As part of our series of Lunch and Learn webinars we invited Mr Nick Panay to talk to us about menopause and long-term health. A gynaecologist with a special interest in women’s health, he is also President Elect of the International Menopause Society and director of Hormone Health.
Henpicked: Today we’re focusing on long-term health. Can you explain why we need to consider this during menopause?
Mr Nick Panay: Well we need to consider it from the minute we’re born! But menopause is now a midlife point, which I like to refer to as middle youth. It’s a great time to start to focus on long-term health and making sure the second half of our lives is at least as healthy – if not even healthier – than the first part.
None of it is rocket science. We need to make sure diet is optimal as possible, take regular exercise, minimise alcohol, don’t smoke.
The key change during and beyond menopause is the loss of ovarian function. We know there are hormone receptors throughout the whole body, including our bones, heart, muscles, cartilage, bladder and vagina. And all of these are areas where loss of oestrogen can potentially have an adverse effect. The degree to which someone is affected is probably genetic, but not always.
Henpicked: What happens to our bones during menopause?
Mr Nick Panay: There are intermediate symptoms like bladder and vaginal changes. But if we don’t look afer our heart and bones there can be a decline in health. Bone is dynamic organ, being forever broken down and reformed. As oestrogen levels start to drop there is an increase in osteoclastic activity (bone breakdown), so bone loss accelerates during menopause. We could expect to usually have around 0.5-1% loss of bone density every year, but during menopause this could go as high as 5%.
Bone density reaches its peak in our late 20s. Beyond that, as ovarian reserves start to fall, bone loss continues. So even before menopause it’s important to think of your bones, making sure you have enough calcium, vitamin D, zinc and magnesium in your diet.
Henpicked: Do we need to worry about osteoporosis?
Mr Nick Panay: Without intervention 50% of women will have osteoporosis by the time they reach 80. There are treatments, but prevention is better than cure.
Common fractures are in our spine, hips and wrists. In prevention terms, we need to keep the bones strong and healthy, making sure the bridges that hold bones together remain connected and bone remains dense. This means preventing falls, keeping our home and workplaces safe. Exercise is important for our muscles, to keep us upright and give us more padding to prevent fractures if we do fall. Minimising alcohol and smoking can also help.
Also, unless you’re on a hormonal cycle modifying treatment, eg the mini contraceptive pill, get irregular periods checked out. Loss of periods in younger life could mean loss of oestrogen and make you more prone to fracture later on.
Henpicked: It’s even more important for those experiencing menopause earlier to get help and support, isn’t it?
Mr Nick Panay: Yes, World Menopause Day on 18 October has a theme of Premature Ovarian Insufficiency (POI), which is early menopause before the age of 40. If you don’t replace hormones adequately until at least the average age of menopause – 51- it can put you at an increased risk of osteoporosis and cardiovascular disease and possibly even Alzheimer’s, so it’s really important to address these issues.
Henpicked: What are the extra risks during and post menopause in terms of heart health?
Mr Nick Panay: Menopause is a time when the metabolism may not be as good as it was. As oestrogen levels fall, insulin levels rise to try to control blood sugar. This can lead to fat depositions in the trunk and waist area, which is often associated with changes in cholesterol levels, and an increased risk of blood clots. If you smoke, quitting can help, as can keeping your weight at a healthy level and remaining as mobile as possible. Blood vessels can also become stiffer, which is we we why need to keep an eye on blood pressure. Appropriate dietary interventions and hormonal replacement in those with a predisposition to heart disease can help. Again, we’d always rather prevent than treat.
Henpicked: A lot of people are waiting until COVID-19 is over before seeking treatment. But for the vast majority menopause can be diagnosed on symptoms alone. How do phone and video consultations work for menopause-related
Mr Nick Panay: Unless we have to physically examine someone, which is the exception rather than rule, we can carry on doing consultations. Don’t let problems fester, get these things sorted out even if virtually rather than face to face. There’s no reason why looking after yourself should stop. In fact, it’s an opportunity to think about ourselves. The healthier we are the less chance this awful virus can have an adverse effect on us.
Henpicked: Some people tell us it’s very hard to get diagnosed as perimenopausal if under they are under 45, with GPs being dismissive. Any advice on how to talk to our GP?
Mr Nick Panay: If you’ve found your GP unsympathetic then you can ask to speak to another within the practice, and see if there’s anyone who specialises in women’s health. You’re perfectly at liberty to seek help from a GP from another practice – your Clinical Commissioning Group (CCG) can help you find one. Please don’t take no for an answer.
However, I don’t want people to think if they’re over 45 or approaching their 50s they need lots of tests. If you’re having hot flushes or sweats in your late 40s this can be treated as menopause without investigation. Where there is doubt, certainly before 40 but also between 40 and 45, appropriate history taking and targeted investigation can enable us to give the right advice and treatment.
Henpicked: Would you advise HRT as soon as a woman is in perimenopause?
Mr Nick Panay: This will differ from person to person, which is why it’s so important to get assessed by a healthcare professional. There can be some reluctance to start HRT in women that still have periods. But most women get symptoms while having periods so it doesn’t make sense to wait for years.
If you’re going through perimenopause but feel well and have no risk factors, you could wait it out and see what happens. You don’t have to go onto HRT.
Henpicked: Do hormone-related heart palpitations tend to get better post menopause?
Mr Nick Panay: They usually do. But if they’re not settling then it’s important to see your GP for a check-up. This is a very common symptom of menopause, a feeling that your heart is racing, and this is something that hormone therapy can treat very well.
Henpicked: Are the same risks around HRT as there were?
Mr Nick Panay: We’re constantly striving to optimise the benefits and minimise side effects and risks. One of the mistakes of the past was starting women on higher doses that were more likely to give side effects. Now we try to use lower doses and use body identical hormones which mimic the effect of hormones the ovaries would naturally release. Metabolically these preparations are much better tolerated.
Henpicked: How long can a woman stay on HRT?
Mr Nick Panay: The guidance on hormone therapy from professional menopause societies is not to put arbitrary limits on usage. Some women will never need it, others use it for a lifetime. For a majority of women, assessing treatment on an annual basis can be the best course of action. As women reach their 60s and beyond they will need lower doses of HRT, so it’s important to have check-ups to make sure these are correct.
Watch the video here: