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

@Ihearditthroughthegrapevine

Im 39 and for the past 4-5 months my periods have been all over the place and anything from 2 -7 weeks apart, im having so many migraines and dizziness and I'm finding things that didn't used to make me anxious make me quite anxious. My GP hasn't really offered any decent advice or support and told me I may have a hormone imbalance. Ive had a smear recently thats negative. Does this sound like the start of peri-menopause

Hi @Ihearditthroughthegrapevine it certainly does sound as though you are experiencing symptoms of perimenopause. You should go back to your GP or seek another GP who you can have a better, more helpful discussion with. It is important to be heard and make sure you are offered all available treatments. You then need to understand your personalised risk and benefits (based on symptoms, age and other medical history) and make an informed decision about the best management of your symptoms. I hope you get this sorted and feel better soon.

@VintageGill

Why are GPs so badly informed about the latest developments in treating menopausal symptoms? If a woman experiences bad menopause symptoms, the last thing she needs is to have to enter into battle with a patronisingly defensive and ill-informed GP.

Why do most NHS GPs not know what body-identical HRT is? I am not talking about health food shop creams and potions here, I am talking about NHS approved HRT - for example, micronised progesterone (not synthetic progestogen) and natural oestrogen, such as Oestrogel. Doctors, by and large, do not seem to know the difference between these and synthetic hormones and I had to do my own research. For anyone interested, Professor John Studd, a menopause specialist with a Harley Street Practice, has an excellent website with lots of information about body identical HRT and everything you need to know to help you discuss your treatment in an informed way with your NHS GP.

Why is it not widely accepted by NHS GPs that, if prescribed in the right way and carefully monitored, testosterone can be very helpful for women who have suffered menopausal loss of libido? The NHS is a dead loss on this topic, despite the fact that my doctor told me that this is the number one thing that menopausal women come in with worries about. The NHS no longer licenses testosterone for this purpose. Unless you are very lucky, you are simply not going to get this treatment without a battle and then it is likely that you will have to continue battling if you move house and have to have to change GP.

Why are menopause symptoms generally trivialised and not taken seriously by the NHS? Some women experience symptoms that are devastating and life-altering.

Whilst I do appreciate that some people find CBT helpful for relaxation, but the NHS still offers this quasi-quack 'treatment' as an alternative therapy for the menopause, but they wouldn't (hopefully) suggest that you go home and re-frame your thinking if you went in with a broken leg.

I am now through the worst of the menopause. The symptoms do get better, but don't all go away. You just learn to adapt. However, when I did seek help, it was horrific just how uninformed almost all the NHS medical professionals I came into contact with were.

I applaud those activists - like Diane Danzebrink - who are fighting to improve menopause awareness and services for women.

Hi @VintageGill

I am so sorry to hear that you had a tough time finding help when you needed it. I am also really impressed with activists like Diane Danzebrink who are doing amazing things to improve menopause awareness and services for women! And Professor John Studd provides great explanation of menopause symptoms and advice on the best management, he has a very informative website too. There is a lot in your question, but the issue around testosterone is a common one. 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 women 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.

@zindeggeh this addresses your question too.

@spaceghetto

How long does it last for?

Hi @spaceghetto every woman is different. But the average age of menopause is 51 and the average menopause journey is 10 years.

@MrsFrTedCrilly

How do you know that menopause has begun when you aren’t having periods due to IUD ( Mirena)? Also how does body composition change and what specific exercise will help?

Hi @MrsFrTedCrilly whilst you have an in date Mirena in situ and you don't normally bleed, you will know by your other symptoms such as hot flushes and night sweats. Yes fat distribution changes in perimenopause and beyond due to falling oestrogen levels. Please see my answer to Theredjellybean for more information.

@CompleteBarstool

Where do you stand on the prescribing of fluoxetine for menopausal symptoms such as hot flushes/nightsweats and mood swings when a woman cant take HRT due to a history of breast cancer in the family.

Hi @CompleteBarstool as per the NICE menopause recommendations, SSRIs such as fluoxetine can be prescribed for hot flushes if you cannot take HRT. However, please note a family history alone is not a contraindication to taking HRT especially if you take it as a patch, gel or spray. It is also helpful to look at lifestyle factors which exacerbate hot flushes such as caffeine, smoking and spicy food.

