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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 83 (winter 2019-20) and issue 84 (spring 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 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.

Can I take complementary medicines with HRT to help my menopausal symptoms?

Dr Sarah Gray, GP, replies:

The answer to this is possibly, but you need to be careful if you’re going to take any complementary medicines. At the top of my ‘to be avoided’ list are Chinese herbs (which contain an unidentified mixture of ingredients, some of which may be actively harmful) and St John’s Wort (which will make HRT less effective and may also affect sexual function, including how much you want and enjoy sex). The mildly oestrogenic soy derivatives are unlikely to do any harm, but these are so much less active than true oestrogen that they will have little to add to HRT. Agnus castus may help to ease mood swings for some women. There’s no research looking at the use of black cohosh with HRT. In theory, it may help to ease hot flushes, but doctors can’t say for certain that it will. Calcium supplements are, however, a good idea if your diet doesn’t deliver enough calcium, and some vitamin D will help your bone health if your sunlight exposure is limited. These will both work with HRT. Other vitamins and minerals are generally only needed if your diet doesn’t provide a good balance of fresh food.

If women take the contraceptive pill, will it affect their experience of the menopause?

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

Women who don’t have any medical conditions are currently advised to take the combined oral contraceptive (COC) pill until the age of 50. Many women have erratic bleed patterns and classic hot flushes and night sweats as they become menopausal. But if you’re on the COC pill, these symptoms will be masked, which means you won’t notice them. As the COC pill contains oestrogen and progestogen hormones, it will also protect against bone loss and osteoporosis. If you have any medical conditions, you should check with your doctor, who may advise that you use other contraception. For example, a woman who is 35 or older and smokes or has a history of migraine will be advised to stop the COC pill and change to another form of contraception. The progestogen only pill (POP) is sometimes called the ‘mini pill’. It may be recommended if the COC pill isn’t suitable, such as for breastfeeding women, smokers over 35 and some women with migraine. If you have any medical conditions, your doctor will discuss whether you can use the POP pill. Current advice is that the POP isn’t linked with an increased risk of blood clots, strokes or heart attacks and it doesn’t affect bone density. You can use the POP until you reach the age of 55, after which there’s no need to use any contraception. Many women have menopausal symptoms as they go through the menopause, and blood tests can be used to check whether you have gone through the menopause while you’re taking the POP.

What is the difference between vaginal lubricants and vaginal moisturisers? And can you give me any examples?

Dr Kathryn Clement, consultant in sexual and reproductive healthcare, replies:

Vaginal lubricants are gels that lubricate intimate tissues and are most often used during sex when there’s vaginal dryness or soreness. The effects tend to be short-lived and some of the older varieties, unfortunately, can leave a sticky or tacky feeling as they dry. Some lubricants contain oil and can weaken condoms. Examples include KY Jelly, Durex Play range, Yes WB, Yes OB and Sylk.

Vaginal moisturisers help with dryness but are designed to last longer so they can be applied every now and again. They can ease symptoms straight away but using them regularly may give long-lasting relief. Some products are available on NHS prescription and many can be bought in pharmacies or online. These are a good alternative for women who can’t use vaginal oestrogens for medical reasons, such as breast cancer treatment. Examples include Replens MD, Yes VM, Canesintima Intimate Moisturiser.

Can any vitamins and minerals help hair loss and thinning? Can I get them from foods and supplements?

Gaynor Bussell, dietitian, replies:

A change in hormone levels during the menopause can have an negative effect on your hair. Any deficiency in your diet is going to reflect in the condition of your hair and skin, so don’t miss out on any food groups, and make sure you eat as wide a variety of food as possible. Don’t go short on protein as this forms the basic building blocks of hair. Fat provides fat-soluble vitamins and essential fatty acids, which are important for hair lustre, but go easy on saturated fats and trans fats. Eat unrefined carbohydrates that are rich in wholegrains and fibre. Vitamins that are important for hair quality and quantity include C, B group and A. Important minerals include zinc, iron, copper, selenium, silicon, magnesium and calcium. If your diet is balanced and varied, you should be getting enough of these nutrients without resorting to dietary supplements.

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