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

@ohdannyboy

I am pretty terrified of the Menopause as my mum had a terrible time, I remember her with the flushes and mood swings, and depression, which started when she was in her early 50s. I am 36 now and would like to know, what is the age I should go to my GP to see if i can have any tests to see when my Menopause will start, so I can look into taking medications to help the process.

Thanks @ohdannyboy, this is a great question as many women would like to know where they are in their menopause journey. Please see my answer to Cotswoldmama to understand more about the stages of the menopause journey. But in answer to your question, in short there is no clear test for menopause. As per the NICE guidance, the diagnosis of menoapuse in healthy women aged over 45 years is based on symptoms. So you are in perimenopause if you are suffering from hot flushes/night sweats and irregular periods, menopause once you have had a year of no periods and are not using hormonal contraception. If you have had a hysterectomy (uterus removed) at any point, your diagnosis of menopause is based on the symptoms you report. Blood tests may be offered by your GP and/or gynaecologist if you are aged 40-45 if you have menopausal symptoms AND a change in periods or if you are below 40 where menopause is suspected. Please take a look at our blog for more information!

@MrBeagles

I know the evidence for maternal link is a factor for early meno, but is it a certainty? Is there anything I can do to delay?

Also - sorry two questions I guess. What's the one thing you'd like GPs to know or do for women experiencing menopause symptoms?

Hi @MrBeagles, please take a look at my answer to Summergarden. This is still a poorly understood area which needs more research. As far as we know there are factors which affect the age of menopause but few factors are controllable in that there is little we can do to change them. However, there is an association between smoking and an earlier menopause.

@WhoLettheCatOut

I'm 38 and struggling with breakouts (never had a problem even as a teen) and mood swings as well as becoming very irregular. I think it's perimenopause. What can I do to help with the symptoms?

Hi @WhoLettheCatOut breakouts can be a really horrid symptom of menopause especially because we think we have put that to rest during our puberty years! However, unfortunately the changing oestrogen levels does again cause this - oestrogen has an anti-acne effect (hence why many young girls are prescribed the combined pill for acne). As the oestrogen level falls in perimenopause, skin flare ups start. Go and see your doctor to be assessed - there are other non hormonal acne treatments which may help. Obviously make sure you are cleaning your skin - nothing too abrasive, but regular cleansing and ensuring you don't sleep with make up on. Women on HRT do report an improvement in their skin however, HRT is not given for cosmetic reasons alone. With regard to your mood swings, please take a look at my answers to Hatethewordhun

@nutmegsteddytoes

I'm 48 and have been on the mini pill for 8 yrs My gp says I'll stay on it until 55 then come off it-the contraception nurse at the gp's told me I'd have to come off it and go onto hrt-whats best for me? I'm sure I'm peri menopausal,as my joints ache,I can feel VERY angry at times instead of my usual calm self and my vagina sometimes feel sharp pin like stabby feelings which I imagine is it drying out?! I'm really nervous of coming off the mini pill as the last time I did,I couldn't stop crying-what would I gain from being on HRT?

Hi @nutmegsteddytoes. please see my answer to Peacenquiet for more information about the mini pill. It only contains progesterone. Oestrogen is the hormone you are looking to replace. It sounds as though you are struggling with perimenopausal symptoms and therefore I would go back to your GP to discuss your options reguarding HRT and replacing oestrogen. However, this is led by your symptoms. If you are having vaginal and vulval discomfort, oestrogen cream applied to the area and/or using oestrogen pessaries maybe the most effective. Oestrogen is anti-inflammatory hence many women complain of joint and muscle aches once their levels of the hormone start to fall. HRT can improve this, but also there are other options including exercise, focused on increasing energy and protecting the joints, and alternative therapies - please see my answer to Strangeways19 for more information.

@Folicky

Any address about menopause-related hair loss? And menopause related lip thinning?

Hi @Folicky please see my answer to maisietoo for hair thinning. Lip thinning is likely due to reduced collagen. Collagen nicely 'plumps' all of our tissues. You may have noticed 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. It is unlikely that replacing oestrogen will affect the loss of collagen in the lips now it has happened, so there is little that can be done I am afraid.

