The Most Common Menopause Questions and Answers - Stella
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Answers to the big questions about menopause

byDr Michelle Griffin

Dr Michelle Griffin, medical doctor and a qualified gynaecologist, was invited by Mumsnet to answer menopause questions from their community. 

It was a great experience to be trusted with their community’s concerns and we’ve shared some of the common menopause questions and answers here with Dr Griffin’s answers to help you navigate your way through menopause. 

Menopause questions

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Is there a test to tell me when my menopause will start?

I am pretty terrified of menopause as my mum had hot flushes, mood swings and depression, which started when she was in her early 50s. I am 36 now, when should I ask my GP for tests so I can look into medications to help my menopause?

This is a great menopause question as many women would like to know where they are in their menopause journey but there is no clear test for menopause. The diagnosis of menopause in healthy women aged over 45 years is based on your symptoms. You are in perimenopause if you’re suffering from hot flushes/night sweats and irregular periods, menopause once you’ve had a year of no periods and are not using hormonal contraception. 

If you’ve had a hysterectomy (uterus removed) at any point, your diagnosis of menopause is based on the symptoms you report. Blood tests may be offered if you are aged 40-45, have menopausal symptoms and a change in periods, or if you are below 40 and menopause is suspected. Read more about the stages of menopause.

Do hormonal contraceptives mask symptoms of menopause?

I’m 46 and taking the combined pill – I still get withdrawal bleed ‘periods’ in the 7-day break between packs but they are mainly very, very light. I’ve recently started suffering insomnia and have cut out caffeinated drinks in the afternoon to try to combat this. Is this likely to be a symptom?

Difficulties with sleep can be a menopausal symptom and cutting caffeine can definitely help. Read more about dealing with sleep issues here.

The combined contraceptive pill contains oestrogen and progesterone. It can help with menopausal symptoms and be used for contraception at the same time. In this way, it replaces any lack of oestrogen and can ‘mask’ symptoms of menopause. 

You can’t use the combined contraceptive pill:

  • If you are over 35 and smoke
  • Have high blood pressure
  • Suffer focal migraine
  • Have complicated diabetes

If this is your menopause questions, talk to your GP and discuss alternative management to provide contraception and offer relief from any perimenopausal symptoms. Read more about HRT here.

Will your coil prevent menopause symptoms?

I’m 45 and know very little about menopause, but I suppose I’ll have to find out soon enough. I have the Mirena coil so I’m hoping a lot of it will pass me by. Am I being naïve?

The Mirena intrauterine device (IUD) releases progesterone only and in a small amount. It does control bleeding, making periods lighter and more regular. However, it will not have any masking or treatment effect on other symptoms of menopause. 

The same goes for the other types of IUD on the market including Levosert and Benilexa.

Are my night sweats down to perimenopause or something else?

I’m 44 and suffering night sweats in the lead up to my period every month. Is this perimenopause or hormone-related?

Hot flushes and night sweats are very common menopausal symptoms and are well known because they are so awful! We currently do not fully understand what causes a hot flush or night sweat. Read more about hot flushes in our symptoms library.

It’s likely that the changing oestrogen level during menopause is affecting a part of the brain called the hypothalamus, which regulates body’s temperature. It enables the body to change in relation to the temperature in your environment, such as when you’re doing exercise, you start to get hot and you sweat.

It’s thought the changing oestrogen level causes a hypersensitivity to temperature and the hypothalamus starts identifying and responding to minor changes in temperature. This leads to the dilation of blood vessels (feeling and becoming flushed) and sweating. 

On average, women seem to suffer from hot flushes and night sweats for around two years. The good news is that once the hormone levels have fallen and stopped fluctuating, then the hypothalamus corrects itself and settles back to normal temperature control. 

Make sure you are optimising your bed and bedroom for sleep – so do the simple things of opening a window, using a fan, wear thin cotton nightwear and use layers of cotton sheets rather than a duvet. You can avoid trigger foods for hot flushes too, such as caffeine and hot curries. If you are still struggling, talk to your doctor to discuss HRT and other options if HRT is not suitable.

Read Jenenva’s experience of hot flushes at work.

I’m so worried about brain fog, what can I do?

I forget words halfway through a sentence or forget a word altogether. I’m 54 and on HRT. I feel like I have dementia sometimes and worse when tired. I work full time and I don’t want to show weakness. Help!

Brain fog is a very common symptom of perimenopause – women can find it hard to concentrate and remember things, such as what they went upstairs for. This can be particularly difficult at work and can lead to much frustration and anxiety. 

Oestrogen has an important role in our cognition and memory, which is why brain fog comes about in perimenopause and postmenopause. It is likely that HRT will improve this symptom. 

Exercise your brain as much as possible, it is a muscle and needs to be kept active and trained with mental exercises. The link between brain fog and long-term effects is unknown and the evidence is conflicting on whether HRT lowers risk of dementia or not. Read more about the HRT debate.

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Why am I experiencing really heavy periods?

My periods are all over the place. Why is this and what can I do? 

It happens because your hormones are fluctuating so much. An erratic period is one of the hallmark signs of perimenopause. You won’t ovulate every month and won’t get a period in those months. 

The lining of the womb builds up when you don’t bleed, leading to a pattern of skipped periods followed by a very heavy bleed. There are many different bleeding patterns and you’re the best judge to know what feels abnormal. If you are concerned about the frequency of bleeds and/or heaviness, do speak to your doctor. Read Amanda’s experience of having a hysterectomy after very heavy periods or Alice’s story of having a Mirena Coil to manage heavy bleeding.

