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

@Martinisarebetterdirty

If one has a history of young (mid 20s) hormone reactive breast cancer, and is about to undergo a full hysterectomy including ovaries for “peculiar” and large fibroids in late 30s, would you recommend HRT?

Hello @Martinisarebetterdirty! You would need to have a discussion with your GP, gynaecologist and breast oncologist. Typically advice is sought from the oncologist regarding the specifics of your cancer and how that applies to the latest evidence. HRT is not contraindicated in women who have had a previous history of breast cancer, but it is crucial that you understand the risks and benefits to you and make an informed decision.

@RudolphtheRemaindeer

I'm 48 and had a bilateral salpingo oophorectomy and hysterectomy in June this year after a endometrial cancer diagnosis. It was caught early and was a very low grade and stage. My menopause symptoms are horrible - night sweats, hot flushes, no libido at all and I'm a moody cow. I've been told that under no circumstances can I have HRT by my consultant. However it seems that in some cases HRT can be prescribed. Would you agree width this? I feel pretty fobbed off having been told that as I was near the average age of menopause anyway I would just be able to deal with it.

Hi @RudolphtheRemaindeer. I am sorry you feel fobbed off. It is not possible to say without knowing your full medical history. However, you should feel that you can have an open and full discussion about the risks and benefits of HRT with your GP and gynaecologist. If this is not happening please try to push for it and/or seek another GP or menopause specialist. Each woman is entitled to have a discussion and understand their own personalised risks and benefits regarding HRT and also what are other treatments are open to them.

@Hatethewordhun

I'm 48. Is it normal to feel depressed after ovulation each month right up until your next period. I can feel my mood deteriorating about 14 days into my cycle. I hate everyone, and turn into a hermit until my next period. I'm already taking a low dose SSRI but this seems to be entirely hormonal. It's beginning to affect my life in quite an extreme way. This has been going on for about 18 months.

Hi @Hatethewordhun and @WhoLettheCatOut

I am sorry to hear this. And I think you are right, this sounds hormonal. You have not said how long you have been on the SSRI - it will typically take several weeks to months to settle in and have some effect. However, if you are suffering from hormone related symptoms, it is quite likely that the SSRI does not improve these symptoms. I would recommend you explore some other options - in particular ensure that you are are doing exercise which can really improve mood and symptoms. There is also increasing evidence that practicing mindfulness can be helpful in managing mood swings. Also, do go and speak to your GP as HRT may be beneficial for this but you need to discuss your individual the risks and benefits.

@dexterslockedintheshedagain

I'm 52, had my last period over 2yrs ago. Was prescribed oestrogen and progesterone 2 yrs ago, but after the initial script was only given the oestrogen, so have been taking this alone for nigh on two years now (I still have a womb). Recently I have been bleeding, heavily. GP has referred me to gynae and I have an appt in Feb. Have had bloods and ultrasound, GP is phoning to discuss the results on the 11th. Should I be worried?

Thanks @dexterslockedintheshedagain. I am glad you have gone to the GP to get this checked out. All bleeding when you are post menopause needs to be checked out by a GP (except if you are still on cyclical HRT where you have a regular withdraw bleed. Once you are post menopausal or 54 and above, a woman should be changed to continuous HRT). And it is correct for the GP and/or gynaecologist to do a pelvic ultrasound scan to look at the uterus (womb), the scan looks at a number of areas but most specifically the lining of the womb. Oestrogen leads to the build up of the lining of the womb and so women with a uterus and on a HRT need to be prescribed progesterone which protects against this (the progesterone can be given in a number of ways - combined with oestrogen in a 'combined HRT' or separately as a tablet, or perhaps you remain on the progesterone only pill or the Mirena IUS). I hope your call with the GP has gone well.

@bestbefore

Why are so many GPs so uneducated about menopause? I asked about hrt and was told it would give me blood clots, a stroke and cancer . And I know this is out of date and incorrect advice. It's so annoying. And worries me that there's a generation of women who are being denied access to modern hrt which can make menopause easier and also prevent heart disease, osteoporosis and cancer...

Hi @bestbefore I am sorry to hear you feel like this. Many GPs do know a lot about menopause and are fantastic advocates for women - helping them have the best experience possible. However, menopausal symptoms are notoriously vague which can lead to difficulty diagnosing them, and often it is necessary to rule out other issues. This can lead to a woman feeling as though things are going on and on without much help. However, women should be able to access a GP who is understanding and educated about menopause and treatment options including HRT and alternatives. If you do not feel your GP is offering this to you, you should persist with them or see another GP who ideally has an interest in this area or is a menopause specialist.

@chuffedasbuttons and @JamieLeesCurtains this addresses your questions too.

