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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 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.

Does HRT have an effect on migraine?

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

If you have a history of migraines during your period and you’re prescribed a monthly bleed type of HRT, you may get migraines with your HRT-pack bleeds. You should discuss this with your GP or healthcare professional, as a different HRT may suit you better. If you’ve never had migraines but find you’re getting them with a particular type of HRT, discuss this with a healthcare professional, as you may need to change your HRT. Changing the progestogen hormone may be a simple solution. If you have very bad migraines, stop HRT and seek medical advice. To manage stress-induced migraines or headaches, try relaxation therapy and identify any triggers. If stress is partly due to menopausal symptoms and affects your quality of life, HRT will help.

What are antioxidants and will they help me during the menopause? If so, in which foods are they found?

Gaynor Bussell, dietitian, replies:

Antioxidants are substances that can protect your cells from the damaging effects of free radicals. Free radicals are made when your body breaks down food or is exposed to tobacco smoke and radiation. These play a role in the development of certain diseases, such as heart disease and cancer.

The risk of these diseases tends to rise when you reach the menopause due to falling oestrogen levels, so it’s important to get plenty of antioxidants in your diet: eating foods rather than taking supplements is the most effective way to do this. The best sources of antioxidants are colourful fruits and vegetables, such as blueberries, raspberries, broccoli, cabbage and spinach, red kidney beans and some products made from plants, such as tea, red wine and dark chocolate.

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’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 (www.anxietyuk.org.uk), including free digital booklets on stress & anxiety and breathing & relaxation.

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.

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