Do you have questions about menopause? Ask Vira Health’s expert Dr Michelle Griffin - £200 voucher to be won

[CeriMumsnet]

Please note this Q&A is now closed for questions but you can see Dr Griffins answers here

Menopause can feel daunting and complicated. Maybe you’re perimenopausal; maybe your periods have stopped but you’re still having menopause-related symptoms. Maybe you’re going through an early menopause, or one brought on by medical treatment. Or maybe you’re just wondering what the next few years might hold for you and how you can best embrace (or at least get through) whatever may be heading your way. Vira Health is here to help, and their expert Dr Michelle Griffin will be answering your questions about everything to do with menopause from 18th to 27th Jan.

Here’s some more information about Dr Griffin: ‘Dr Michelle Griffin qualified as a doctor from University of Cambridge and specialised in Gynaecology, working in a number of hospitals in London and the East of England. She is a Member of the Royal College of Obstetrics and Gynaecology and has completed her training with the Faculty of Sexual and Reproductive Healthcare. She has worked in the NHS for over a decade, as well as for the Department of Health, Public Health England and the World Health Organisation on women’s health projects. She is leading the clinical development of Stella, a new app to help you manage your menopausal symptoms'.

Here’s what Vira Health, the team behind Stella has to say: “Women spend on average 7-10 years in menopause, with symptoms changing and fluctuating all the time. Yet, in the UK, less than 7% of women are satisfied with the care they receive. That’s not ok. Stella offers women personalised plans to help manage menopause symptoms better with support from an expert coach. From insomnia to weight gain and anxiety to incontinence issues, Stella supports women to find relief backed by proven science. Plans are customised to your needs and you can track your progress quickly and easily.”

If you feel in the dark about the symptoms of menopause, you’re looking for advice on managing its effects in day to day life, or you have questions about treatment or care options, you’re in the right place. Share your questions for Dr Griffin below and you’ll be entered into a prize draw where one Mumsnet user will win a £200 voucher for the store of their choice (from a list).

Thanks and good luck!

MNHQ
Insight Terms and Conditions apply

@TheProvincialLady

How can I tell the difference between fibroids and peri menopause? I have a huge family history of problematic fibroids leading to hysterectomy (mum, her 5 sisters, grandmother and her two sisters). I am now experiencing more frequent, heavier periods (and cycle related anxiety, insomnia and painful breasts) - how do I know when to see my GP?

Hi @TheProvincialLady, it is difficult to know from your question what issues and symptoms you are currently experiencing. If you have erractic, irregular and heavy bleeding you should go and see you GP to have a full assessment and run investigations including ultrasound scan to diagnose fibroids. Whether the fiborids and/or perimenopause is the cause of your symptoms, heavy bleeding and your other symptoms can be managed.

@Bemystarlord

I’m 38 and had a full hysterectomy two years ago, i currently have 100mg everol parches and testosterone but i’m really struggling with body pain and fatigue , my joins and muscles are constantly so painfu and i just feel so lethargic all the time and it is making me miserable. I’ve had full bloods and vitamin deficiency tested and everything is ok so i just don’t know what to do.

Hi @Bemystarlord

I am sorry to hear you are struggling. I would recommend you go back to your GP to discuss your options regarding changing HRT e.g different route, type, dose etc can all be changed to provide more relief. However, you also need to consider your exercise and fitness around joint pain and fatigue. Exercise will help this and does make women feel more energetic.

@PetrovYelyenaAndMe

I’m experiencing waves of a ‘jangly nerve’ feeling, particular night - as I’ve recently also started getting hot flushes I assume it’s a peri menopausal symptom but I can’t find it described in menopausal literature. It’s really unpleasant - what is it and is there anything I can do about it?

Thank you.

Hi @PetrovYelyenaAndMe, it sounds as though you are experiencing perimenopausal symptoms and the 'jangly' feeling is difficult to understand with the information you have given. However, it could be anxiety at night time which is very common and can come along side feeling the hot flushes and night sweats or it could be something quite separate. I would recommend reviewing your caffeine intake especially in the hours before bedtime, practise a bed time relaxation and wind down routine to see if that helps. Also it is worth getting this checked out by the GP because it can be a symptom of palpitations which can be the result of falling hormone levels in perimenopause but heart issues need to be ruled out.

@Montydoo

What is the best over the counter product you would recommend for vaginal dryness ? Or is there anything else - natural/herbal that can be used.