@Willowcat77

I'm worried that my GP might refuse to keep prescribing my HRT (Estrogel + Utrogestan) after the first 5 years. I've heard of this happening to other women. Do they have the right to do this? I want to be on it for the rest of my life if possible!

Hi @Willowcat77, there is no arbitrary limit on the duration of use HRT or maximum age you need to stop. Every woman needs to make the decision based on their personalised risks and benefits. I recommend you speak to your GP about your concerns.

@pushchairprincess

What are your views on how employees should treat women with the menopause - I feel many women suffer in silence with this. Is there anything being done to give them support in the workplace, so this is not demonised by employers (time off - WFH options, sitting next to a window, etc)

HI @pushchairprincess. I think this is a really important issue and affects so many women across the different work places and sectors. I think some individual companies and organisations are set up with policies and working groups, and others are starting to look at what they can do. However, I think a lot more can be done. Women can help by understanding and speaking to their employers where possible, explaining what would help them.

@RamsayBoltonsConscience

Can losing weight delay menopause symptoms or even menopause itself? I was suffering with hot flushes and anxiety and went 9 months without a period. I've lost 5 stone this year and all my symptoms have disappeared and my periods have become regular. What's going on?

Hi @RamsayBoltonsConscience, I am afraid I cannot advise you without knowing a bit more about your medical history. However, I would advise you go and see your GP to discuss and find out what is going on - it is likely your GP will need to run some investigations.

@Pineconelights

Will pelvic floor exercises help with incontinence - this is several years after a surgically induced menopause in early forties. Also if you're on a low level of HRT how will you know when or if to increase it? Thank you.

Hi @Pineconelights, incontinence is a complex topic. Urgency incontinence is related to not being able to hold your wee when you need to go to the toilet and suffering form the typical 'key in the door syndrome' (when you suddenly need to wee when you get home). Stress incontinence is leaking on movement such as sneezing, coughing, or exercise etc. Both types of incontinence improve with pelvic floor exercises, especially stress incontinence. It is key to do pevlic floor exercises regularly and consistently everyday, and to make sure you do them correctly. After approx 4-6 weeks you should start to feel some improvements in your symptoms. We have developed a programme for women suffering from issues related to their pelvic floor such as incontinence on the Stella app (you can sign up to the waitlist at www.onstella.com). You should see your GP to discuss your symptoms and see if any other treatments are needed alongside doing pelvic floor exercises.

@MirandaWest

I’m 45 and had my third Mirena coil fitted last year. Haven’t had any actual periods for over 10 years and so not sure how I’d know if I were menopausal.

I had a bad bout of anxiety and depression from July 2018 for about 18 months (still on anti depressants but reducing) after having not suffered for over 10 years. I have wondered if this could be connected with menopause at all but when I did ask a GP they glossed over it. I also asked what treatments for menopause were available and was told that the main one was the mirena coil and as I had one already I was probably all right (or something like that).

Is that true? And if not, how would I know if I needed anything additional?

Hi @MirandaWest, the Mirena releases a small amount of progesterone locally into the womb where it sits, and has no effect on the rest of your body so does not treat any menopausal symptoms other than regulating bleeding. You will not know exactly when your menopause is if you have an in-date, working Mirena in situ, as you do not bleed. The recommendation is to continue having a Mirena in until the age of 55, changing every 5-7 years when over the age of 45 years (but you need to discuss this with your doctor) - this should take you through menopause and offer contraception throughout. Therefore the Mirena only is not really the main treatment for menopausal symptoms especially not mood swings, anxiety and depression. I would therefore go back you your GP to discuss this further. Depending on your medical history and whether your anxiety and depression are related to anything else, the GP can discuss your treatment options.

@Purplemirror

Why do they not teach about menopause in schools?

Hi @Purplemirror, menopause has now been added to the school curriculum through the great work of Diane Danzebrink!

@UntamedWisteria

So this seems to be a promotion for a new app?

How does the app work?

Can you prescribe bio-identical HRT through the app? Or will it just be herbal remedies and mindfulness that doesn't really work?

How is the app better than having a proper consultation with a qualified menopause specialist? Which literally changed my life for the better.

Hi @UntamedWisteria and @Summerhillsquare

Stella is a science led behavioural change app which provides a personalised programme specific to your symptoms. You also have a human coach who can answer questions at any point and helps you get relief from symptoms. Women will be able to try this app in the Spring. It is not to replace the consultation with a specialist - these are 2 very different things. A specialist is needed to assess and understand your symptoms, carry out any necessary investigations and discuss treatment options with you. However Stella can be used by itself or alongside any treatment a woman is currently taking, as it provides information and help through its programmes which can provide relief.