@mrsrobin

I wonder what percentage of women (in UK) go onto HRT? It seems most people I know are on HRT. I am not, although I do have some symptoms which I can just about manage. Personally, I choose not to unless because I don't really want to be on any medication for life.

Hi @mrsrobin it is very difficult to know how many women take HRT at some point through their menopause journey. At ViraHealth we are trying to collect more data on this and women can complete reviews for all and any treatments, including HRT at menopausewhatworks.com/. A recent survey of women by the Royal College of Obstetricians and Gynaecologists showed less than 15% of women are using HRT but that was just at a specific timepoint. I think it is important that you do what you feel happy with and best suits you.

@Honeyroar

I am in 51, still have regular periods, but very heavy and short. For the past few years, when my period has been particularly heavy I’ve had incredibly bad cramp in my right leg. My GP didn’t seem very interested. Do you have any suggestions?

Hi @Honeyroar leg cramps can be a symptom of iron deficiency anaemia which could tie in with your heavy periods. Without seeing and examining you it is difficult to diagnose, but leg cramps and restless leg syndrome are common in women during menopause, possibly linked to irregular and heavy periods causing anaemia. You may find taking iron supplements helpful. Some women find these lead to constipation, so you may want to start off increasing foods rich in iron such as dark green vegetables,

@HelloKitty145

I'm so panicked that I might be going into early menopause. I'm 34, no children (2 miscarriages, 1 natural, 1 medical). After the medical miscarriage, my chest broke out in spots, nurse called them "pustules". I'm still trying to have a baby. In the last year or so, sex has become very painful and I've been very dry. Was putting this down to age. My period has always been like clockwork but has now been later than normal twice. I have developed acne on my jawline but it's appearing as cyst like spots rather than normal whiteheads. Also, last week (1 week before period due) my chest has broken out again but with what looks like little pinprick whiteheads. I also sometimes get terrible low mood around this time. I've convinced myself this is all hormonal and signs of early menopause. I'm panicking.

Hi @HelloKitty145 I am so sorry for all that you have been through with the miscarriages and now these symptoms. It sounds as though you are experiencing a number of different issues and so I would recommend you go to your GP and talk to them about it. That way you can also be examined and any investigations be done. It sounds as though you are on the right track thinking this is related to hormones. Possibly this is more a picture of pre menstrual syndrome, so symptoms relating to your cycle rather than perimenopause. I know you said your periods have been late twice, but some variation in a woman's cycle is normal and expected. Sex will be painful if the vagina and vulva are dry - but this could be related to how you feel about sex and other worries/anxieties, rather than hormones. I would definitely go and speak to your GP to try to untangle the different issues and get the right treatment.

@Mooncupdotcom

How can I best support colleague going through the menopause? (teachers)

Hi @Mooncupdotcom I think there is a lot to be done in the workplace. It is a really important issue and affects so many women across the different work places and sectors. It is a vital support is put in place so that women can continue to work and perform at their best level. This then benefits everyone in the team. 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. Everyone, men and women, can help by being more informed and and speaking to their employers where possible, explaining what would help. Some workplaces are setting up training sessions, and menopause advocates to ensure the latest policies are put in place.

@DeRigueurMortis

How do you get past your (male) GP constantly undermining your symptoms as "perfectly normal"?

In context when you haven't slept for many, many months due to hot flushes and as a result are in "brain fog" though sleep deprivation.

When you do have a period it's like the hoover dam being breached and there is no mooncup, tampon, pad (or combination) that will contain it.

When you realise it's like it's having the mother of all "bad" period symptoms for years but your GP quips that you should be happy that you're not bleeding so regularly and should sell your shares in the owners of tampax?

When you are told it's not a priority in Covid-19 times and the fact you've just ruined yet another set of clothes, but worst the sofa because you've flooded all over it with no warning.

When your husband/children see that and your embarrassment as you scrub the sofa. They are kind but you can't bear then being "kind" as you've so embarrassed.

I'd really like these questions answered, thank you.

