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Your questions on the menopause and HRT - answered by our expert
You asked, she answered: a women's health expert explains how to manage the symptoms of perimenopause and beyond
Every woman will go through it, so why do we know so little about the menopause? In fact, many of the symptoms we most closely associate with it - such as hot flashes - can also occur in perimenopause, the transition that happens to the female body before periods stop, typically around the age of 51.
Author Maisie Hill is on a mission to help women get to know their own bodies, and in her new book Perimenopause Power, she sets out the symptoms and strategies for dealing with them, from hormone therapy (HRT) to the importance of managing your diet and exercise. As she told Stella magazine, ‘We’re socialised to accept that menstrual and perimenopausal symptoms are just part of having a female reproductive system – that’s something we have to get over. We need to share more and require more and get better access to care.’
Here, she answers your questions about how to manage symptoms - and get the help you need.
Will I be on HRT for the rest of my life?
Q: Anonymous, 53: I have been going through this since I was 38. I tried natural remedies followed by HRT then back to natural and then back to HRT about 10 years ago. Can I expect to be on HRT for the rest of my life?
A: The great news is that there isn’t any evidence suggesting that HRT should be stopped after a certain number of years or at a particular age, so if you’re taking it and it’s working well for you without issue, then there’s no reason to stop. HRT offers so many benefits and they continue well into our post-menopausal years.
I'm still getting periods at 54. Do I need to take anything?
Q: Natalia, 54: My periods are as regular and as heavy, painful and long (8 days) as always. Have only missed them twice in the last two years. Get sweaty at night at times (neck and breast zone). No mood swings, apart from getting over sentimental two days ahead of my period. My doctor doesn't think it's time to take support therapy. Do I need to start taking anything in advance? Should I get a second opinion?
A: Progesterone can actually be prescribed to treat heavy periods as it has the ability to lighten them, and it can also reduce vasomotor symptoms such as night sweats, so you may want to raise this topic again with your GP as although your cycle is still regular, you could still benefit from HRT in some form.
Will HRT just delay menopause symptoms?
Q: Anne, 56: I finished my periods four years ago and am definitely experiencing post menopause symptoms, hot flushes and night sweats. Also general stiffness and extra belly fat despite exercising well, and having a healthy diet. My question is, will these symptoms stop and if so when can I expect that? If taking HRT which many of my friends do, will this just delay what I am experiencing now?
A: It sounds like you’re taking great care of yourself, Anne, and you may get some relief without taking HRT, but without the presence of hormones they’re likely to remain to some degree. Taking HRT won’t delay your experience of these symptoms, as, although many of us have been told that we have to stop taking it after 5 years, that’s not the case at all. Combining HRT with lifestyle measures such as exercise and eating a healthy diet means you’ll see an even greater impact than using one or the other.
Could my hot feet be a symptom of perimenopause?
Q: Claire, 47: I am almost 48 and have the Mirena coil. For the past few months I’ve had difficulty sleeping due to hot feet or toes to be specific. I fall asleep OK but wake nightly after a few hours with hot feet, unable to settle back to sleep for a good few hours. In the morning my feet feel swollen and tender for the first five minutes or so. Is this related to perimenopause? I am otherwise fit and healthy, 5’6, 10 stone (weight has increased by a stone in the past year).
A: Yes, this could be related to the hormonal shifts of menopause, and is something that I’d suggest exploring the use of Chinese medicine for, though I’d recommend speaking with your GP as well to rule out any other possible causes and discuss treatment appropriate strategies. The British Acupuncture Council maintains a list of qualified and insured acupuncturists.
Is spotting normal in perimenopause?
Q: Joan, 47: Are occasional spots of blood a normal symptom of perimenopause?
A: Dysfunctional uterine bleeding - bleeding that occurs outside of the usual pattern of bleeding - is very common during perimenopause, and is often down to shifting hormone levels. That being said, bleeding can also be for other reasons which is why it’s always a good idea to speak to your GP about any changes to how you bleed. So many women don’t do this and it’s a habit we need to get out of, regardless of what age we are.
Would contraception mask the signs of perimenopause?
Q: Helen, 40: Where does hormonal contraception fit in with perimenopause and HRT? I started getting horrendous PMT at 37 and use the Evra patch to manage it - will it mask the signs of perimenopause? What is the difference between hormonal contraceptives and HRT, and how would I know when to switch from one to the other?
A: Hormonal contraception can mask perimenopause as the main way the Evra patch works is by suppressing ovulation. That means whilst you’re taking it, you won’t be experiencing a menstrual cycle, just a withdrawal bleed during the week that you skip using a patch. I love that you’ve asked this question and there’s a whole chapter about sex in my book where I cover contraception and HRT.
Could I still get pregnant at 55?
Q: Louisa, 54: I've been on HRT for several years and have continued to take the mini pill. One of the GPs said they didn’t prescribe the pill after 55. I am 55 in a couple of weeks so I stopped taking the pill 5 days ago. I now appear to be having a period for the first time in some months. Can I still get pregnant?
A: The NHS guidance is that contraception probably isn’t needed after the age of 55, as the average age of menopause is 51 and the recommendation is to continue to use contraception for 2 years following your last menstrual period. The bleeding episode you described could be your body adjusting to coming off the mini-pill, but you should speak to your GP about whether ovulation is likely or not at this stage and see what they recommend.
Is there anything I can do about my adult acne?
Q: Claire, 47: Historically I have suffered from acne and in the last couple of years it has recurred, normally occurring in the week before my period. Is this likely to be a symptom and is it something I could ask my doctor for help with? My periods are now more irregular and seem to be more frequent with longer periods of very light flow.
A: A nickname for perimenopause is the second puberty and acne is partly why. It can be frustrating and disappointing for it to appear at this stage of life, and can be down to hormonal changes. Your GP may suggest HRT and for anything skin related, nutritional therapists can be very helpful.
Perimenopause Power: Navigating your hormones on the journey to menopause by Maisie Hill (Bloomsbury, £14.99) is published tomorrow. Available for pre-order now.