The 13 most asked questions about the menopause

Swansea’s HMT Sancta Maria Hospital has recently launched a women’s health and wellbeing service with women’s health specialist, Dr Sandar Hlaing.

The introduction of this service includes a Friday clinic hosted by Dr Hlaing, where women can book one-to-one consultations for additional support with menopause, health and wellbeing concerns.

Dr Hlaing, who has recently experienced menopause herself, is passionate about supporting women through this challenging time of their lives and has shared with us the 13 most asked questions she receives from women experiencing menopause.

Q: What exactly is menopause?

A: Basically, “meno” is your period and “pause” means cessation, so in a nutshell, it’s when your period stops. In Europe, the ‘official menopause age’ is between 45 to 55 but you could be going through menopause a lot younger than that too. If you were having menopause under the age of 40, that is called premature menopause.

Q: What are the main symptoms?

A: There are 34 symptoms associated with menopause. They are mainly due to the lack of oestrogen. So, oestrogens live in pretty much all cells in a woman’s body. When you are lacking that hormone, you notice it. When you don’t have enough of that in your brain cells, you’ve got this brain fog where you can’t concentrate, you forget things. It’s even involved in your body temperature regulation and that’s why you have hot flushes. It is there in your heart, which is why you experience palpitations, and raised heartbeats for no reason. Oestrogen lives in your joints, in your muscles, that’s why you’ll experience joint pains, and you feel exhausted.  

Q: What is HRT?

A. HRT stands for Hormone Replacement Therapy. When you reach menopause, your ovaries will stop functioning as they have done your whole life. They stop producing oestrogen (the female hormone), progesterone (that protects the lining of your uterus) and the thyroid hormone, testosterone. HRT replaces these lost hormones, which most women need to function normally.

Q: Can HRT cause palpitations and increase in blood pressure?    

A: All drugs have side effects, and every person is different, so it is possible. A menopausal woman is already prone to have palpitations and with age, our blood vessels get thickened, and we are prone to have high blood pressure. The best recommendation is to ensure low salt, low sugar, less processed food, regular, weight-bearing exercise for 30 minutes a day and if the blood pressure is on the high side, treat it and withhold HRT for a short duration.  When blood pressure becomes under control, you can try HRT again and monitor your blood pressure.

Q: How do you know if you are menopausal if you’re still having periods?     

A: Periods vary around the time of perimenopause. It takes a while for periods to completely disappear. You will start noticing other symptoms such as easy fatiguability, extreme tiredness, being emotional, aches and pain, forgetfulness, brain fogs, being sensitive to temperature, sweating, flushes.

Q: I have just started taking HRT Evorel Sequi Patches, how long will it take to start working? Also is there anything else I can take to help with my mood swings which are explosive and are really getting me down?  

A: Cognitive Behavioural Therapy (CBT) has evidence for being so helpful with menopausal symptoms. You can do computer courses online for CBT or you can start by just having a simple book for CBT. Response to HRT varies with individuals and which symptoms respond first also vary too. Adding in lifestyle measures, such as low salt, low sugar diet, water based and weight bearing exercise, reduce caffeine, stop smoking, reduce alcohol, regular sleeping times all help in making HRT more effective. Most people tend to find tiredness and lethargy improved in the first month. Sleep tends to improve after the first few weeks. Aches and pains tend to improve in 2-3 months. Brain fog and libido takes longer to improve. Hot flushes may lessen from the early days but may take a few months to completely disappear.

Q: Is there anything that triggers early menopause?    

A: Family tendency, physical or mental stress, chronic illnesses that require intensive treatments, eating disorders, they all can trigger early menopause but if menopause occurs secondary to such conditions, it can reverse back to normal too.

Q: Should I approach the menopause differently with diabetes type 1?

A: You shouldn’t have to. If you are thinking HRT, I would advise transdermal (gel or patch methods) rather than oral to reduce blood thickening, clotting side effects and also to bypass the liver metabolism. Lifestyle measures for diet, exercise, stop smoking, reduce alcohol are all good for diabetes too.

Q: I have fibroids in my womb and have been told that I can’t have HRT until I have been seen by a gynaecologist, but I have been waiting for an appointment for years, is there anything I can do in the meantime please? I assume I am peri menopausal but not sure as bleeding constantly due to fibroids anyways, but am having flushes, mood swings and sore joints.

A. Mirena coil will hold the bleeding to a stop or at least reduce it down a lot. Mirena can reduce the size of the fibroid too. You can have oestrogen in gel, patch, or tablet form alongside the Mirena (oestrogen may counter some effects of the Mirena in reducing the bleed and fibroid size but overall benefit should be better) and you will be well-prepared for perimenopause and menopause.

Q: My GP refused me HRT, as mum had breast cancer, her mum and sister too. What can I do? I have all the symptoms especially pain, joint pain, etc, plus also have fibromyalgia and psoriatic arthritis so I don’t know what is causing what?

A: You should ask for a genetic testing referral for breast cancer so that you know your risk properly. Vaginal symptoms can be treated with vaginal oestrogen as the dose is very low and it should not change your risk. The rest of menopause symptoms can also have medication for each symptom (drugs which are not in the HRT category). Checking bloods for tiredness and adding some supplements in such as vitamin D and magnesium in your diet should help too.

Q: Is it normal to keep on changing your HRT until you find one that suits you or is there any. way of knowing beforehand which one would suit you the best?    

A:  It can be frustrating, and some practitioners may claim that you can check bloods and titrate the drug to exactly how much you need. That isn’t the case in reality. The type of HRT we use now is body identical so we do not need to do tests to see which HRT chemical form will suit you. At the initial stage of menopause, all the hormones that your ovary used to produce will be very low. Once you start HRT, you can mainly tell by the improvements in symptoms as to whether you are at the right level of HRT. The main purpose here is to make the person feel better and function better. Not to get correct blood levels. Drs tend to give a plan to patients as to how to titrate their dose up and down in the safe limit rather than changing the form of HRT or brand to start with. If someone seems to be on a decent dose of HRT and still symptomatic, it is useful to do blood levels to see if absorption of medication is an issue. If this is the case, changing the form of HRT, rather than the dose would be helpful.

Q: How long can you take HRT for? When should you stop?  

A:  There is no time limit. HRT in the first 7.5 years has most evidence so all the safety data and risks are based on this. You can stop early or late depending on how you are and your approach to risk. I tend to advise my ladies to gradually tail it off so that you don’t feel the lack of hormone so much but there are no real hard rules about it.

Q: Why have I gained weight after my full hysterectomy? I’m even taking HRT gel?

A: Lack of oestrogen in menopause does produce slower metabolism. Oestrogen is stored in fat cells so your body does try to hang on to fat more too. Your ability to exercise may reduce in intensity due to joint and muscle stiffness and easy fatiguability due to lack of oestrogen. It may help to check your thyroid if you are still concerned.

To book an appointment with Dr Sandar Hlaing, please complete this booking form or call 03456 252 252 referencing ‘Dr Sandar Hlaing Menopause Consultation at HMT Sancta Maria Hospital Swansea’.