Thanks @Montydoo for your question. It would be good to understand a little more about the dryness. If it is there all the time or perhaps only a problem in reference to sex. Either way, it is wise to ensure you stop any irritants. You do not need to wash or douche a vagina. The vulva can be washed but only gently with a water, emoillient cream or a non perfumed, non allergenic soap. Then pat dry, do not rub. Wear comfortable, cotton underwear. And use a gentle non biological washing powder. Don't use scented sanitary or incontinence products, nor scented toilet paper. You can buy vaginal moisturisers over the counter in a pharmacy, these can also be given on prescription. It can take 3-4 weeks to see an effect. Do not use a non vaginal, 'body' moisturiser on your genitals as it will cause irritation. If you struggle with dryness during sex, you may want to use a lubricant as well (a moisturiser would be used more regularly, a lubricant is just used for sex, and you can be use both products). Note lubricants can cause irritation to a sensitive sore vulva and vagina. There are many different types - I would recommend a oil based one as it is thicker and creamier and lasts longer (water based feel more like natural lubrication but do not last very long and can become sticky). It is best to try a couple of different ones and see which you prefer.

@jobbyjg

I'm 36 and have a mirena cook so a lot of my menopause symptoms are weakens but I seem to suffer from in intense especially at night. Is this normal as I find it really embarrassing

Hi @jobbyjg! The Mirena IUS releases progesterone only and in such a small amount. It does control bleeding, making periods lighter and more regular. However, it will not have any masking or treatment effect on other symptoms of menopause. I am sorry but it is not clear what you are suffering from at night.

@OnlyTeaForMe

Is there any evidence that the menopause can bring about new allergies and intolerances? Since my mid-40s and perimenopause/menopause I've become allergic/ intolerant of several foods I previously ate happily.

Hi @OnlyTeaForMe, I am not aware of this. If you are allergic to more foods it may be worth seeing your GP to be referred for allergy testing to understand what is happening.

@mymenoname

I'm 48 and am on HRT and also sage tablets. How will I know when I can stop taking HRT? Is there an optimum length of time to be on it?

Hi @mymenoname, there is no optimum length to be on HRT. You need to be guided by your symptoms and also have at least annual reviews with your GP to discuss your personalised risks and benefits and decide when to stop.

@Destinysdaughter

Can HRT help with loss of libido and hair thinning? Also, how do you know which type of HRT is best for you?

Hi@Destinysdaughter. With regard to hair thinning and loss, approximately one third of women will develop some hair loss during or after menopause. Typically the hair loss during menopause is at the front around the hairline, as we get older it is around the crown and temples. Pubic and armpit hair also thins and becomes sparser. This is caused by decreased oestrogen levels. However, there are, like most menopausal symptoms, multiple reasons for this, so it is worth seeing your GP to be checked out. Low iron levels (particularly likely if you are having heavy erratic periods) can contribute and easily topped up. Also, avoid factors which weaken the hair e.g. hair bleaches and dyes, excessive heat from dryers and straighteners. HRT may help with this and also provide improvement with vaginal symptoms which may improve libido. However, libido is affected by many factors depending on cause (e.g. your relationship with your partner, any issues your partner may have etc). Testosterone can help in some women to improve interest in sex and sexual desire.

@Cismyfatarse

Does HRT prevent signs of ageing such as grey hair / wrinkles / loss of muscle?

I have used it for a while now and am much less grey than my contemporaries but this could be genetic. My Mum had a hysterectomy so can't easily compare with her.

Hi @Cismyfatarse. Collagen nicely 'plumps' all of our tissues. As you say, older women's faces are less 'full' and skin is less elastic - this is due to falling collagen levels as we age and it happens to men and women. However, in women, the falling oestrogen also has an effect on collagen as well as on our muscles. HRT may help with this and also you are likely to have 'good genetics' and look after you skin.

@DrDolittlesParrot

I'm mid fifties, no periods for 2 years, on hrt patches and using local oestrogen. Now my gp has said I should be coming off hrt in the next year. I'm sure I've read this isn't the case. How do I approach this with him? Any documentation that I can print off to show him that will convince him?

I have lichen sclerosis and possibly vaginal atrophy, as often poison in my clitoris. I can't get a referral to a gynae specialist, my gp just prescribes steroid cream and local oestrogen. Have I anything to gain from insisting on a referral and how to go about it? I feel I'm just being dismissed by him. It's even more difficult, now I can't even sit opposite him when talking to him, but have to discuss everything on the phone.