Hi @DeRigueurMortis, I am so sorry you are having such a tough time. You definitely need some help to better manage your symptoms and you should not be suffering in this way. I am sorry your GP has not been more understanding. I think it might be best to seek help from another GP or menopause specialist to discuss your issues and get the help you need. You may also need to see a gynaecologist regarding your heavy bleeding for investigations and treatment. I hope you feel better soon.

@naturesbuds

I am aware the average age of menopause is 51 and am 50. I am combating perimenopause symptoms with exercising, a plant-based diet, and meditation . Am prepping my mind and body but my question is can you go through this estrogen depleting without HRT if symptoms mild at present or will they increase with age?

Hi @naturesbuds it sounds as though you are very much informed and in control of your perimenopausal symptoms, which is great! Every woman experiences a different menopause and a woman does not have to go on HRT. In fact many women go through menopause without it. The key point is to be led by your symtoms and how they are affecting you. If you are managing well, continue with your plan and take it day by day. Just be sure to reach out and seek help if that changes. Most symptoms will reduce and settle with age as the hormones settle to their new normal level. However, vaginal dryness and irritation can be an increasing problem as the tissue reponds to the increasing lack of oestrogen. This can be managed successfully with topical oestrogen.

@Downriver

Is it possible to go through it without problems. I mean I feel I have but are my bones just going to snap like twigs one day if I don't medicalise?

Hi @Downriver, please see my response to naturesbuds. With regard to osteoporosis, perimenopasual 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. HRT has been shown to have a protective effect against osteoporosis and related fractures. But again you need to balance your own personalised risks and benefits and a GP can help you do that.

@sheilads105

I'm 5 years in and still getting hot flushes...is this OK?

Hi @sheilads105 and @Redshoeblueshoe hot flushes are very common in perimnenopause. They should settle as you go through the point of menopause and enter post menopause. Perimenopause may last many years, sometimes 10 years and beyond. If you are not seeking out treatment for them, you should go and see your GP and discuss your options. In addition, make sure you optimise your diet and lifestyle and avoid anything which exacerbates them.

@Ortega888

How can I find a natural HRT treatment plan as my drs won’t prescribe HRT to me due to my multiple allergies, intolerance and also because of the link to breast cancer. I have multiple health issues and react to anything that is not natural. What do you advise. Thank you.

Hi @Ortega888 and @Nottheshrinkingcapgrandpa you have not specified what you need an alternative for. HRT is not just given to replace falling hormones, but to treat symptoms. There are many different options available to you depending on your symptoms. Take a look through some of the other posts to get some ideas.

@idontknowaboutmortgages

An app is great for recording symptoms but how can we use this information to get practical support from GP’s?

Hi @idontknowaboutmortgages. 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.

@clairedunphy

Sorry if this has been asked elsewhere.

I'm using everol patches on a cycle, so everol 50 for two weeks and conti for the next two.

This still gives me periods which is fine because I was still having them naturally anyway.

Will there come a point where my periods start to change / become less regular while I'm on this regime? If not, how will I know when I should move onto an oestrogen only regime?

Hi @clairedunphy and @KickingBishopBrennanUpTheArrse It is difficult to tell when a woman has reached the age of natural menopause when on HRT. It is accepted that by the age of 54, natural menopause can be assumed and you can be moved to a continuous regime (ie not cyclical and you will not bleed). This mimics post menopause more closely and consequently is liked more by women. All post menopausal women with a uterus (womb) need to have progesterone in some form to protect the womb lining from building up too much with oestrogen (i.e. so you should not be moved onto an oestrogen only regime if you have a womb). This can be given a number of ways and should be discussed with your GP.

@IronNeonClasp

Why are we so uneducated about menopause still without doing our own research when symptoms start or we've been living with them for a couple of years?

Hi @IronNeonClasp , @Dontsayfuckorbugger and @AllDoneIn I think it can be very difficult to be educated on menopause since it is different for every woman and more so is a massively under-served area. There is very little clinical and scientific research in this area and this results in a lack of education amongst healthcare professionals. More can definitely be done and we are helping change that at Vira Health. It is important that women are educated on recent science backed data, which is easy to access and understand. I hope I have provided some help on this Mumsnet feed which we plan to continue on Instagram @relyonstella.