@desperatetostaypositive

I'm 52 and peri-menopausal (last period in March) Have suffered with menstrual migraines since I was pregnant 24 years ago. Over the past few months they have become more regular and more severe and the triptans don't work as well. Any advice or light at the end of the tunnel do you think? Many thanks for any advice

Hi @desperatetostaypositive! Please see my answer to Tipster100. Some women feel throughout their menopause journey, their headaches and migraines improve whereas others feel it gets much worse. I am sorry this is the case for you. Your GP can also help you with specific advice regarding your nutrition - what foods and drinks you should take and ones to avoid. And again the benefit of regular daily exercise.

@LizzieVereker

Are severe headaches normal? I always had headaches associated with my menstrual cycle but sine being perimenopausal they are more frequent and really severe.

Is there anything I can do to relieve them as they are really affecting my quality of life and ability to work? My GP is unconcerned as he is sure the6 are menopause related, and prescribed strong painkillers which make me nauseous.

Hi @LizzieVereker please also see the above answer to desperatetostaypositive's question about headaches/migraine.

@Cotswoldmama

I don't really know anything about going through the menopause other than periods stopping and hot flushes. I'd like to have a sort of timeline of usual symptoms and average ages, also what exactly is HRT I know what it stands for but are there different strengths and does it work for everybody or are there alternatives?

Hi @Cotswoldmama, This is a great question as it is really important to understand about menopause, not only so you know what and when things might happen, but so you are informed to make better decisions for yourself regarding your health and the best management of your symptoms now and in the future. So in summary, menopause is the point in time when you have not had any periods for over a year (providing you are not on hormonal contraception). The average age of this is 51. Perimenopause is the time leading up to the menopause milestone. For many, this is when menopausal symptoms appear, such as hot flushes, unexplained mood swings, erratic periods, restless sleep, increased anxiety and many more. This phase tends to occur between the ages of 45 and 55. Time after the point of menopause is described as post menopause. You may still experience some menopausal symptoms but often they are less bothersome. So you can see that 'menopause' is in fact a journey of several different phases. You can read more about the stages of menopause in our blog [[https://www.onstella.com/your-guide-to-stages-of-menopause/ here]]. Menopause is different for every woman and other factors can contribute to an earlier menopause. You may have heard of ‘an early menopause’, if a woman stops having periods between the age of 40-45. However, this term is not used so much since women have very different experiences. But this is very different to a premature ovarian insufficiency which is when women’s ovaries stop functioning before the age of 40. There are multiple causes and some are not permanent. There are over 40 different symptoms of menopause, not everyone will experience every symptom. Hot flushes and night sweats tend to be the hallmark of perimenopause since they are very common but not everyone suffers from them, and many women will struggle more with other symptoms. Please see my answer to PrincessNutNuts for more about HRT.

@Asuwere @cissyandbessy @ButterflyOfFreedom @LankyJolene @salemaxo @MParke @mummyuk86 and @PatrishaPatel this should help with your questions too!

@UpOnDown

what are signs of perimenopause?

Hi @UpOnDown, there are over 40 different symptoms of menopause and not everyone will experience every symptom. Typical symptoms include hot flushes, night sweats, sleep disturbance and insomnia, mood swings and so on. Hot flushes and night sweats tend to be the hallmark of perimenopause since they are very common but not everyone suffers from them, and many women will struggle more with other symptoms. At the same time, you are likely to notice your periods will become erratic because your hormones are fluctuating so much,you will not ovulate every month so on those months you don't get a period. Therefore the lining of the womb builds up month to month when you don't bleed, leading to a pattern of skipped periods followed by a very heavy bleed. This is just one example of a bleed pattern, there are many different versions and you are the best judge to know if it feels abnormal. If you are concerned at all about frequency of bleeds and/or heaviness do speak to your doctor about this. Also, bleeding after sex and between periods (it can be difficult to tell if you cycle is very irregular) is not normal and you should speak to your doctor.

@maisietoo

How do I know when I'm on the menopause. I don't want to bother the doctors for tests. My hair has really thinned out this year. Will it grow back or if it is the menopause - is that it!?

Hi @maisietoo there is no clear test for menopause. Please see my answer to ohdannyboy regarding how you know whether you are in menopause and cotswoldmama for the different stages of menoapuse. You may also like to take a look at our blog Your guide to the stage of menopause. 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 be easily topped up. Also, avoid factors which weaken the hair e.g. hair bleaches and dyes, excessive heat from dryers and straighteners.

@PrincessNutNuts

What's the gold standard of treatment for menopause? What combination would you recommend to your best friend?

When's a good time to start HRT?

My periods started changing at 38. In my forties I am told I am too young for HRT, my friend who is 51 was dismissed as too old, and another friend's GP insisted she couldn't have HRT unless she had a Mirena coil fitted.