Hi @DrDolittlesParrot, you are correct. There is no arbitrary limit or age when you need to stop HRT. You need to be guided by your symptoms, and your personalised risks and benefits of HRT. This is recommeded in both the NICE guidance and the British Menopause Society 2020 HRT recommendations. I hope that helps with your discussions with the GP. Regarding the lichen sclerosis, the typical treatment is steroid cream and oestrogen cream. I am not sure if this treatment is working for you or not. A referral to gynaecology may be useful as check that nothing else is causing the symptoms as well as optimising you treatment.

@Gazelda

I started menopause at 39 and have been on hrt ever since (I'm now 52). After struggling to get prescriptions this year, I haven't been on hrt medication for about 3 months. I'm now getting hot flushes and suffering with terrible insomnia. Surely this can't still be menopause? How can anyone tell when it's the right time to stop taking hrt?

Hello, @Gazelda. I am sorry you have been struggling with getting your HRT prescriptions - that sadly has been a very common experience with the current issues of pandemic and Brexit on supplies and being able to see your GP. It is likely you are suffering from symptoms of menopause (hot flushes and insomnia) in part because you may be still perimenopausal (you don't say what is happening with your periods) but also the body's reaction to stopping the HRT medication. Depending on how much oestrogen you were taking, a sudden stopping of HRT can cause some symptoms to reappear. It is best you arrange to see your GP to discuss your symptoms and review you overall risks and benefits about restarting HRT and also look at other options to help with your symptoms.

Thank you @DrMichelleGriffin. Sadly gp won't refer me to gynaecology.

@BeyondMyWits

I am currently perimenopausal (at56) and have a heart condition (heart attack at 53, coronary artery disease).

Would hrt help. I get night sweats. I get dryness everywhere. I get an occasional heavy period (last one 4 months back). I also seem to now be suffering from my guts slowing down.

EVERYTHING gets attributed to menopause if you mention it at the doctors.

Hi @BeyondMyWits, I am sorry you are having such symptoms. Menopausal symptoms can be quite vague and also be present due to other conditions, so it can be very difficult to determine exactly what is going on and what is the cause of symptoms. It is best you speak to your GP regarding your specific medical history to determine your risks and benefits of HRT. HRT can help with night sweats and dry skin. If you suffer from vaginal and vulval dryness, there is topical oestrogen cream as well. Also whilst at your GP you could ask about treatment options regarding your heavy periods.

@Snog

Should I swap from the oral HRT my GP gave me to a separate cream and pill? Is this likely to me A) safer and/or B) more effective in managing my symptoms specifically tiredness I'm 7 years post menopause.

Hi @Snog, the evidence shows that transdermal HRT (that is via patch or gel etc) is generally safer than the tablets in terms of lower risk of a clot in the legs and a stroke. However, it is best to discuss this with your GP as there may be a specific reason why you were prescribed it in the tablet form. Every woman should have a discussion with their GP regarding their personalised risks and benefits of taking HRT and the best route and dose. Note oestrogen cream is for topical use on the vulval and vagina. This has an incredibly low dose of oestrogen as it needs only to provide relief to the area the cream is being applied. It is incredibly effective but offers no relief for other menopausal symptoms since very little oestrogen enters the bloodstream.

@alwaysataldi

I have always felt that the menopause has not been taken seriously by employees, and make staff - women just 'get on with it'. My question would be if I wanted to take hormones to delay the menopause - are there any, what would you recommend, and what are the potential side effects ?

Hi @alwaysataldi, there are no hormones to delay menopause as such. But there is treatment to help with the symptoms of menopause. Women can take HRT-hormone replacement therapy, which is a term really to encompass many different medications, essentially replacing the hormones that are decreasing as a woman progresses through her menopause journey. There are also other non hormonal medications. However the best management of menopausal symptoms is based on your symptoms and personal medical history.

@ItsCovidOutThereThisChristmas

Do menopause symptoms come back when you stop taking HRT? Can you use oestrogen patches for much longer - so into 60's/70's if you choose?

Hi @ItsCovidOutThereThisChristmas. HRT replaces the hormones you are lacking as you progress through your menopause journey. Therefore when a woman stops HRT, she is likely to experience of lack of hormones again. However, you can come off HRT in a number of ways which helps with this and if you feel your symptoms are still present and not settling off HRT, you can discuss going back on HRT with your GP. There is not arbitrary limit on the duration of HRT use or a set age you must stop HRT, it is guided by your symptoms, benefits and risks.