Also, bleeding after sex and between periods (it can be difficult to tell if your cycle is very irregular) is not normal and you should speak to your doctor. Read more about menopause symptoms you need to talk to your doctor about.

Will taking HRT change where fat is stored on my body?

I am 52 and perimenopausal with a Mirena IUD fitted ready for HRT. I eat the same, exercise the same and the scales say the same weight. In the last year, my chest, upper abdominal area and back have got bigger. I eat well, run marathons and strength train twice a week. It’s so depressing. 

This is so common. As we get older, our metabolism slows down so even if you do and eat the same things you will put on weight or your new fat distribution may change your measurements. Our falling oestrogen levels affect how and where we store fat and this is what you are noticing. 

HRT will not be able to directly affect this, so target it with exercises specific to your new fat distribution. Try to eat more healthily and do more exercise to keep up – easier said than done, I know! Helping yourself through lifestyle, nutrition and potentially HRT to sleep and feel better, can help many women to better manage their weight at this time of life. Read more about weight gain during menopause or visit our symptoms library.

What vitamins and minerals should I take?

Or should I concentrate on my physical health and other environmental factors, would these have more of a bearing on my experience? 

Heading into menopause, you want to be in your best health physically and mentally. If you have any current medical issues, work to manage them as best as possible. It’s a great time to review your diet and exercise – your overall lifestyle. I cannot emphasise enough how important this is. Here’s how to get started with improving your nutrition during perimenopause and beyond.

One of the most common menopause questions is around treatment. Medications, including HRT, are not magic pills which can solve all problems. Menopause is a great opportunity to see if you’re making the best choices. Many issues during perimenopause and beyond respond to an improvement in nutrition and having an active, varied exercise plan. 

Make sure you’re getting the right nutrients by eating plenty of fruit and vegetables, minimise the proportion of fat and carbohydrate in each meal and ensure you are eating plenty of fibre. Look at incorporating some meat-free meals to help with reducing fat content. Focus on reducing your sugar and salt content, and take a look at how much caffeine and alcohol you are drinking. It goes without saying that if you’re smoking, use this time to stop. There are many different stop smoking programmes available and some are available on the NHS. Read more about how lifestyle changes can make a difference.

Are my bones just going to snap like twigs if I don’t take HRT?

Perimenopausal and menopausal women should have a balanced diet with adequate calcium (1000mg per day) and vitamin D (1000IU per day) and use supplements where necessary to reduce the risk of osteoporosis. Make sure your routine includes weight-bearing exercises, such as walking, dancing and jogging.

HRT has been shown to have a protective effect against osteoporosis and related fractures. But you need to balance your own personalised risks and benefits when considering HRT – talk to your doctor if whether HRT it is right for you is one of your top menopause questions.

Will I still have good, juicy enjoyable sex during and after menopause?

I want to know about the likely implications for my sex life and what I can do about this. I am already getting soreness and dryness around my labia, and this has been for over a year now. I am in no way ready for my sex life to end or be diminished so I want to know how I can maintain my sex drive?

I’m so sorry to hear this and it’s a real, debilitating problem! Focus on minimising irritants:

  • Don’t wash or douche your vagina
  • Wash your vulva gently with water, an emollient cream or a non-perfumed, non-allergenic soap, then pat it dry and do not rub
  • Wear comfortable, cotton underwear
  • Use a gentle non-biological washing powder
  • Avoid scented sanitary or incontinence products, including scented toilet paper
  •  Don’t use non-vaginal moisturiser on your genitals as it will cause irritation

You can buy vaginal moisturisers in a pharmacy with or without a prescription – they can take 3-4 weeks to see an effect. If you struggle with dryness during sex, you may want to use a lubricant as well (a moisturiser would be used more regularly, a lubricant is just used for sex, and you can use both products). 

Lubricants can cause irritation to a sensitive, sore vulva and vagina. There are many different types and I would recommend an oil-based one as it is thicker, creamier and lasts longer or a mixture of both oil and water-based (water-based feels more like natural lubrication but does not last very long and can become sticky). It’s best to try a couple of different ones and see which you prefer. Talk to your doctor about using topical oestrogen to see if it helps. Read more about sex during menopause.

Do I need HRT if I have mild symptoms? 

I am aware the average age of menopause is 51 and I am 50. I am combating perimenopause symptoms with exercising, a plant-based diet, and meditation. Can you go through this oestrogen depletion without HRT if symptoms are mild at present or will they increase with age?

This one of the most popular menopause questions and it sounds as though you are very much informed and in control of your perimenopausal symptoms, which is great! Every woman experiences a different menopause and a woman does not have to go on HRT. In fact many women go through menopause without it. Read more about the HRT debate.

The key point is to be led by your symptoms and how they are affecting you. If you are managing well, continue with your plan and take it day-by-day. Just be sure to seek help if that changes. 

Most symptoms will reduce and settle with age as the hormones settle to their new normal level. However, vaginal dryness and irritation can be an increasing problem as the tissue responds to the increasing lack of oestrogen. This can be managed successfully with topical oestrogen.

Read more menopause questions on our blog. Get started with menopause 101 by reading our symptoms library. If we’ve missed a question that you need answering, send us a message on Instagram.

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