Hi @PrincessNutNuts There is no gold standard treatment for menopause and I think this reflects that firstly menopause is a phase in life where there is a lot of change related to fluctuating and reducing levels of hormones which leads to a number of different symptoms. Secondly, every woman is different and experiences a different menopause journey. This is coupled with the fact that this phase of life often accompanies many changes such as caring for parents, changing jobs, starting a job, going back to education, children leaving home etc all of which can lead to many changes mentally and physically. The British Menopause Society 2020 recently published their 2020 recommendations on hormone replacement therapy and highlight that there should be a holistic and individualised approach in assessing and advising women, with particular reference to lifestyle advice and dietary modification. Also, all women should be able to access advice on how they can optimise their menopause transition and the years beyond. The evidence shows that HRT is the most commonly used treatment for managing menopausal symptoms. Also, HRT can lower future risk of heart disease, diabetes, dementia and osteoporosis. However, HRT does have some risks (many of which depend on the way that you take it - see later in the answer) which need to be weighed up against the symptoms a woman is experiencing, their individual medical history, their family history and their view on HRT. This is why it is critical that this is an open and informed discussion with your GP to understand your own risks and benefits regarding HRT. The evidence shows, that if you are going to take HRT, it is better to start it earlier rather than wait for your symptoms to get unbearable. HRT is a collective term for replacing the hormones in your body. It will always contain oestrogen but some forms of HRT contain progesterone (called combined HRT) and other hormones as well. HRT can be given as a patch, gel, or spray, or a tablet or implant. There are also creams and pessaries for local oestrogen application to the vagina and vulva. All women with a uterus need to take a progesterone in some form (e.g. combined HRT, additional tablet, the progesterone only 'mini pill' or the Mirena IUS). This is because oestrogen causes the lining of the womb to build up which is a risk factor for womb cancer. Progesterone protects against this and so is prescribed to all women taking HRT who have a womb. If you have had a hysterectomy and therefore do not have a womb you do not need 'addback' progesterone. If you are perimenopausal or around the age of the point of menopause, it is likely you are on cyclical HRT - this mimics the more natural pattern of having a bleed every month. However, if you are post menopause or 54 and older, you should be on continuous HRT. This means you take this continuously without a break and do not bleed. Most women will start on a low dose of oestrogen and increase dosage until they feel they have relief from their symptoms. There is no set limit on duration of HRT use or a maximum age at which you have to stop taking HRT. It is guided by your symptoms, and your own personal risks and benefits. When you first start HRT you should be reviewed by your GP within at least 3 months to check and see how you are. Then after, once you are on a set dose and you are doing well, you should have at least annual reviews with your GP. When you first start HRT you may notice some 'settling in' symptoms, these should settle in a few weeks to months. As I have said, each woman needs to understand their own individual risks with regard to HRT. Different doses, preparations and routes of HRT have different risks attached. Transdermal (e.g.patch) is unlikely to increase the risk of a blood clot or stroke compared to oral tablets and so should be considered the first type of HRT offered if possible. Combined HRT can be associated with an increased risk of breast cancer but this risk is low compared to other lifestyle risk factors such as obesity and alcohol intake. For more information about HRT please our blog knowledge is power or the menopausewhatworks site for more specific information.

link:

Hi @BatleyTownswomensGuild @Katinthedoghouse @Gurufloof and @RaininSummer

Please see my above answer to PrincessNutNuts for more info about HRT

@kennythekangaroo

Although I am very open to the idea of HRT, I don't feel the need for it yet. I am 51, not had a period in 6 months, hot sweats, low libido, vaginal dryness. Are there any natural treatments you would suggest?

Hi @kennythekangaroo generally the evidence suggests that starting HRT earlier rather than later provides the maximum benefits, so don't wait for your symptoms to become intolerable before you start HRT if you are happy to start it. However, regarding alternative treatments - I would advise (even if you take HRT as well) to increase exercise which has been shown to improve mood including how you feel about yourself, both of which are tied up with sexual desire and libido so can help with that. Also hot flushes and night sweats have been seen to reduce in women who do regular aerobic exercise. Also, avoid food and drink (spicy food, caffeine) can help with night sweats. Regarding natural supplements, please see my answer to Strangeways19

@weebarra

What is your advice for someone with a history of breast cancer (7 years since dx) due to Brca2 gene, post surgical menopause, to treat vaginal atrophy and loss of libido?