@justmeand2DC

I'm 55 and have been taking HRT for 7 years since I started experiencing severe night sweats/insomnia. Initially my symptoms were completely alleviated but they have returned to a certain extent so not great but liveable. I started off on tablets then patches and now am using Sandrena sachets of 1.5 mg estradiol daily plus Utrogestan which is micronised progesterone. My question is why is the maximum estradiol dose I can be prescribed by my GP in the form of Sandrena only 1.5 mg whereas, if I understand correctly, if I had estrogel I could take 4 pumps daily which is 3 mg estradiol? Is this a licensing thing which I could bypass with a private prescription as I'm wondering if a higher dose might reduce the night sweats I'm still experiencing?

Another question, the Utrogestan was initially prescribed as 2 x 100mg daily for part of the cycle but now I've been told since I'm 55 and presumably post-menopausal I can take 1 x 100 mg continuously and I should no longer have a bleed. However I am still having a bleed approximately every 21-28 days after 6 months. Does this mean I'm not post-menopausal? I'm also a bit confused as to why the progesterone stays the same regardless of how much estradiol you take, maybe if I dropped the estradiol dose the daily progesterone might stop the monthly bleed?

Hi @justmeand2DC. There are a number of different things happening here and I would recommend you go back to your GP to have a review of your current medication, symptoms (including your bleeding), and risks and benefits of taking HRT. There are options available and you can try different preparations - this should include route (patch, gel, spray, tablet), dose, type of hormone. Since you are now over 54 years, it is recommended every woman is switched to a continuous HRT(which they don't have a withdrawal bleed on) which mimics the post menopause stage of life better.

@TreacleHart

Went through an early menopause (39 , natural , females in the family tend to do it early ) never been on any HRT. Now 20 years later have vaginal atrophy including a shrinking clitoris. Have been on vagifem past 6 months or so which helps with the dryness. Would I benefit going on HRT ( cream or patch ) to help my poor shrinking clitoris or have I missed out ? Would it cause breakthrough bleeding ?

Hi @TreacleHart, if you are having issues with vaginal atrophy, it sounds as though you may benefit from some topical oestrogen cream as well as Vagifem, you can apply the cream to the whole vulval area. Since only a tiny quantity of oestrogen is absorbed from pessaries and topical creams, women can use both at the same time for as long as necessary. However it is important in these situations for a woman to be examined by a GP or gynaecologist, as sometimes it is not only the effects of lack of oestrogen causing the discomfort and irritation. Other conditions can affect the vulva such as lichen sclerosus which is a skin condition and needs a different treatment. So please go and see your GP to be checked out and managed accordingly. Also, it is worth speaking to your GP regarding HRT and other options regarding your early menopause.

@Strangeways19

I'm 52 & have had menopausal symptoms for several years, yet bleed every month without fail. I also have terrible sensitivity & mood swings. I take black cohosh but is there anything else you would recommend under the alternative therapy umbrella?

Hi @Strangeways19, black cohosh is a popular alternative treatment for menopausal symptoms. It is not clear how it works, possibly interacting with oestrogen receptors or working more centrally in the brain. However, the latest research shows that there is currently insufficient evidence to support the use of it for menopausal symptoms but it does justify more research. There is a major concern as highlighted by NICE regarding how much quality and standardisation of products varies (for black cohosh and all supplements/alternative therapies). And women should be wary of interactions with other medical conditions and treatments (especially those with hormone sensitive conditions such as breast cancer). Another popular alternative treatment is phytoestrogens, plant substances which have effects similar to those of conventional oestrogens. The most important groups are isoflavones (in soybeans and chickpeas) and lignans (found in flaxseed). Studies show that these have an effect on intensity of hot flushes but unlikely to reduce frequency. Other supplements include ginseng, oil of evening primrose, dong quai and wild yam do not have supporting evidence of any effect. Whereas gingko biloba has been shown to possibly improve memory and cognition in the short term. There are also 'therapeutic approaches' which offer a more whole body symptom treatment which many women are finding useful either as a standalone or combination with other treatments. This includes acupuncture and cognitive behavioural therapy (CBT.) CBT has already been shown to improve sleep disturbance, insomnia and mood disorders in other settings and is now proving more popular with women to help with their menopausal symptoms. CBT can be prescribed on the NHS so worth speaking to your GP about. All women should be honest and open with their GP about what they are taking, how much and where they obtained it from as it can have consequences on other medical conditions and treatments. Please be wary of the standard, quality and quantity of alternative treatments which are not medicines.