@Teaplease29

How common is the early menopause? I recently suffer symptoms such as hot flushes and low moods. I am moving towards my mid thirties, am i possibly entering early menopause? If this is the case, how long do I have left to try for more children?

Hi @Teaplease29 menopause is different for every woman and other factors can contribute to an earlier menopause. Just to start off, I will explain that an 'early menopause' is when you stop you periods between 40-45 years. However, this term is not used so much since women have very different experiences. This is very different to a premature menopause which is when women’s ovaries stop functioning before the age of 40. If you are experiencing hot flushes and low moods, you may be experiencing these as symptoms of perimenopause. However, this could go on for many years, meaning you do not reach the point of menopause until your mid to late forties, which would not be an early or premature menopause. So given your age you may want to go and see your doctor to discuss your symptoms a bit more and understand better what you are experiencing. With regard to trying for more children, this is a very difficult call to make and although there is a blood test (for AMH, Anti-Mullerian Hormone) which can be an indicator of your ovarian reserve, it is hard to exactly determine how long a woman has left to become pregnant.

I'm on a continuous regime and have been for over 3 years. Those pesky periods still appear although they're not regular. I'm 53 so hopefully they'll stop soon!!!

@purplepandas

I would love to know how to manage the sleep issues. I have noticed such changes in my sleep ( early morning waking) and it's really getting me down as exhausting.

Hi @purplepandas I am sorry you are having such a difficult time with your sleep. Sleep is precious to us all - we need it to repair and restore physically and mentally and if we are able to achieve good sleep, we do really enjoy it. However, if it is a problem it can really haunt you and have so many horrid knock on effects such as exhaustion, weight gain, mood swings and anxiety. Sleep disturbance and insomnia (defined as difficulty sleeping at least 3 times a week for 3 months or more) is very common, nearly half of women have sleep issues during their menopause journey. There are many causes for this. Firstly oestrogen and progesterone are fluctuating and decreasing. The changes in oestrogen lead to night sweats which will wake you and often make it difficult to get back to sleep. Reduced levels of sleep inducing progesterone reduces your ability to get to sleep, and when you are asleep can cause you to wake up or have poor quality sleep as lower levels are linked to sleep apnoea. Also, as we age, we naturally produce less melatonin, a sleep-inducing hormone, which means sleep can become lighter and more disrupted. There are also some specific menopausal symptoms which affect your sleep such as vulval and vaginal irritation or soreness, anxiety and joint or muscle pains. We talk more about the causes of sleep disturbance and how you can improve your sleep in our blog here. As so much is related to reducing levels of hormones, HRT does improve women's sleep disturbance, especially as it improves hot flushes and night sweats. However, this is not the only solution if HRT is not for you for whatever reason, and even if you are on HRT it is unlikely to solve all the problems. Cutting out things which stimulate you, such as caffeine, TV and working near bedtime can improve your ability to get to sleep. Optimising your bedroom for sleep helps (a fan, window open, layers of bedsheets), along with preparing for bed with a wind down routine and relaxation is useful. Most women with sleep disturbance have got out of the habit of good sleep, they dread bedtime, very anxious that they will just spend the night tossing and turning and feeling dreadful the next day. This becomes a vicious cycle and needs to be broken in many different ways. Incorporating these and other behavioural changes along with the way you manage your thoughts has become a mainstay for treatment of insomnia - it is known as cognitive behavioural therapy for insomnia (CBT-i) and is integral to our Sleep programme in the Stella app. You can sign up to the waitlist at www.onstella.com

@ViewsAreMine this should help you too

@purplepandas

I would love to know how to manage the sleep issues. I have noticed such changes in my sleep ( early morning waking) and it's really getting me down as exhausting.

