Saturday, August 13, 2022

Everything you need to know about life before, during and after menopause

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In day two of our exclusive series, Kate Muir answers the most commonly asked questions about life before, during and after menopause.

Welcome to day two of our exclusive menopause guide. Yesterday we talked through the menopause survival toolkit – everything you need to feel your best during perimenopause, menopause and beyond.

As the producer of Davina McCall’s Channel 4 documentary Sex, Myths and the Menopause, I’m passionate about opening up the conversation about menopause.

Today, I’m here to answer some of the most common questions surrounding it – including the ones you might not ask your GP.

Will my menopause symptoms ever end?

Some menopause symptoms, such as sleeplessness and anxiety, start in perimenopause. And studies show that some women still get hot flushes when they are in their 80s. So yes, symptoms can last for decades.

However, this is because the hormonal deficiency caused by menopause, which produces the symptoms, doesn’t end unless you
take HRT.

When you do, HRT replenishes your depleted hormones and the symptoms typically go away.

Kate Muir has written a book on menopause
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Studies show that some women still get hot flushes when they are in their 80s
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That’s not to say symptoms don’t improve in time without HRT. Memory loss, for example, may improve slightly after you’ve gone through the worst of the menopause in your 50s.

But if you want to protect your brain from the damage that it can endure as a result of hormone deficiency, you are better off replacing your hormones in the long term.

Are there any benefits to the menopause?

In short: yes. If you start HRT, and you’re one of the 90 per cent who is able to tolerate it, you will never have the ups and downs from your menstrual cycle again. On top of this, you shouldn’t suffer from many of the common menopause symptoms.

Indeed, once you’re at the other side – you’re over 50, you’re on HRT – you really settle down emotionally and physically, and that’s fantastic.

Will HRT increase my risk of breast cancer?

A study 20 years ago from the Women’s Health Initiative indicated there was a small increased risk of breast cancer on the old combined pill, which was made of oestrogen and synthetic progestins.

What we have now is a completely different kind of HRT, and if you take transdermal oestrogen and micronised progesterone, or its equivalent, the studies (so far over five years) suggest there is no extra risk of breast cancer.

Will menopause ruin my sex life?

Experts say 80 per cent of women can develop a dry vagina and/or vulva at some point during menopause. If you take HRT, this can help. But sometimes you need extra vaginal oestrogen, which helps with the dryness and also prevents urinary tract infections. It also ensures that you feel comfortable when having sex.

There’s no cancer risk from vaginal oestrogen, a tiny amount of the hormone is used – the equivalent of about two oral HRT pills in a whole year – and it is applied directly. You can use a cream, gel or a pessary.

Experts say 80 per cent of women can develop a dry vagina and/or vulva at some point during menopause (Stock photo)
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What can I do if my sex drive disappears?

Start with vaginal oestrogen to make sure you’re comfortable. Also, under the NICE guidelines 2015 you can ask for testosterone on the NHS if your libido is low. It’s not always easy to access, and you are usually referred to a menopause specialist (something we’re trying to change). But testosterone helps with libido, energy and concentration.

And no, it won’t make you more hairy. You are simply replacing the amount of testosterone that would have existed in your body 10 years ago.

It’s seen as a male hormone but, actually, we produce testosterone too, and don’t get it back after menopause.

Does menopause give you mood swings?

So many women talk about “the rage”, but this mostly occurs during perimenopause, when periods are coming to an end and oestrogen levels plummet.

When oestrogen and progesterone are going up and down, your stress, anxiety and chances of hormonal depression all increase.

Your hormones are unstable, and until you find a way to stabilise them or get through to the other side, you’re going to find that it has an incredible effect on your mental health, memory, concentration and sleep, which can all affect your mood.

Your hormones are unstable (Stock photo)
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Is HRT safe – should I take it or should I go natural?

HRT is indeed safe. And I would argue that taking something like a herbal remedy is actually less of a natural approach.

The most natural thing is to take hormones as you are simply replacing what your body used to make.

If you want to protect your brain and bones, and prevent osteoporosis and dementia, then taking HRT will protect you from these and the other long-term diseases that come from hormonal deficiency. However, if you have been diagnosed with breast cancer, you may not be able to take HRT afterwards because of its oestrogen content. If that is the case, you will have to go the natural route, and do the best you can using exercise and nutrition, CBT therapy or meditation.

Can I take HRT for years after menopause begins, and can I take it for the rest of my life?

There’s been some new research done on starting HRT gently in later life, and starting transdermal HRT is much safer than starting old-fashioned HRT. The benefits of taking it in later life is that it rebalances the hormone deficiency brought about by menopause, preventing sleeplessness, anxiety, brain fog and health conditions such as osteoporosis. The advice is to start with one pump of the oestrogen gel (most people have two a day). A slow-drip start is being trialled by doctors here and it seems to be very successful because the new HRT is much more easily tolerated.

In the past, you were only expected to take HRT for five years. But now we’re looking at HRT not just in terms of reducing symptoms, but in terms of a booster for your health.

There is a group of menopause experts who now say you can keep going with HRT for years after you begin to take it, although that is not yet NHS advice. However, I’ve been on it for five years now and I’m certainly not giving it up. To me, long-term benefits massively outweigh any risks.

Women tend to develop a band of fat around their waist during the menopause
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Will I put on weight?

Women tend to develop a band of fat around their waist during the menopause. This is because as oestrogen levels plummet, the body starts making more of a replacement for oestrogen called estrone. This is made by the fat cells that appear around your waist.

Estrone is not as good as the oestrogen our bodies used to make. But the body continues to make more to compensate for its loss of oestrogen, and so that ring of fat stays around your body.

Taking HRT to replace lost oestrogen will help, as will following a healthy daily diet, drinking plenty of water, and doing some exercise every day.

Everything You Need To Know About The Menopause (But Were Too Afraid To Ask) by Kate Muir (£16.99, Simon & Schuster) is out now. Follow Kate on Twitter and Instagram at @menoscandal

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