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Forward thinking for your menopause

Introduction

The menopause is a time of change, a time when hormones fluctuate and your daily life may be upset by troublesome symptoms, such as flushes and sweats. For each woman, the experience of menopause is unique. As you approach the menopause you will want to know what changes may occur, how you may feel and what effects you may see on your body. You will want to know what’s available to help you through it and what steps you can take to ensure a healthy life both during the menopause itself and into the years beyond. The menopause can also be seen as a time to change, a time to look again at your health and make assessments and decisions which will improve your health. The menopause need not be a mystery. Much is now known about the effects it has on the body, how hormone replacement therapy may help and what you yourself can do to stay healthy for years to come. For many women the menopause is a time for fact finding and making choices. This leaflet will help you understand more about the menopause and enable you to make your choices in greater confidence.

Osteoporosis is difficult for you to spot yourself, but your doctor or practice nurse can help you assess your risk, including further tests if necessary.
After the menopause, the incidence of heart disease in women rises. Women often believe that only men get heart disease, in fact it is the most common cause of death in western women. Oestrogen is thought to help by protecting the heart before the menopause and may have a beneficial effect when given as HRT too.

What can I do?

Hormone replacement therapy (HRT) will effectively relieve menopausal symptoms and also protect against  bone thinning. You may find that you can find other ways of relieving your symptoms too, depending on how severe they are. For example:
  • Identify things which will trigger your flushes, e.g. Hot drinks, caffeine, spicy food
  • Reduce the need to rush and feel stressed, which may exacerbate flushes.
  • Wear layers of comfortable clothes, which you can remove if you feel a flush coming on.
  • Relaxation may help to reduce the intensity of a flush.
  • To help with night sweats, try sleeping under  thinner layers of bedclothes rather than a duvet that can you throw  off if you feel a flush coming on.

How else can I stay healthy?

HRT has many health benefits but there are several other things you can do to keep yourself healthy around the time of menopause.
  • Eat a healthy balanced diet, which is low in fat and rich in calcium.
  • Do not smoke.
  • Take regular exercise, which will keep your heart and circulation strong as well as protect your bones.
  • Keep your alcohol intake moderate (no more than 15 units per week)
  • Take the opportunity for regular health checks, in particular mammograms and cervical smears.
  • Remain aware of any changes in your breasts and see your gp if you are worried.

What is HRT?

For most women, HRT contains a combination of two hormones, oestrogen and progestogen. Women  who have a hysterectomy (removal of the womb) need only the oestrogen part of HRT. The hormones used in HRT mimic the hormones produced normally by the female body and so are described as natural. This makes them different to the hormones used in the contraceptive pill, which are synthetic and many more times more potent.

How is HRT given?

HRT is given in one of the following ways:
  • Oestrogen on its own for women whom do not have a womb.
  • Oestrogen with monthly progestogen- for women who still have periods- whether regularly or occasionally.
  • Oestrogen with daily progestogen- for women who have not had a period for at least one year.

You may be given HRT with both hormones combined one preparation or with oestrogen and progestogen given separately

Bleeding

Women who have had a hysterectomy will not bleed with HRT. Taking HRT with progestogen include for part or the month (or sequential combined HRT) causes a monthly bleed in most women. Taking  HRT with daily progestogen (continuous combined HRT) should avoid regular bleeding, although irregular bleeding may occur initially.

Types of HRT

HRT can be given in various forms and in different doses, although the basic patterns of each will be as described above. For most women the type of HRT you will get depend on factors such as convenience, dose needed, doctor’s choice hopefully your choice too. You may feel more comfortable with one type than another and you should discuss with doctor which you prefer. Occasionally there may be a medical reason why one type is recommended.
HRT can be given in a variety of ways:

Tablets, patches, gels and implants
  • These have been available for many years, and many women know someone who have used one of these options.
  • HRT tablets are a familiar and easy way of taking medicine. However, they must be taken every day for a maximum effectiveness.
  • HRT patches are stuck on to the skin and the medicine is absorbed directly through the skin. They only need to be changed once or twice a week, but can cause skin irritation in some women.
  • HRT gel is applied to the skin  and the medicine is absorbed directly through the skin. Once applied, the gel is invisible, but some women find it messy and time consuming to apply.
  • HRT implants are small pellets containing oestrogen and are inserted beneath the skin. They release oestrogen  over many months, so you don’t have to remember to take medication, but they be difficult to remove and may cause a small scar.
The nasal spray and vaginal ring
  • New alternatives which may provide advantages in some women.
  • The HRT nasal spray contains oestrogen and is a quick and discreet method of taking HRT. However, you need to remember to take it daily for maximum effectiveness.
  • The HRT vaginal ring releases oestrogen which is absorbed through the lining of the  vagina. It can be left in place for 3 months at a time, but is only suitable for women who have had a hysterectomy.
Vaginal creams and pessaries
  • Suitable for treating local symptoms such as vaginal dryness and urinary problems, but are not appropriate for managing other problems such as hot flushes or night sweats.

There are lots of different options- so if you feel your HRT is not suiting you, it’s important that you go back and discuss it with your doctor or practice nurse so that together you can get it right for you.
If you think you want to stop your HRT, you should discuss it with your doctor to be sure that this is appropriate and discuss other ways of maintaining your health. You should not need to stop HRT just because of minor side effects- try a different type or dose.

How do I know the dose is right for me?

HRT comes in various doses. Your doctor will start you on one, which is not to high or too low. The dose can be changed if for example, you still have flushes or if you experience side effects. The first dose you try may not be the best for you, so you need to try and find one that suits you. Your doctor will help you with this.

Can I safely take other medications as well as HRT?

HRT will not generally interact with other medications, although you should tell your doctor about anything else you take.

How soon will I feel the benefit?

Menopausal symptoms should begin to improve within about a month, although it may take a further two months to see the full benefit. Some symptoms such as vaginal dryness may take longer to improve. It is important to remember that HRT cannot solve all your problems at the menopause and if you are unhappy or depressed for a reason other than the menopause, then HRT will not help.

Can HRT make me put on weight?

Many women do notice that they put on weight around the time of menopause. However, there is no evidence to show that this is due to HRT. In fact studies show that women taking HRT are less likely to gain weight than those who are not. If you do put on weight around this time, it’s more likely to be due to the change in your general habits, for example less physical activity. It’s important for general well-being that you try to stay healthy by taking regular exercise and eating sensibly which will help keep your weight at a healthy level.

Conclusion

The menopause is a time of major change in every woman’s life. If you feel you need help to deal with it, the first place you should go is to your doctor. He or she will be able to advice you on the most sensible way to approach these changes and handle them the best way for you
If you want to speak to someone else about the menopause, there are many women’s health telephone lines which offer advice.
The amarant helpline
Tel:01293 413000- lines are open 11am to 6pm every weekday and all calls are answered personally by a menopause nurse specialist.

Northwick Park Menopause Advice Line

Tel 020 8869 3965/2877

Wellbeing

Tel 020 7262 5337

National Osteoporosis Society

Tel 01761 471771

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