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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 issues 72 (spring 2017) and 73 (summer 2017) 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.

What tests and checks will be carried out before I start HRT?

Dr Sarah Gray, GP, replies:

Other than checking your height, weight and blood pressure, it’s rare that you would need any specific tests or checks before starting HRT. The menopause is diagnosed and assessed on the basis of your period pattern and your symptoms. I would expect your doctor or nurse to ask questions about your general health, medical history and family history to determine your risk profile and then assess what effect HRT may have on top of this. Investigations will be arranged if your doctor or nurse has any concerns, or if results will affect the decision. An example may be that a bone density scan is arranged for you if you’re believed to be at risk of osteoporosis and if the answer would affect your decision to take, or not to take, HRT.

I read with interest the article on plant oestrogens in issue 71. With reference to supplements, at what time of day and when in relation to food should they be taken? Is there anything that can help absorption?

Gaynor Bussell, dietitian, replies:

It’s always best to get plant oestrogens from food, such as tofu and soya milk. If you can’t, take your plant oestrogen supplements with food. If you need to take more than one tablet/dose, spread them throughout the day try to take them at a regular time each day, close to when you have food. You can also add soy-based protein powders to hot or cold drinks or porridge or soup. Choose a supplement supplying a mixture of isoflavones, including genistein and daidzein. There’s some evidence that the active helpful part of plant oestrogens is best absorbed if it’s taken with a probiotic (such as a yoghurt, drink or supplement). When using isoflavone supplements, always read the instructions and take no more than the recommended dose (around 40-50mg a day). If you’re not sure, ask a pharmacist.

I’m 42 and taking letrozole, an aromatase inhibitor, for breast cancer. Since taking it, I’ve had horrendous hot flushes. Apart from self-help measures, such as layering up my clothes and being careful with what I eat, what do you suggest I take? I’m not taking any other medicines.

Kathy Abernethy, senior nurse specialist, replies:

If you have exhausted the ‘self help’ strategies, it sounds as if you’re ready to discuss medical alternatives to HRT to relieve your flushes. Your GP can discuss low dose antidepressants, which can sometimes help. A short trial of around a month will give you an indication of whether this will work for you. Clonidine is another option that also helps flushes in some women.

Do allergies increase around the time of the menopause?

Kathy Abernethy, senior nurse specialist, replies:

The menopause can have an effect on your immune system and, therefore allergies. Sometimes existing allergies get worse. Asthma occasionally worsens around the menopause too. Occasionally allergies can arise for the first time, although it’s not always clear if the hormonal changes of the menopause are influencing the allergy or if it’s other factors, such as lifestyle, stress or even ageing, all of which play a part in our susceptibility to allergens (anything that can trigger allergies).

I’m taking the combined contraceptive pill. I’m 46. How will I know if I’m going through the menopause?

Dr Nicola Mullin, consultant, replies:

The short answer is you won’t know because of the hormones in the combined contraceptive pill. The oestrogen in the pill will smooth out fluctuations of your natural oestrogens and may help hot flushes. This pill can help to improve heavy irregular periods that may occur in the perimenopause, and reduces the risk of endometrial and ovarian cancer by 50% for up to 10 to 15 years after the pill is stopped. Bone density is higher in combined pill users, but research hasn’t yet proved ex-pill users have fewer fractures in later life. Normal healthy women may safely take the combined contraceptive pill to age 50. The oestrogen content means that a menopause blood test (follicle stimulating hormone, FSH) will be inaccurate. If you do want a blood test, you will need to change to a progestogen-only pill or implant, IUD or IUS. However, official NICE guidelines say menopause blood tests aren’t necessary in women over 45 if they have menopausal symptoms.

What can you tell me about using natural progesterone cream to help menopausal symptoms?

Dr Sarah Gray, GP, replies:

Natural progesterone cream is available from a variety of sources but not on NHS prescription. This is because scientific assessment has shown that very little, if any, progesterone is absorbed through the skin. Some years ago, a study showed that natural progesterone cream didn’t bring about the protective changes to the uterine lining that are required to balance the effect of oestrogen. It’s not recommended by menopause experts.

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