@DinkyDaisy

I'm so worried about brain fog. I forget words half way through a sentence. Also forget a word altogether.. I am 54, not on HRT and still having periods. I feel like I have dementia sometimes and worse when tired. Working full time and do wonder if workplaces should be more aware/ supportive. In this job climate, don't want to show weakness though..

Hi @DinkyDaisy, @Cocopogo, and @jitterbugintomybrain

Brain fog is a very common symptom of perimenopause - women can find it hard to concentrate and remember things e.g. rest of their sentence, what they went upstairs for. This can be particularly difficult at work and can lead to much frustration and anxiety. Oestrogen has an important role in cognition and memory, hence why brainfog comes about in perimenopause and postmenopause. It is therefore likely that HRT will improve this symptom. You should also look to exercise your brain as much as possible, it is a muscle and needs to be kept active and trained with mental exercises. It is unknown the association of brain fog and long term effects and the evidence is conflicting on whether HRT lowers risk of dementia or not.

@LatelyOfShalott

I started HRT a little before my 40th birthday: single mum with 2 youngish kids and a Full-time job meant I needed sleep. I’ve been on HRT ever since (am now 55). I get very very occasional periods that last a day at most and occur once every 3-4 months. I don’t want to come off HRT and at the moment my GP is fine with that. There is no cancer history in my family and I’m pretty hale and hearty. Realistically can I stay on HRT?

Hi @LatelyOfShalott I am pleased HRT has been of such help to you. As long as you are seeing and discussing this with your GP, who should be doing at least annual assesssments of your risks and benefits of HRT, you are doing the right thing. There are no arbitrary limits on the duration of usage of HRT. It just requires a continued review of personalised risks and benefits.

@SoLongFurlough

What can you do about the incessant heat at night? No longer sweating but seem to radiate heat in the middle of the night. Been on HRT for about 2 years (I'm 49)

HI @SoLongFurlough. It sounds as though you are still suffering from hot flushes. 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, please go back to you GP to discuss increasing the dose of HRT.

This is going to be an interesting and important thread.

My situation is I have been peri for four to five years. Then was ill and had three months with no periods. Then three months of periods. Now almost four months into no periods. .

@Bluntness100

I’m fifty two and going through it. The issue I’m having is my periods are not just unpredictable date wise, but can be terribly heavy, as in so heavy I can feel it literally “chugging” out of me. To the extent it can flood through my clothing snd I need to dash to the loo as it suddenly “chugs” out.

I don’t want the coil, is there anything I can be prescribed or that I can take to reduce the flow and make it more manageable. Literally for those two days I can’t go anywhere, and I don’t even know when those two days will be, as my cycle is so messed up.

Hi @Bluntness100, I am very sorry to hear this.

It is fairly typical of perimenopause to have erratic and heavy bleeds. Yes there is treatment for this. You firstly need to go and see your GP to be investigated to check nothing else is contributing to this bleeding pattern. And then accordingly you will be offered the best treatment. You say you don't want the coil - if you mean copper coil for contraception this is not appropriate for you as it can make periods heavier. However, the Mirena IUD which has a small amount of progesterone and is inserted into the womb can help significantly with heavy and irregular bleeding. If you do not want to try that there are other options, but best to be investigated first.

@starlight36 this may help you too.

@hopeishere

Loads of interesting questions here! I think I'm peri but not really sure. My OBGYN seems to rely on night sweats and hot flushes as a diagnostic tool - is there anything more reliable?!

Hi @hopeishere, it makes sense what your doctor is doing as these are the 'hallmark' symptoms of perimenopause along with irregular and heavy bleeding. If you mean is there a test, for those over 45 years, there is not a clear test. Sometimes, often for women below 45, a blood test measuring FSH can be done - however even then this can be quite inaccurate. So it is best to be guided by symptoms.

@wehaveafloater this answers your question too.

@AnneOfCleavage

Mid 40s and have missed my December period so wondering if this is the start of irregular periods - the last year I've come on a few days either side of my due date. Have flushes pretty much daily and mini night sweats but both are manageable at the moment. Brain fog starting to be annoying as can't get my words out at times. My question is since August I've been having achy shoulder/ top of left arm pain but not to touch so no bruising etc and I don't have the movement as I used to eg washing under my right arm using left hand can be tricky as feels tight and also lifting it feels heavy. Is this a symptom of peri menopause do you think?

Hi @AnneOfCleavage. it sounds as though you are experiencing perimenopausal symptoms. Throughout these answers I have described various management options dependent on symptoms. Every woman has a different experience and should be led by your symptoms. It sounds as though you would benefit from going and seeing your GP to discuss your management options. You did not say whether you were on contraception. It is important to remember women are still fertile during menopause and so need to use contraception if they don't want to become pregnant. Be careful not to assign a missed period to perimenopause and not pregnancy! Regarding your joint pain I think you should pick this up with your GP who can examine you. Although joint and muscle aches and pains are very common throughout menopause since oestrogen is anti inflammatory.

