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The Menopause Exchange Blog


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 75 (winter 2017/18) and issue 76 (spring 2018) 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.

If I come off HRT, how likely is it that my hot flushes will return? If they do come back, what should I do?
Dr Kathryn Clement, consultant in sexual and reproductive healthcare, replies:

Unfortunately, some women’s hot flushes do come back when they stop their HRT, but this isn’t the case for everyone. Hopefully if you’re a bit older when you stop the HRT, you’ll find that your symptoms aren’t as troublesome. For many women, the symptoms are easier to cope with. Most women find that their hot flushes do improve over the first few months after stopping HRT, as they get used to being without the medicine. It’s sensible to stop HRT gradually rather than suddenly, and you should talk to your HRT provider about ways of doing this. It’s also sensible to choose a calmer time of your life to stop the HRT, e.g. not just before an important event. Many women choose to come off their HRT once they’ve retired, when life is easier. If you do find it difficult without HRT, I would recommend that you persevere for several months before going back to your GP to discuss your options. Many options are available, including trying non-hormonal preparations, or perhaps trying a lower dose of HRT for a bit longer before stopping completely.

My daughter has endometriosis. Can you tell me about this condition and how it can be treated?
Dr Jenifer Worden, GP, replies:

Endometriosis is the name given to the presence of tissue from a woman’s uterine lining (endometrium) outside her uterus (e.g. around her ovaries, fallopian tubes, pelvis and in or around her bowel). Each time she has a period, she bleeds from her normal endometrium and from the external sites. If these are in her bowel, this may cause rectal bleeding. If her ovaries or fallopian tubes are affected, the blood can’t escape and can build up into painful cysts (‘chocolate cysts’). Periods are normally heavy and more painful at the middle and end, rather than at the beginning. Treatment through a specialist gynaecologist involves surgery to remove the external endometrium or medicines to stop periods until the endometrium becomes inactive. Endometriosis normally resolves after the menopause.

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.

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