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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 issues 90 (autumn 2021) & 91 (winter 2021/2022) 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

My mother and grandmother both had osteoporosis. I’m 43. What can I do to prevent it?
Dr Nuttan Tanna, pharmacist consultant, replies:

With a family history of osteoporosis, it’s important to consider what you can do to help slow down the process of bone loss. Especially if there’s also a family history of a fracture (broken bone). Bone density loss happens as we grow older. A healthy balanced diet, not smoking, reducing alcohol intake, doing regular weight bearing exercise and relaxation strategies, which can help to motivate you to do regular exercise, are all ways of keeping your bones strong. When you reach the menopause, your oestrogen levels fall. Oestrogen protects women from losing bone density. At this stage you should see your GP to discuss whether HRT would help. Other risk factors can make a woman with osteoporosis end up with a higher risk of having a low trauma broken bone. This is when the bone breaks with very little pressure put on it. If you have other medical conditions or have had a fracture in the past, it’s important to see your GP to discuss whether you need to be on stronger bone-protective medicines.

Can acupuncture help to control hot flushes at the menopause?
Kathy Abernethy, senior nurse specialist, replies:

There’s some evidence that acupuncture can help to improve quality of life around the menopause. Small studies comparing real acupuncture with sham (or pretend) acupuncture have been shown to help sleep, hot flushes and mood swings. Whether this is an actual effect of acupuncture on hot flushes is unclear. It may be the full experience of seeing a sympathetic practitioner, understanding your symptoms, being mindful and taking time for yourself, as well as any direct acupuncture effect that may be of benefit. Be sure to use a registered practitioner and check out the costs upfront.

Are the risks of breast cancer smaller on a lower dose of oestrogen- or progestogen-containing HRT?
Dr Diana Mansour, consultant doctor, replies:

Recent data suggests that neither the dose nor the route of oestrogen in HRT affects the potential increased risk of breast cancer with HRT. The key ingredient that affects breast cancer risk is the type of progestogen used and the length of its use. Data suggests there appears to be a small increased risk of breast cancer if oestrogen replacement therapy is started when women are in their early 50s. For women with a uterus, there’s a further increase in risk if progestogen is added. Taking progestogen continuously in HRT rather than sequentially (for example, 12 to 14 days of each 28-day cycle) adversely affects risk too. The type of progestogen is important. Dydrogesterone has the least impact, and probably micronised progesterone too (although there were too few subjects in the studies to confirm this). The impact on breast cancer risk with the use of the Mirena IUS is still unclear.

I was interested to read about vaginal moisturisers and lubricants in the article on ‘Easing vaginal dryness’ in issue 88 of The Menopause Exchange. Which products do you suggest?
Kathy Abernethy, senior nurse specialist, replies:

Moisturisers help to encourage moisture into the vagina. They’re used on a regular basis (every three days or so) and will last a few days. They’re not used in association with sex. Examples are Yes VM, Replens and Hyalofemme. You may find one suits you more than another, so it’s worth trying a couple of them. You may see some added discharge at first. Lubricants (lubes) are short-lasting and are used at the time of sex or at any time you want to soothe skin that feels dry or itchy. These create the added ‘slippiness’ needed to make lovemaking comfortable, and often enhancing sensation too. Avoid those with added perfumes. Keep to natural products, as vaginal skin after the menopause may be irritated by some additives. Examples of lubes include Sylk, Yes WB, Yes OB (oil based). If you’re using condoms, avoid oil-based lubes. Many people use a combination of a regular moisturiser with ad hoc lubes. Remember too that local vaginal oestrogen can be used with any lube or moisturiser.

I’m 52, and I’m currently going through the perimenopause with irregular periods but not flushes and sweats. Recently I’ve been suffering from depression. I’ve not yet been to my doctor. What do you suggest?
Dani Singer, specialist menopause counsellor and psychotherapist, replies:

Perimenopause is the time, flexible in length, where our hormones fluctuate. Some studies have linked depression to the perimenopause via genetic mutations, but this still isn’t definitive and any link is complex. Other factors, common at this time of life, can trigger depression. These include a previous history of depression, stressful life events (e.g. divorce or job loss), disappointment about having any or more children, ill health or death of a parent, negative feelings about the menopause, and aging. Always helpful is self care in the form of a healthy calcium-rich and protein-rich diet, exercise, yoga practice to help regulate body rhythm, listening to music, and mindfulness. Some women have found that acupuncture or acupressure can help too. If the depression is more severe or persistent, cognitive behavioural therapy (CBT), HRT or antidepressants may help. All of these are accessible via your GP.

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