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Menopause myths are rife. And as the UK finally wakes up to the reality of the perimenopause for women, there are many sources of information. It’s important to check these are reliable. The myths can come from family, friends, printed and social media and, more concerningly, other healthcare professionals. It’s important to question the logic of many of the statements around the menopause and HRT, and if they don’t make sense, check them out.

This article was included in issue 91 (Winter 2021-2022) of The Menopause Exchange newsletter.

The menopause happens to ‘older’ women
The average age of the menopause, which is determined as one year from your last period, is 51 in Western Europe. Many women may not know when this is if they’re using hormones for contraception or the menopause or the Mirena IUS or other medicines to treat heavy bleeding. The perimenopause can span a few years either side of this age, similar to puberty. So half of women will start to have menopausal symptoms a few years before they reach the age of 51, and half will start their symptoms after this. Age is in the eye of the beholder!

Blood tests can tell me at which stage of the menopause I’m at
The perimenopause is a time of changing hormone levels, when your ovaries are running out of eggs so your menstrual cycle is frequently not regular. At any one time, the blood tests may be normal or abnormal. It’s not recommended by NICE (National Institute of Health and Care Excellence) that blood tests are used to diagnose the menopause in a woman of average age for menopausal symptoms. But these can be used to diagnose those going through the menopause earlier than 45 (early menopause) or under 40 years (premature ovarian insufficiency, which affects one in 100 women).

All women get hot flushes and sweats
Although these are the most common symptoms in the perimenopause, they are not suffered by all women and may not be the most troublesome of symptoms. There are a vast number of different symptoms during the perimenopause. The difficulty in diagnosis may be life changes for midlife women at that time overlap with changes in mood, anxiety, brain fog, lack of concentration, memory loss, feeling overwhelmed and low libido. This can result in life, work and relationship issues.

Levels of oestrogen replacement correlate with level of risk
Women’s bodies absorb and break down oestrogen differently so the dose required to ease symptoms will vary according to the stage of the menopause and the woman herself. Comparing different doses with different modes of delivery and in other women may not be helpful. If you still have symptoms on a standard dose of HRT, the best way to assess how well oestradiol is being absorbed is to perform an oestradiol and FSH (follicle stimulating hormone) blood test. The FSH level will show the absorption or production of oestrogen in the previous few weeks. But occasionally a raised FSH level can indicate a spontaneous ovulation. There’s no convincing data to confirm that higher oestrogen levels in the body cause a higher degree of risk, but there are ranges of hormones that are considered acceptable.

I no longer need contraception at the menopause
It’s still possible to conceive around the time of the menopause, so contraception is advised for woman at this life stage, although their fertility will be lower than at a younger age. The risk of miscarriage is also much higher around the time of the menopause. Official guidance suggests that contraception should be used for two years after a diagnosis of the menopause under the age of 50 and for one year after the age of 50. HRT isn’t a contraceptive. There’s some evidence that women who have vaginal atrophy may have a slightly higher risk of sexually transmitted diseases, so it’s important to consider using barrier methods.

HRT causes ongoing bleeding
If you’ve had your last period within the last year, it’s preferable to use a cyclical bleeding regime of HRT to coordinate with your menstrual cycle so you don’t get erratic bleeding. But in the long term, it’s safer for your uterine lining to have a nonbleeding version of HRT called continuous combined HRT, for women who still have a uterus. It’s common to have some spotting during the first three months of changing onto this HRT regime but after that any unexpected bleeding should be investigated.

I need to have regular check ups when I’m taking HRT
You should have the normal routine health checks, including cervical smear screening and mammograms, in addition to blood pressure measurement for women over 50. But you don’t need anything over and above what would be routine for your personal and family history. It’s not necessary to have a blood pressure check at every new HRT prescription, unlike with the combined contraceptive pill where you have your blood pressure measured when you first start it and then at three and six month intervals. The ‘pill’ is synthetic and has a much greater negative effect on metabolism than most HRT regimes. Any blood tests should be organised according to your treatment goals and the usual screening for all postmenopausal women.

HRT can’t be taken forever
The length of time that you can take HRT is determined by your wishes, the age at which you start the HRT and the reasons why you’re taking it. There are no set times for how long HRT can be taken. Each decision should be carefully considered by you and a healthcare professional who understands prescribing around the menopause.

About the author
Dr Claudine Domoney is a consultant obstetrician and gynaecologist at Chelsea and Westminster Hospital, London, specialising in pelvic floor and hormonal & sexual problems.

Created Winter 2021-2022
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