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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 87 (winter 2020/21) and issue 88 (spring 2021) 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 found your recent article on workplace menopause policies and guidance (issue 86) really interesting. You mentioned having a menopause champion or ambassador. Who would be the best person for this role?

Norma Goldman, founder and director of The Menopause Exchange, replies:

You could choose an employee going through the menopause or someone with an interest in the menopause. This could be a learning and development manager, an equality, diversity and inclusion officer or a health and wellbeing manager. It could also be someone working in the PR or occupational health departments.

I’m 52. I have no medical conditions and I’m not taking any medicines. Can non-hormonal prescribed treatments help hot flushes?

Mr Nick Panay, consultant gynaecologist,replies:

Medication that may help these symptoms include antidepressants (such as venlafaxine) and neuropathic pain drugs (such as gabapentin). Research is currently being conducted into neurokinin antagonists, which work on the part of the brain where it’s thought these symptoms are generated.

I’m a GP. I would like to begin prescribing Utrogestan capsules instead of the progestogens I usually prescribe. What’s the best way to prescribe these – the dose, frequency (how often) and at what time of day should these be taken?

Dr Sarah Gray, GP, replies:

Utrogestan can be prescribed cyclically or continuously. If a woman has had a period within 12 months, she should take two 100mg capsules at bedtime from day 15 of her menstrual cycle for 14 days. This is essentially two weeks on and two weeks off. This mimics the pattern in combined preparations, such as Femoston 2:10. It may need to be adapted if the woman is still regularly ovulating but has a shorter cycle. The evidence suggests that taking Utrogestan for 10 days is the minimum necessary, and 12 to 14 is better. So, if she has a 25-day cycle, she should start at day 11. The licensed advice for taking Utrogestan capsules continuously is to take one 100mg capsule daily for 25 days and then to stop for three days. This isn’t what we do in the UK, where we tell women to take 100mg continuously every night. Some women find it makes them drowsy, which is why the standard advice is to take the capsule at bedtime.

I always feel bloated after eating bread and pasta, and sometimes get diarrhoea too. Can gluten intolerance develop at any age, and should I ask my GP for a test?

Angie Jefferson, consultant dietitian, replies:

Gluten intolerance can occur at any age and is often linked to the immune system, which can change at any time. So do speak to your GP. It’s important NOT to cut out bread and pasta until you’ve had tests, as this can cause false results. There are different levels of intolerance: coeliac disease, non-coeliac gluten intolerance, or an intolerance to wheat. It may be helpful to do Coeliac UK’s free online assessment (https://isitcoeliacdisease.org.uk/#) to see if your symptoms could be linked to coeliac disease.

I’m 45 and perimenopausal. Will my fibroids be affected by the menopause? If so, how?

Dr Jeni Worden, GP, replies:

Fibroids are oestrogen sensitive, which means once levels of oestrogen in your bloodstream reduce during and after the menopause, they’ll shrink down. But sometimes changes in your hormone levels during the menopause can mean they sometimes get slightly bigger and add to the heavy periods associated with the perimenopause. Most gynaecologists try to manage this with medicines to reduce bleeding at period time or can carry out an operation to cut off the fibroid’s blood supply (embolisation); hysterectomy is rarely needed these days. You may notice no difference as you go through the menopause, but if you have any concerns, contact your GP for further advice.

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