. Maybe they are bored with work. Maybe they are just beginning to feel their age. I can’t tell for certain if these symptoms are due to lower oestrogen levels.

When physical symptoms start to arise, such as sweats and hot flushes, I’m able to help by offering HRT. A lot of people come to me because of insomnia caused by hot flushes.

Me: So will I need to see my GP when it starts to happen?

My friend the GP: Not necessarily. Some women ride through the menopause very easily, while others struggle. So not everyone ends up at their GP’s by any means.

Some women don’t go to their doctors because they know they don’t want to be prescribed HRT. Though there is increasing evidence that antidepressants can also combat hot flushes. I can’t recommend alternative therapies because they generally aren’t sufficiently proven. But if someone doesn’t want to go on HRT then I point them to the site Menopause Matters. That gives some dietary suggestions such as soya beans to combat hot flushes. It’s important to note that these may take 6-8 weeks to take effect.

(Note from me: I later found this book recommended on Menopause Matters.)

Me: So would you recommend HRT?

My friend the GP: It’s a personal choice. It does combat those physical symptoms such as hot flushes. It’s not now thought to protect the bones as previously thought – it works when you are taking the tablets but the bone-softening will take place once you stop taking it.

And there are the risks of high blood pressure, blood clots in legs and possible slight cardiovascular risk in the susceptible. There is also thought to be a small increased risk of breast cancer, though this is hard to quantify and thought to only occur if someone is on HRT for more than the 5 year limit. It is important to discuss the risk verses benefit of starting and continuing HRT with your GP depending on individual risk profile.

Me: Ah, so you can only be on HRT for 5 years? Don’t the flushes come back when you come off it?

My friend the GP: The current guidelines say 5 years. Though that’s after the normal menopausal age of 50. So if someone had an early menopause at say 40, they could be on HRT for 15 years.

Generally some of the physical symptoms do return when you come off HRT but they are usually less severe and your GP will advise you how to wean off HRT slowly to reduce this if it happens. This is enough for some people to want to carry on despite the risks beyond 5 years. Then it depends on whether they can persuade their GP to carry on prescribing it.

Me: Are there different types of HRT?

My friend the GP: Oh yes, firstly there are different strengths. So if you haven’t had a period for more than a year you can go on a no bleed variety. However, if you were to go on those when you’d had a more recent period, there would be possible irregular bleeding. So if you have had a period within a year you are likely to be prescribed a cyclic preparation which will cause regular periods to return. This can come as an unpleasant surprise!

There are a plethora of ways you can take HRT. I tend to prescribe tablets, or patches that you change twice a week. But there are also creams, implants, vaginal rings…

If you take cyclic preparation there is an oestrogen taken daily, and then an additional progesterone tablet to take for up to the last two weeks of each monthly cycle to cause the withdrawal bleed. If you take a “no bleed” preparation then both oestrogen and progesterone is taken throughout the month.

Me: And would I need to see the GP regularly when taking HRT?

My friend the GP: Yes, you should have an annual blood pressure check.

You should also be sure to examine your own breasts regularly. You will be invited for mammograms from the age of 50, but they are only every 3 years.

Me: So how do you feel about the menopause? What will you do?

My friend the GP: I’m actually dreading it! But I do only meet the women who have a hard time going through the menopause.

I have a Mirena coil fitted at the moment as a contraceptive which also means I don’t have periods. I’ll probably keep it as that will provide contraception through the menopause but will also supply the progesterone. So I’ll just need to take oestrogen tablets in addition. And I won’t have to go back to having periods.