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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 90 (autumn 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.

Does HRT prevent osteoporosis?
Mr Nick Panay, consultant gynaecologist, replies:

Yes! The main indication for HRT is menopause symptom control. However, HRT not only treats osteoporosis but also increases bone density in women who don’t have osteoporosis, whichever age group it’s started at. HRT also reduces the risk of osteoporosis-related broken bones. There’s a dose dependent effect – the higher the dose, the greater the benefit. Bone density starts to reduce when women stop HRT but they may still get some benefit after this, even in the long term. Any treatment with HRT should be underpinned by weight bearing exercise, a good diet with adequate calcium and vitamin D, reducing alcohol consumption and avoiding smoking.

I’m 37. I’m having a hysterectomy soon but will be keeping my ovaries. How will a hysterectomy affect me? How can I cope?
Dr Jeni Worden, GP, replies:

If you’re having a hysterectomy at a relatively young age for a non-cancerous condition, such as a pelvic floor prolapse or heavy periods (causing anaemia), then you should feel physically better afterwards, but remember that having a hysterectomy is still a major operation. It can take at least six weeks to feel back to near-normal activities after a vaginal or laparoscopic (keyhole) hysterectomy or slightly longer after you’ve had an abdominal hysterectomy. Bear in mind there can be emotional issues associated with losing the means to having a baby. For some women, there’s relief that they don’t have to worry about periods and contraception any more; for others, there’s a sense of loss, even if their families were complete or not a concern. Your hospital may be able to advise you of a local support group.

How many portions of fruit and vegetables should I be eating each day for good health? Which are best out of fresh, frozen, tinned or dried fruits and vegetables?
Angie Jefferson, consultant dietitian, replies:

We should eat at least five servings of vegetables and fruit every day. This could be split further into at least three servings of vegetables and two of fruit. Fewer than one in three of us actually manage to eat five-a-day so there’s plenty of room for improvement. Fresh, frozen, canned and dried all count equally. In terms of vitamin C, levels will be highest in frozen and fresh but other vitamins, minerals and antioxidants are less affected by canning and drying. Vitamin C is easily destroyed, so try to steam, microwave or stir fry. When cooking in a pan of water, use the smallest amount of water possible and don’t overcook. The different colours are different antioxidants and vitamins – so try to eat a rainbow of colours and at least five servings every day.

Which HRT products are likely to cause less breast pain?
Dr Diana Mansour, consultant doctor, replies:

Before starting HRT, be breast aware so you’re familiar with how your breasts look and feel. If you’re between 50 and 70, you’ll automatically be invited for breast screening every three years. Breast pain and discomfort aren’t uncommon when you first start HRT, especially if there’s at least 12 months between your last natural period and starting HRT. Breast tenderness tends to get better over the first two to three months. If it continues, wearing a supportive, well-fitting bra and taking oil of evening primrose may ease discomfort. If the pain carries on, discuss it with your healthcare professional. They may suggest reducing the dose of oestrogen in HRT. For example, taking a 1 mg oestradiol oral product rather than 2 mg product or using an oestradiol 25 mcg/24 hour patch rather than a 50 mcg/24 hour patch. If you have a uterus, this may mean taking progestogen separately as a tablet or having a Mirena IUS fitted. Tibolone, a medicine that breaks down to a small amount of oestrogen, progestogen and androgen, is another useful option. It’s been shown to give less breast pain than low dose oral HRT products.

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