Dear @weebarra thanks for your question and I sorry to hear of your cancer history, You have been through a lot and the good news is, the amount of oestrogen which is absorbed from topical application is small, and now the evidence suggests that most women with a history of breast cancer can use it. However, your GP will just need to first discuss with your breast oncologist to check with your specific cancer history. If that is not possible, your GP can just contact their local breat oncologist to seek advice. You may also just want to cross check with my answer to Montydoo re routine things you can do and avoid to improve vaginal and vulval symtpoms. With regard to libido, this is slightly more difficult since sex drive relates to many physical and mental factors about yourself and your partner! Lack of sexual desire affects around 40% of post menopausal women. It would be useful for you to have a think through what really is causing reduced libido, did it just happen or do you feel differently about yourself and/or your partner. Often looking at those issues, and seeking help (e.g. counselling, psychosexual services) leads to a great improvement in women's sex lives. Several studies have shown the benefit of testosterone therapy but most of those are in women who are also taking oestrogen. GPs and gynaecologists do prescribe testosterone although it is currently not licensed for this use in the UK.

@bunny27

I am coming to the end of taking tamoxifen after being diagnosed with Breast Cancer 5 years ago. I have been told I cannot take HRT. I am really struggling with intimate itching. GP prescribed Vagisan and I have bought some YES YES YES products. Also am experiencing more bouts of cystitis. This really gets me down. Is this a menopausal symptom and is there anything I can do to reduce it or even eliminate ?

Hi @bunny27 I am sorry to hear this. I wonder if you have been diagnosed with cystitis and regular urinary tract infections (UTIs) based on lab testing of your urine specimen? I ask because it is very common for women to feel they are suffering from cystitis and recurrent UTIs, but in fact are suffering from the effect of lack of oestrogen on the genital and urinary tract. This results in a very sore, uncomfortable, irritated vulva, vagina and urethra. These symptoms are very similar to those of a UTI. Topical oestrogen to the area can help massively (see my answer to weebarra and Montydoo) , and if you feel more of an urgency and need to pee, systemic HRT (patch, pill etc) may help also. If you have been diagnosed with recurrent UTIs - women are prone to these due to the lack to the changes in the urinary tract in relation to lack of oestrogen. Often people on HRT see an improvement. Please seek more advice from your doctor and to discuss starting treatment.

@Hopezibah

I think I'm in perimenopause stage and my periods suddenly went strange from June 2018 and followed a new pattern since then but my GP can't shed any light on it and although he was sympathetic, there was nothing he could do. The old pattern used to be a couple of heavy days at start of period followed by getting lighter then stopping. The new pattern is up to 4 or 5 days of very light bleeding to the point that it comes to a virtual stop and then 2 days of very heavy bleeding (floods through night towels every hour) - often accompanied by my blood pressure crashing really low (even before the heavy bleeding starts but just before), and then "period headaches" for a couple of days at end of period. Surely I can't be alone in experiencing this change in pattern and is there anything I can do to help matters?

Hi @Hopezibah it does not say your age but if you are around 40 years plus, I would expect that this change in your periods is a sign of perimenopause. As I explained to Upondown, it is common and it sounds as though you are experiencing other menopausal symptoms. I would suggest going back to your GP and asking for some treatment for your very heavy bleeds - there are many options depending on your age, medical history and what you feel happy to take.

Hi @EternalOptimist7, @KiansKuddles, @OfficeDrama, please see my answer to ohdannyboy!

@haliborange0verdose

I'm 46 and up until about 15 months ago I'd been on the pill since the age of 17 (other than a couple of breaks to have kids). Since stopping the pill, I've not had a period at all. I'm wondering if it's possible that the pill had "masked" the menopause, and I've gone through it already? I do have some menopausal symptoms such as night sweats and low libido, but tbh I had those before stopping the pill. Or is it possible that my periods could eventually return?

Hi @haliborange0verdose this is a very interesting question. Whenever a woman stops the contraceptive pill, it can take many months for their period to return. In most woman it returns in approx 6 months, but it can be 12-18 months. Given your age and symptoms, you are right that you may have gone through menopause. However, there is no clear test to know, and really only time will tell. If your periods have not returned within 2 years of stopping the pill I would think you have reached the menopause. The key points are to manage your current and any future symptoms (see my answer to Gazelda for more information and advice) and also you need to use contraception if you do not want a baby and are not sure you have gone through menopause. All perimenopausal woman need to use contraception if they do not want to become pregnant and are sexually active - having irregular periods and approaching menopause just means fertility is decreasing but it is not zero! Only post menopausal women do not need to consider contraception (although all women should think about the need for protection from sexually transmitted diseases, whatever their age!)

