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MENOPAUSE ‘ASK THE EXPERTS’ QUESTIONS & ANSWERS

The following ‘Ask the Experts’ questions were sent in to The Menopause Exchange by our members, the answers were provided by our ‘Ask the Experts’ panel and included in issue 74 (autumn 2017) and issue 75 (winter 2017/18) of The Menopause Exchange newsletter. If you would like to read the questions and answers in the latest issue of The Menopause Exchange newsletter sign up for FREE emailed newsletters.

Can bio-identical hormones help to ease menopausal symptoms?
Dr Sarah Gray, GP, replies:

The short answer is ‘yes’. Menopausal symptoms are caused by a deficiency of naturally produced hormones, particularly oestrogen. Replacing the oestrogen should relieve the symptoms. The most effective products are those that most closely resemble what’s missing. The longer answer cautions against using products that are promoted as bio-identical but are compounded and not standardised or regulated. There are no controls or safety standards in relation to these products.

If you seek body identical HRT, approved patches and gels can be used. These contain 17 beta-oestradiol identical to that produced in the ovaries and delivered into the circulation. Micronised progesterone is available on NHS prescription. This can be used with oestrogen if you need to protect your uterine lining.

How long do menopausal symptoms last?
Kathy Abernethy, senior nurse specialist, replies:

There’s no way to predict this. Many women get very few symptoms at all. Others have quite bothersome symptoms but the duration varies. Two to three years is quite common, but a few women have menopausal symptoms for around five years (not always troublesome). A few women continue to have menopausal symptoms for much longer than this, and occasionally the symptoms can continue for 10 years or more. More long-term symptoms such as vaginal dryness can worsen in the years after the menopause and continue indefinitely if left untreated.

I read with interest the article on ‘Vegetarian and vegan diets’ in issue 73 of The Menopause Exchange newsletter. Can you tell me more about calcium-fortified products and fish oil supplements?
Gaynor Bussell, dietitian, replies:

It’s unusual to fortify foods with calcium but non-dairy milks (e.g. almond and soya milk) are fortified to bring them back to the calcium level of cow’s milk. Organic milks, however, aren’t fortified. Dairy is by far the best source of calcium. An equivalent of a pint of milk a day (e.g. 1/3 pint of milk, a matchbox-sized piece of cheese and a yoghurt), provides all the calcium you need. If you can’t have dairy, then the fortified milks can supply the equivalent. Dark green vegetables, tinned sardines/salmon mashed with their bones, dried fruit and beans are other good sources but not as high as dairy.

As for fish oil supplements, supermarket 1000mg brands containing 300mg EPA/DHA (the recommended fish oils) are good. Go for high strength ones or take the equivalent of the lower strength ones to get 300mg EPA/DHA.

I am 47 and going through the menopause. I am healthy and I am not taking medicines.  Apart from general health advice, what do you suggest will help my hot flushes?
Dr Sarah Gray, GP, replies:

Don’t dismiss general health advice, as exercise and alcohol reduction will reduce flushing while other elements keep you well. Soy isoflavones (plant oestrogens) have some ability to reduce flushing but generally this doesn’t last for many months. Black cohosh has a similar ability though it comes with some concerns about liver damage. This isn’t a worry for most women as the effects are rare and haven’t been shown to be directly caused by the products. Some antidepressants in low doses will reduce flushing but can increase them in high doses; they’re not recommended unless you’re depressed. Replacing missing oestrogen is the most effective way to reduce flushing. It will ease other symptoms and protect bones. If you’re otherwise healthy, the risks are greatly outweighed by the benefits.

Can vitamins and minerals help anxiety?
Angie Jefferson, consultant dietitian, replies:

Vitamins and minerals are involved in a wide range of body functions, including the correct working of the nervous system, so it makes sense that a shortfall in one or more of these could affect mood and anxiety. Research is wide-ranging with reports of B-complex vitamins, C, D, E, magnesium, copper, selenium and iodine (to name a few) involved in the prevention and easing of anxiety and stress. For mild anxiety, eat a healthy varied diet. If you want to, supplement this with a ‘one-a-day’ multivitamin/mineral. The results won’t be instant and it may take several weeks to feel any improvements. If your anxiety is more severe, speak to your GP.

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References:

Kaplan BJ et al (2015) A randomised trial of nutrient supplements to minimise psychological stress after a natural disaster. Psychiatry Res. 228: 373-9. doi: 10.1016/j.psychres.2015.05.080. Epub 2015 Jun 27.

 

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