@Peacenquiet2

2/3 years ago, when I was 37/8, my periods started to become much closer together, from average 35 days to 26/7, and became heavier, and ovulation was becoming quite painful and prolonged. I was also feeling very hormonal and emotional with angry and/or teary outbursts, which was very unusual for me. Id not been on the contraceptive pill for several years so my periods had been natural. I asked for some blood tests at my gp's and was told I was post menopausal, which clearly wasn't true as I was still having full on monthly periods. I then started to take the mini pill cerezette almost 2 years ago, and since then I've not had a single period/bleed and have felt much more emotionally stable and happier in myself. I'm happy to remain on this as long as I'm able to, is this a good idea? How will I know if I am actually in perimenopause? I've had 3 children and my youngest is almost 7, I do not want any more. Thanks for any advice

Hi @Peacenquiet2. I am sorry you have had such difficult periods and difficult advice from your GP. I am glad Cerazette is helping you. Cerazette is progesterone only. It is also a contraception. Therefore it is not the same as HRT. You will therefore experience menopausal symptoms as you would if you were not on it. I would continue on it for as long as you need contraception and keep up with regular 'pill checks' with your GP. You can then be guided by menopausal symptoms to determine what is the best management and discuss with your GP.

@EuphieKat and @voyager50 this should answer your questions about the progesterone only pill too

@Jcee

I'm 48 and peri for last couple years. No symptoms really apart from my periods have become very unpredictable and very light, often missing 2-3 months then coming back with a vengeance!

When my periods go missing I keep experiencing joint pain and inflammation in my hands and feet. I only have the problem with my hands when I've missed months of periods hence me making this connection - seems a bit odd but is this a menopause symptom?

Hi @Jcee. Yes joint and muscle pains can be a menopausal symptom. Oestrogen is anti-inflammatory, so when you are perimenopausal and post menopausal with decreased oestrogen levels, musculoskeletal problems occur. You can look into doing specific exercises and activities. However, you may also want to speak to your GP regarding HRT.

@Madwomanuptheroad29

I suffer from dry and sore and itchy skin in the vulvar area. On her patches but that does not help. Have tried estroring, that has improved the vaginal but not the vulvar area

Hi @Madwomanuptheroad29, I am pleased the Estring is providing some relief. It sounds as though you may benefit from some topical oestrogen cream as well which you can apply to the 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.

@likeamillpond

Why wont GPs prescribe small amounts of testosterone as part of an hrt package. When it's been proven that menopausal women are lacking in this hormone Oestrogen and progesterone can o my do so much.

Hi @likeamillpond and @ChrissyCarol

Testosterone used to be prescribed, often with combined HRT to help with libido. However, it is not licensed for this use in the UK, so many doctors are not comfortable in prescribing it. It is worth going back to your GP and discussing if they are happy to prescribe it and, if not, asking for a referral to a gynaecologist. We are collecting information on the women who have used testosterone to develop the evidence base for its use - please write a review at our sister site menopausewhatworks.com/

@NotJustACigar

I'm 48 and don't get periods because I have a Mirena coil. How can I know whether I'm menopausal? For various reasons my coil is "stuck"and my specialist gynaecologist has no plans to remove it anytime soon so I can't just wait it out. So far I do get night sweats but that's the only symptom I've noticed.

Hi @NotJustACigar. You do not say how long your Mirena has been in place. Given that you said it is stuck, I presume it is longer than 5 years (the normal length of a Mirena to be in place before you change it). The Mirena releases a small amount of progesterone locally into the womb where it sits, and has no effect on the rest of your body so does not mask any menopausal symptoms. It you are getting night sweats, it sounds as though you are perimenopausal. You will not know exactly when your menopause is if you have an in-date, working Mirena in situ, as you do not bleed. The reccommendation is to continue having a Mirena in until the age of 55, changing every 5-7 years when over the age of 45 years (but you need to discuss this with your doctor) - this should take you through menopause and offer contraception throughout. If your Mirena is out of date and there is no way of knowing you have reached menopause, you need to use other contraception and see you GP/gynaecologist to have it removed and another inserted.

@SmallestInTheClass this may help you too!

@billybear

mum dad a terrible time on the menopause when its time does it run that i will suffer badly as well or is it just luck

Hi @billybear, every woman has a different menopause journey and it is very difficult to determine how yours will be. There is no evidence to suggest you would have a similar journey to your mother. It is best to improve your health and lifestyle as much as possible and seek help when needed.