@saffysabir and @lovemyflipflops thanks for your questions, this may help you too!

@littlefireseverywhere

Unfortunately I sought advice from my GP just before the first lockdown so didn’t have the greatest experience but why isn’t it something we talk about more. Bearing in mind it affects 50% of the population?

Also, are there other alternatives to HRT if I’m overweight?

Hi @littlefireseverywhere being overweight does not mean you cannot be prescribed HRT. However, every woman needs to go to their GP to discuss ther personalised risks and benefits of HRT and determine if you can take it.

Please see my answer to Strangeways19. @TheClitterati this may help you too!

@searchthesky

Is the age you enter menopause hereditary? My mum had an early menopause, I'm now at the same age she started having symptoms and am dreading getting the hot flushes she had. Are there any supplements you'd advise taking in advance? Thank you

Hi @searchthesky, currently the evidence shows that the average age of menopause is 51. However, please note this is an average and covers a wide range. It is not completely understood what determines the age a women reaches menopause (that is no periods for 1 year and not on hormonal contraception). However, it is likely to be determined by both genetic and environmental factors (i.e. the lifestyle you lead and life choices you made). So it is likely that there is a link between the age a woman reaches menopause and the menopause age of their mothers and other females in the family. Regarding supplements, if you are fit and healthy, I would not necessarily recommend taking any supplements ahead of perimenopause. It is better to focus on optimising your health - as part of this taking some vitamins may help. It is more important to be led by your symptoms and act quickly to manage them. See my answer to PickledChicory for guidance on optimising your general health. And lastly, the falling oestrogen in perimenopause can lead to acne outbreaks unfortunately.

@EggysMom and @mummyuk86 this answers your questions too!

@surelynotnever

I want to know about the likely implications for my sex life and what I can do about this. I am already getting soreness and dryness around my labia, and this has been for over a year now.. The GP says is not menopausal as I still have regular periods, but they can't find any other cause. I am in no way ready for my sex life to end or be diminished so I want to know how I can maintain my sex drive and still have good juicy enjoyable sex during and after menopause.

Hi @surelynotnever. I am sorry to hear this and it is a real debilitating problem. It is great you have already been checked out to see if there is anything else going on. As I said to Montydoo, 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, emollient cream or a non perfumed, non allergenic soap. Then pat dry, do not rub. Wear comfortable, cotton underwear. And you should 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 use both products). Note lubricants can cause irritation to a sensitive, sore vulva and vagina. There are many different types - I would recommend an oil based one as it is thicker and creamier and lasts longer (water-based feels more like natural lubrication but does not last very long and can become sticky). It is best to try a couple of different ones and see which you prefer. Also, you should look at speaking to your GP regarding topical oestrogen to see if it helps.

@Nootkah

What are usually the first signs of perimenopause?

Hi @Nootkah, typically women will experience changes in their periods - becoming more irregular and heavier. This is accompanied by hot flushes and night sweats. However, there are over 40 symptoms of menopause and every woman experiences a different menopause journey.

@lillypopdaisyduke

I am 36 and my periods have always been irregular, and it's been 4 months since my last period (I'm not PG) My doctor has recommended medication (low dose contraceptive) If I was to go ahead with this, would this affect the onset of the menopause (my mum started hers at 40 so I expect to be an 'early starter') Are there any blood tests I can get to see if I am starting the menopause ?

Hi @lillypopdaisyduke it sounds as though your GP is suggesting the contraceptive pill to help regulate your periods to give you some relief. This will not delay the onset of menopause nor the duration of your menopause journey. It you take the combined contraceptive pill, which contains oestrogen, it can mask some perimenopausal symptoms. If you have perimenopausal symptoms below the age of 45 you can have a blood test for FSH (follicle stimulating hormone), however this can be very inaccurate.

@Sadsammy

I'm on HRT and for a few years have noticed a receding hairline and thinning hair. I've read that the nothisterone in Elleste Duet, can cause the hair problems. Is this true and if so, will changing to a non androgenic HRT make my hair grow back and prevent any further hair loss?

Hi @Sadsammy 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 (possibly related to the Elleste Duet), 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, but can be easily topped up. Also, avoid factors which weaken the hair e.g. hair bleaches and dyes, excessive heat from dryers and straighteners.