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The Menopause Exchange Blog


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 78 (autumn 2018) and  79 (winter 2018/19) 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.

Please can you tell me about using black cohosh for menopausal symptoms?

Kathy Abernethy, senior nurse specialist, replies:

Black cohosh is a herbal treatment that, over the years, has been used to help menopausal symptoms. While there’s a lack of good scientific evidence to show that it may be effective, NICE guidance in the UK states that there may be some evidence that black cohosh helps flushes and sweats. The quality of products varies, so buy a standardised product from a UK-based supplier. Black cohosh sold directly in the UK must meet standards in terms of quality and safety, whereas some online providers from overseas may not. In the past, there has been a link with liver problems. This is less of a problem with doses found in UK products, but anyone with liver issues already should avoid it. Black cohosh isn’t recommended for women who have had breast cancer.

Is there anything special about how Asian women experience the menopause?

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

Asian women generally report lower rate of menopausal symptoms compared with women in western countries. This may be explained by the Asian culture, where social status increases with age and because of a positive attitude to ageing, which means that women don’t struggle with, or complain of, menopausal symptoms – instead, they accept this as part of getting older. A 2005 study found that Asian post-menopausal women have more backache and muscle and joint pains but less frequent hot flushes and night sweats compared with western women. However, the authors say that it’s difficult to explain the results because of the diversity in Asian populations, where, for example, research shows that Japanese women don’t struggle with, or have, hot flushes as such but Chinese women do. A 2010 US study found that the most severe symptom experienced by Chinese and Korean women was ’forgetfulness’. For Asian Indian women, it was ’exhaustion or fatigue’ and for other Asian women it was ‘loss of sexual interest’. More recently, information from the SWAN (Study of Women Across the Nation) study found wide differences in menopausal symptoms among racial and ethnic groups. It’s thought that Asian women who have settled in western countries now live a westernised lifestyle and have information more readily available about the menopause. This, in turn, makes them seek help from a healthcare professional when going through the menopause.


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I am 51. What foods will benefit my skin?

Angie Jefferson, consultant dietitian, replies:

Our skin lets fluid (sweat) out but not in, makes vitamin D and is completely replaced every seven weeks. No wonder it sometimes feels a little dry and neglected! Nutrients that help to maintain healthy skin include vitamin A, vitamin B group, vitamin C, biotin and iodine. Unsaturated oils (e.g. olive and rapeseed oil) and omega-3 oils from oily fish can help to improve dry skin and conditions such as psoriasis. The best route to healthy skin is to eat a healthy diet: fruit and vegetables in a rainbow of colours; fish and seafood; lean meats and poultry; wholegrains and higher fibre carbohydrates; and small amounts of unsaturated oils.

I’m taking thyroxine tablets for hypothyroidism and I’m thinking of going on HRT to help my night sweats. Will HRT have any effect on the thyroxine I’m taking?

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

HRT can increase a protein in your blood that binds to thyroxine hormone. This means that you have less free thyroid hormone in your blood, so thyroxine tablets don’t work so well. You should have your thyroid levels checked four to six weeks after starting HRT to see if these have dropped and whether you should be taking a higher dose of thyroxine. This varies from person and person and also depends on which preparation you’re taking. It’s always wise to get your thyroxine levels checked after you’ve started a new HRT product or changed the dose or type of preparation. There are plenty of women who take both HRT and thyroxine so it shouldn’t put you off trying HRT.

I get lots of cysts in my breasts. About three years ago, when I had a large cyst, I had a mammogram. I’ve been told it’s quite normal to get more and more cysts as you get older, and mine are syringed to relieve the pain. The trouble is that I’m getting more and more cysts, they’re rather large, at least an inch in circumference, and can get quite painful. Is there anything I can do to stop them or to relieve the symptoms?

Dr Jenifer Worden, GP, replies:

Breast cysts are the most common cause of breast lumps in women aged 30 to 50 and can be most troublesome around the peri-menopause. Caused by hormonal changes, they used to be considered part of a condition called ‘fibrocystic disease’ or ‘fibroadenosis’. These days, doctors use the medical term ‘Aberrations in the Normal Development and Involution of the Breast’ or ANDI, as the cysts aren’t a disease but are part of the normal ageing process all women go through. Breast cysts settle down after the menopause, when the hormonal fluctuations causing them reduce. There’s nothing you can specifically do to stop cysts, although some women find an evening primrose oil supplement (daily dose of 240mg gamma linolenic acid) is helpful. All breast lumps lasting for longer than a couple of weeks should be checked by a doctor or suitably qualified healthcare professional.

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