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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 issue 84 (spring 2020), issue 85 (summer 2020) and issue 86 (autumn 2020) 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’m 49 and perimenopausal. Hot flushes are making my life very difficult. I don’t have any medical conditions or take medicines. Which herbal remedies could I try?

Mr Nick Panay, consultant gynaecologist, replies:

I would recommend using a product that has, at least, some evidence for its effectiveness and safety through basic research and clinical trials. You could either opt for herbal remedies that don’t have any oestrogenic (oestrogen-like) action or phytoestrogens, which are plant products with some similarities to oestrogen in how they work. Evidence-based non-oestrogenic herbal remedies include St John’s Wort and pollen extract products. Evidence-based phytoestrogenic products include red clover and soy-derived products. In my view, it’s better to opt for pure preparations containing one rather than multiple ingredients. Be aware that some of these products interact with medicines, so it’s important to read the label carefully. It’s also important to look for the Traditional Herbal Registration kitemark; the manufacturers of these products have to submit information about the safety, quality and traditional use of the product (but not its effectiveness).

I am 59. I would like to do as much as possible to prevent problems with my teeth and gums. Which foods should I eat to get the correct nutrients?

Angie Jefferson, consultant dietitian, replies:

One of the best ways to look after your teeth and gums is to brush twice a day with a fluoride toothpaste and to use dental floss. You should also eat nutrient-rich foods from all of the food groups. Focus in particular on calcium-rich foods, such as low fat or fat-free milk, yoghurt or cheese, calcium-fortified plant alternatives to dairy, tofu, canned salmon or sardines, almonds and dark green leafy vegetables. Eat calcium-rich foods two to three times a day. Phosphorous, which is found in eggs, fish, lean meat, dairy foods, nuts and beans, is good for strong teeth. Vitamin C encourages good gum health, so eat plenty of citrus fruits, tomatoes, peppers, broccoli, potatoes and spinach. Smart snacking will also help to keep your mouth in good shape. Resist the urge to snack regularly, and choose snacks wisely. The worst offenders are hard sweets and sticky toffee; opt for nutritious choices, such as raw vegetables, fruit, plain yoghurt and popcorn.

I am 51. My joints feel stiff when I get out of bed in the morning. Is this a menopausal symptom? I don’t want to make a GP appointment at the moment. Do you have any tips?

Dr Jenifer Worden, GP, replies:

Aches and pains are more common during the menopause, although the exact reasons for this aren’t known. Research has shown that putting women into a menopausal state by giving them anti-oestrogen medicines, as happens in breast cancer treatment, increases joint pain symptoms, which then settle when the treatment is stopped. So we know that stiffness and pain in joints can be a normal symptom of the menopause. Regular exercise, even just a 30-minute walk four times a week, can help to keep joints mobile and offset stiffness due to getting older. However, it may be worth having a telephone call with your GP to rule out other causes of joint stiffness, such as rheumatoid arthritis is or polymyalgia rheumatica, which are serious but easily treated, if recognised early.

I’m 49 and often feel very anxious, especially just before my period (which is still regular). I don’t have any other symptoms of the menopause. Since the coronavirus pandemic began, my anxiety has been getting worse, not just about the pandemic but about general things as well. I don’t want to go to my doctor or see a counsellor about it at the moment. Can you recommend any online resources or anything else that may help me?

Dani Singer, specialist menopause counsellor and psychotherapist, replies:

It sounds like you’re in the perimenopause, when hormonal fluctuations can already be trying. Around 25% of women experience greater anxiety without the pandemic halting ‘normal’ life and creating uncertainty. Your fear instinct may help you to remember to wear a mask in public and regularly wash your hands, but wearing a mask in the middle of hot flushes (if you start to get these) can be uncomfortable. It’s all too easy to get caught up in negative ‘what ifs’ scenarios. Fortunately there are now several online anxiety resources and apps that you may find interesting to explore, many of these for free, so look at the NHS App Library (which recommends apps for mindfulness, panic attacks, anxiety and managing your emotions) and information on Anxiety UK’s website (, including free digital booklets on stress & anxiety and breathing & relaxation.

I often feel hot and bothered and clammy all over, which I think is a hot flush for me. I am 51. How would I tell the difference between this and a mild fever?

Kathy Abernethy, senior nurse specialist, replies:

Hot flushes tend to come and go fairly quickly, even though they may happen often, whereas you will find a fever doesn’t go away. Hot flushes don’t usually raise your core temperature at all, so if you take your temperature soon after one it won’t be higher than usual. If you have a fever, it will stay high. Similarly, taking paracetamol will lower a fever but won’t affect hot flushes.

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