@queenoftheschoolrun and @BarefootInTheMoonlitSnow this should help with your questions too!

@TweetleBeetlesBattle

For those of us in early menopause who can't take HRT. What supplements do you recommend we take to try and mitigate the effects of menopause...osteoporosis etc?

Hi @TweetleBeetlesBattle. Perimenopausal and menopausal women should have a balanced diet with adequate calcium (1000mg per day) and vitamin D (1000IU per day) and use supplements where necessary. Women should also be doing weight bearing exercises.

@MartiniDry

Is there currently any help for those of us who can't take HRT?

I entered surgical menopause in my 30s when I had a bilateral oophorectomy following breast cancer surgery and treatment. Fast forward nearly twenty years and I am still suffering the effects of it, particularly hot flushes.

At the time of my surgery there was nothing on offer but HRT, which would likely kill me, so I've since 'suffered in silence'. Have you a miracle alternative, please?

Hi @MartiniDry, please see my answer to Strangeways19 above. There are alternatives to HRT including non hormonal treatments for hot flushes such as SSRIs (serotonin reuptake inhibitors) or clonidine. Also ensure that you are avoid triggers for hot flushes such as caffeine and spicy foods. Similarly, there is some evidence that aerobic exercise may reduce frequency. Also there is evidence that isoflavones and back cohosh may relieve symptoms but these alternative treatments lack evidence for efficacy and are not always backed by sound safety data. However, in particular to you and other women with a history of or active breast cancer, you must be very cautious of the possible interactions with your disease and/or treatments such as radiotherapy and chemotherapy. The long term effects of black cohosh is not certain, and is it not clear whether it is safe for women who have hormone sensitive conditions such as breast cancer, and also if you have a liver condition.

@WhispersOfWickedness

I'm 38 and suffering night sweats in the lead up to my period every month. Is this peri menopause or something else hormone related?

Hi @WhispersOfWickedness. Hot flushes and nightsweats have become the hallmark of perimenopause to some extent, mainly because they are very common menopausal symptom and also because they are so awful! We currently do not fully understand what causes a hot flush or night sweat. It is likely that the changing oestrogen level during menopause is affecting a part of the brain called the hypothalamus. This is where the body's temperature is regulated, and enables the body to change in response to a change in temperature in your environment (e.g.e when you are doing exercise and you start to get hot you sweat). However, it is thought the changing oestrogen level causes a hypersensitivity to temperature, thereby the hypothalmaus starts identifying and responding to minor changes in temperature. This in turn leads to dilating of blood vessels (feeling and becoming flushed) and sweating. On average women seem to suffer from hot flushes and night sweats for approx. 2 years, but the good news is that once the hormone levels have fallen and stopped fluctuating the hypothalamus corrects itself and settles back to normal temperature control. To help with these, firstly make sure you are optimising your bed and bedroom for sleep - so do the simple things of opening a window, using a fan, wearing thin cotton nightwear and use layers of cotton sheets rather than a duvet. You can avoid trigger foods for hot flushes such as caffeine and hot curries. If you are still struggling, go to your GP to discuss HRT and other options if HRT is not suitable.

@BristolMum96 @CMOTDibbler, chillimartini and @Ticklytoes this should answer your questions about hot flushes and night sweats too .

Will a GP be able to diagnose me and prescribe HRT remotely during the pandemic?
I coped well with hot flushes that seemed to disappear but lately they have come back wand are much worse. My sleep is really affected now and I am wondering if HRT might be a solution.

Thank you @DrMichelleGriffin

@babypossum

Can you recommend an alternative to HRT? I truly don't want to take it due to my anxieties about cancer. I'm 51 and currently have the mirena. Thank you.

Hi @babypossum

this is a common concern around HRT and cancer. There is an increased risk of breast cancer in women who use HRT but that risk is low especially in comparison to the risk of breast and modifiable risk factors such as obesity and alcohol intake. However, it is important that a woman understands her own personal risk related to her medical history which is why you must discuss this with your GP. However, there are alternatives to HRT but it depends on what symptoms you are needing to treat. The Mirena should help control your periods and prevent heavy bleeding.