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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 80 (spring 2019) 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 thinking of going on HRT. Will it affect my eyes and contact lenses?

Dr Nuttan Tanna, pharmacist consultant (women’s health & older people), replies:

No research shows that HRT can affect contact lenses. But changes in contact lens comfort are related to your menstrual cycle and may be affected by the menopause. Both high and low oestrogen affect your eyes differently during different stages of the menstrual cycle. Many women going through the menopause struggle with dry eyes, and HRT may not help. Treatments for dry eyes include eye drops and dietary supplements. Warm compresses can help if you have dry eyes at the end of the day due to strained eyes after spending a lot of time reading or at the computer. If you wear contact lenses, it’s also important to follow good lens hygiene advice.

Does IVF have an impact on the menopause and does it bring on the menopause earlier?

Kathy Abernethy, senior nurse specialist, replies:

The IVF process doesn’t affect the onset of the menopause, even though you may be worried about stimulating your ovaries during this time. Sometimes the women who need IVF because of poor ovarian reserves are the same women who go on to have an earlier menopause. This isn’t because they’ve had IVF but it’s because of the underlying problem with their ovaries. Not all women who need IVF have poor ovarian function and many factors contribute to getting pregnant, so IVF isn’t a predictor of early menopause.

What are the different stages of the menopause, at what age can I expect them and how long do they last?

Kathy Abernethy, senior nurse specialist, replies:

The term ‘pre-menopause’ refers to the years leading up to changes in your periods and other menopausal symptoms. For most women, this lasts until around their early 40s. Women then enter the ‘perimenopause’ phase, which is when symptoms commonly occur and periods may start to change in pattern or regularity. It’s only during this time that you will have your last actual period, although you won’t know that at the time, only in hindsight. If you’re around your late 40s or early 50s, then once you haven’t seen a natural period for one year, you’re ‘postmenopausal’. Unfortunately for some, even this doesn’t mean the end of symptoms as they may last well into the post-menopause. If you’re under 40, the term ‘premature ovarian insufficiency’ is used when your periods stop. In young women, it’s not so clear which of the phases you’re in until well after your periods stop.

I’m 62 and still have hot flushes. These affect my life just as much as they did when I was in my 50s. What advice can you give me? I don’t want to take HRT. I don’t have any medical conditions and I’m not taking any medicines.

Dr Sarah Gray, GP, replies:

Every woman experiences the menopause and post-menopause differently, both in how bad their symptoms are and how long these last. Not all women have flushes but for the majority that do, these typically last for at least five years and then gradually get better. But I often see women who tell me that their flushes aren’t any better. Sometimes, these even seem to get worse at around the ten-year point. This may be linked to reduced testosterone production. There are limited options to ease flushes, but the most useful self-help ones are to exercise vigorously and avoid alcohol.

I’ve heard that having phytoestrogens (plant oestrogens) in food and drink is helpful at the menopause. Which menopausal symptoms do they help and which foods contain them?

Gaynor Bussell, dietitian, replies:

When your body goes through the menopause, your level of oestrogen falls, causing menopausal symptoms. Having extra phytoestrogens in your diet can help to boost your oestrogen levels but only mildly. This won’t be as much as if you were taking HRT, but may be enough to offset hot flushes and other symptoms. As an added bonus, phytoestrogens can also help to lower cholesterol levels. Research shows that to reduce hot flushes, you need around 40 to 80 mg of phytoestrogens daily. Soya products are one of the richest sources of phytoestrogens: a 250 ml glass of soya milk contains around 20 mg and a portion of tofu contains around 30 mg. Other foods containing phytoestrogens include oats, linseeds and lentils.

Is bio-identical HRT available on the NHS?

Dr Nuttan Tanna, pharmacist consultant (women’s health & older people), replies:

‘Bio-identical hormone’ products contain exact copies of hormones made by the ovaries and adrenal and thyroid glands. The hormones in these products will include oestradiol, oestriol, oestrone, progesterone, testosterone, dehydroepiandrosterone and levothyroxine. Some doctors in private practice will prescribe what they call ‘bio-identical hormones’ after a woman has a series of expensive serum and saliva tests, a practice that’s not backed up by strong research as being good medical practice. These private prescriptions may be dispensed by specialist compounding pharmacies, but it’s important to note that the production of these isn’t regulated. These medicines are not available on the NHS. There are regulated HRT products that are ‘body identical’ on the NHS. These can be prescribed after a good medical history has been taken alongside a risk-benefit discussion with the patient.

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