Expert Answers on the Menopause from Dr Elaine McQuade
To coincide with World Menopause Day, Dr Elaine McQuade of the Marion Gluck Clinic answers your most frequently asked questions about the Menopause.
1. How long should the menopause last?
Symptoms of the menopause last on average up to four years after the last period. This differs for each individual and for some the symptoms can last up to 10 years and I’ve seen patients still having hot flushes 20 years down the line.
Each woman is different and the amount and severity of symptoms are different case to case and are also dependant on genetics, lifestyle, diet, exercise, stress etc.
The perimenopause can start a few years before the periods when the hormones start to change.
2. Should I consider HRT ? What are the risks, benefits and different types?
Conventional HRT is a drug company made formula usually prescribed by a GP which contains a natural type oestrogen and normally a progestogen, which is not the same as progesterone but mimics some of its effects but has side effects. It’s the latter that was linked to breast cancer in the studies that were done that creates the scares around HRT.
Bioidentical HRT (BHRT) are usually made in compound pharmacies and are exact replicas of your own body’s hormones. The dose is adjusted according to blood levels so each woman gets a personalised bespoke treatment. They are monitored by the doctors who prescribe them with blood tests to assess the levels in the blood and also clinically assessed to tweak the dose to suit each individual. The usual format is gels, creams or lozenges. Tests like pelvic ultrasound scans and mammograms are also recommended whilst on treatment.
Same as body identical HRT, your GP can prescribe separate oestrogen and progesterone which are similar to your own body’s hormones. These are usually in the form of a gel or patch for oestrogen and a tablet form of natural progesterone called ustrogestan. The dose however cannot be tailored very well to suit needs.
HRT has come under a lot of bad press over the years based on some studies that showed an increased risk of breast cancer and cardiovascular disease if used for greater than five years. This research was based on conventional HRT and the risk linked to the unnatural progestogen in these products.
More recently the tides have changed and research has shown the massive benefits of hormones, not just in preventing symptoms but for long term prevention of cardiovascular disease and osteoporosis and dementia.
Each case needs to be assessed individually and counselled re: risk and benefits, taking into consideration diet, lifestyle, genetics, personal and family history. If you are considering HRT you should talk to your doctor.
3. How long can I take HRT for?
With conventional HRT the risks increase significantly after five years but are still relatively small compared with the risks of smoking, being overweight and not exercising in relation to breast cancer.
There is no limit to how long you can take it. With BHRT you are monitored closely with regular bloods, pelvic ultra sound and mammogram while on treatment and risks are minimised by keeping levels of hormones appropriate for each patient.
4. Can I just stop taking HRT?
Some people just stop abruptly and have no problems, but most doctors advise to titrate the dose down slowly to minimise risk of rebound symptoms.
5. How can I best deal with night sweats?
• Avoid stress
• Sleep in well ventilated bedroom
• Wear light loose clothing that is easily removed
• Have a fan available
• Avoid caffeine, alcohol and spicy foods
• Lose weight
5. How can I best deal with hot flushes?
• Avoid caffeine and hot and spicy foods. Alcohol can also trigger hot flushes
• Stay cool – wear layers that are easily removable
• Don’t smoke
• Relax and breathe will help reduce the impact
• Lose weight
6. Why do I experience fatigue?
Low energy is contributed to by the drop in hormones. Oestrogen and progesterone are more than just sex hormones – they have an effect on your mood and energy and metabolic rate and vitality. The drop with the menopause causes tiredness and fatigue and things like thyroid issues and low iron are often contributory factors at this time also. Regular meals, protein with each meal and plenty of good fats and complex carbs and avoiding sugar will help. Avoiding stress, good sleep hygiene and avoiding caffeine and stimulants and keeping well hydrated will also help.
7. I find it difficult to concentrate at work – my brain feels foggy. What can I do?
Same advice for brain fog – keep hydrated/ get enough sleep /eat less sugar / regular exercise boosts memory and brain function/ mediate / avoid alcohol. Diet with lots of oily fish and good fats / add omega supplement.
8. I am experiencing mood swings, which is impacting my relationships. Why is this and what can I do?
The mood swings are due to a drop in oestrogen and progesterone which give a permanent state of PMT. Mood swings irritability anxiety and depression are common symptoms
Advice as per question 8 above:
• Avoid drops in blood sugar
• Avoid refined sugar
• Good diet with lots of good fats and proteins with each meal to stabilise blood sugar
• Get enough sleep
• Look at discussing the issue with your partner and helping them understand why
• Seek help from GP hormone specialists
• Avoid stress
• Exercise meditation and yoga and breathe
Obviously, all above can be helped by hormone replacement therapy
Dr Elaine McQuade practices at the Marion Gluck Clinic, where she specialises in treating patients suffering from the menopause and other hormone related conditions. Dr. McQuade practices functional medicine – a holistic approach to healthcare – as a complement to her speciality of bio-identical hormone replacement therapy.