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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 70 (autumn 2016) and 71 (winter 2016/2017) 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.

I am 53 and had a hysterectomy two years ago. I still have my ovaries. My main problem is depression. I am healthy and don’t take medication. I have tried several different types of antidepressants but these haven’t helped. What can you suggest?

This question was answered by Dani Singer, specialist menopause counsellor and psychotherapist.

Anecdotally, around 50% of women who have a hysterectomy go on to experience depression, and a quarter seek additional support. Oestrogen affects the part of your brain that’s responsible for mood. Sometimes post-op depression can be treated by adding oestrogen back, especially if you’re experiencing other symptoms (hot flushes etc). But this may not be the case with you. Women who have previously suffered from depression may be particularly susceptible to the combination of hormone drop and a possible tendency to focus on perceived negative aspects of their situation. Hysterectomies are often performed due to serious or life-threatening conditions, contributing to feelings of a lack of control and frailty.

If possible, enjoy physical activities, such as dancing (e.g. Zumba with a partner or friend), as this can help raise levels of serotonin, the feel good hormone. Any pleasurable way to burn calories and increase your blood flow will help to make you alert and feel uplifted. Yoga prompts the release of gamma-aminobutyric acid (GABA), which promotes calmness and tranquillity, as can relaxation techniques and mindfulness. Using a combination of the above consistently may be all that you need. Consulting a hormonal specialist may help too. As you are two years on and still struggling, consider accessing a counsellor or psychologist for cognitive behavioural therapy (CBT).

At what age are blood tests carried out to see if a woman is at the menopause? What blood tests are used?

This question was answered by Dr Sarah Gray, GP.

The menopause is technically the last period that you have and can only be identified when you haven’t had another for a year. At that point, you are said to be postmenopausal. The state of change leading up to this is identified from your bleeding pattern and your symptoms. Blood tests aren’t recommended as they don’t provide a diagnosis, merely a confirmation. They may be used in young women (under 40) to support a clinical diagnosis, however. The main use is that a persistently raised FSH (follicle stimulating hormone) shows that ovaries are persistently failing to respond. This is not, however, a guarantee that there will be no future activity.

I am 45 and have fibroids. Will they be affected by the menopause?

This question was answered by Dr Kathryn Clement, consultant in sexual and reproductive healthcare.

Fibroids are found in your uterus. They’re formed by the muscle fibres that normally make up the uterine muscle. They vary in size and can develop within the muscle itself or project inside your uterus or out into your pelvic cavity. Fibroids can’t become cancerous, but they can cause heavy menstrual bleeding or pressure symptoms due to their size. Most fibroids become less troublesome after the menopause because they’re triggered by the hormone oestrogen, and levels of this hormone drop at the menopause. This means fibroids tend to shrink from the menopause onwards. The fact that periods stop at the menopause means that the heavy bleeding associated with fibroids won’t occur either. If you take HRT, this can continue to stimulate the fibroids, which then keep growing and cause period problems. Vaginal oestrogens alone don’t cause fibroids to grow.

How do I know if I’m fertile if I’m on HRT?

This question was answered by Dr Nicola Mullin, consultant.

It can be tricky to know when to stop using contraception, particularly if you started HRT before your natural periods stopped. HRT by itself is not a contraceptive. It’s recommended that women use contraception for 12 months after their last natural period if they’re over 50 and for two years if they’re under 50. This is because even after several months without a period, a spontaneous ovulation may occur without any warning and this can lead to a risk of pregnancy.

It’s possible to check your hormone levels with blood tests while taking progestogen-only contraception (e.g. a progestogen-only pill or Mirena IUS) or a non-hormonal contraception such as condoms or an IUD but not while on oestrogen-containing contraception or HRT. The hormone oestrogen interferes with levels of the other female hormones, FSH (follicle stimulating hormone) and LH (luteinising hormone), which rise as women become perimenopausal.

If two FSH levels are higher than 30 IU/L, taken six weeks apart, then contraception should be continued for another 12 months or the Mirena removed in 12 months’ time. But if a woman is taking HRT, the only way to get a reliable blood test result would be to completely stop HRT for eight to 10 weeks, take the first sample after four weeks and another at six weeks. Many women wouldn’t be happy to do this, and most healthcare professionals would advise that the simplest way to be safe is to use a progestogen-only method or an IUS or IUD alongside HRT until age 55.

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