Hi @purplepandas I am sorry you are having such a difficult time with your sleep. Sleep is precious to us all - we need it to repair and restore physically and mentally and if we are able to achieve good sleep, we do really enjoy it. However, if it is a problem it can really haunt you and have so many horrid knock on effects such as exhaustion, weight gain, mood swings and anxiety. Sleep disturbance and insomnia (defined as difficulty sleeping at least 3 times a week for 3 months or more) is very common, nearly half of women have sleep issues during their menopause journey. There are many causes for this. Firstly oestrogen and progesterone are fluctuating and decreasing. The changes in oestrogen lead to night sweats which will wake you and often make it difficult to get back to sleep. Reduced levels of sleep inducing progesterone reduces your ability to get to sleep, and when you are asleep can cause you to wake up or have poor quality sleep as lower levels are linked to sleep apneoa. Also, as we age, we naturally produce less melatonin, a sleep-inducing hormone, which means sleep can become lighter and more disrupted. There are also some specific menopausal symptoms which affect your sleep such as vulval and vaginal irritation or soreness, anxiety and joint or muscle pains. We talk more about the causes of sleep disturbance and how you can improve your sleep hin our blog here. As so much is related to reducing levels of hormones, HRT does improve women's sleep disturbance, especially as it improves hot flushes and night sweats. However, this is not the only solution if HRT is not for you for whatever reason, and even if you are on HRT it is unlikely to solve all the problems. Cutting out things which stimulate you, such as caffeine, TV and working near bedtime can improve your ability to get to sleep. Optimising your bedroom for sleep helps (a fan, window open, layers of bedsheets), along with preparing for bed with a wind down routine and relaxation is useful. Most women with sleep disturbance have got out of the habit of good sleep, they dread bedtime, very anxious that they will just spend the night tossing and turning and feeling dreadful the next day. This becomes a vicious cycle and needs to be broken in many different ways. Incorporating these and other behavioural changes along with the way you manage your thoughts has become a mainstay for treatment of insomnia - it is known as cognitive behavioural therapy for insomnia (CBT-i) and is integral to our Sleep programme in the Stella app. You can sign up to the waitlist at www.onstella.com

@ViewsAreMine this should help with your question too!

@QueenOfTheDoubleWide

My question is from the other side of the menopause! I am now 61, last period was at 53. I had a relatively easy menopause, just some hot flushes but they passed fairly quickly so I never saw a GP or needed medication. I do not sleep as well since then and am possibly a bit more anxious and slower in my thinking (although I am in a job that needs a lot of information retaining and I still cope!). I have lost weight and am probably healthier now than I was then. I am seeing some people (most notably Louise Newson, the menopause doctor) now pushing the idea that all women should take HRT indefinitely for improved health as they age. I am reluctant to start anything that could have side effects at this point so is there advice for women post-menopause on staying healthy without hormones please?

Hi @QueenOfTheDoubleWide it is great to hear from you. Louise Newson is a great advocate for menopause awareness and helping women acheive their best experience. The latest evidence shows that there is no arbitrary limit set on the duration of HRT. However every woman needs to get a balanced view of their risk and benefits with regard to HRT. If you are having difficutly sleeping, please see my answer to purplepandas

@Tenohfour

I am going through suspected early menopause (late 30s). Is my menopause likely to last longer/be different than it woukd be if it was at the usual time of life? I have read conflicting information about this, so clarity on what to expect would be really good.

Hi @Tenohfour Thanks for your question and it must be very difficult to have such conflicting advice and information especially when it is about such an important topic. Sadly this is very common with menopause information - mainly because there is relatively little evidence and data in this space. You did not say whether you are seeing your doctor about your suspected early menopause - if not I would recommend it. If your periods have stopped for 1 year or more before the age of 40, and you are NOT on any form of hormonal contraception, then you have gone through premature menopause. If this is the case, it is recommended women take HRT to replace the hormones your body is not producing. This is because a premature menopause puts you at particular risk of lower bone density (osteoporosis) and associated higher risk of bone fractures, higher risk of heart disease and cognitive problems (e.g. dementia). Depending on the cause of premature menopause, it can be sudden (e.g. surgery to remove the ovaries due to cancer) or more gradual (e.g. history of ovarian insuffiency from an autoimmune disease which then finally results in premature menopause), a woman will experience different symptoms. If suddenly the symptoms most likely come on fast and strong. However, every menopause, whatever the cause, is different and every woman will experience the symptoms differently. Please see our blog Your guide to the stages of menopause to learn more.

@Serender please see this answer too :)

Thank you, really helpful

@Mabelface

Why do gps not keep up with NICE guidelines? I had to battle to get oestrogen gel. Gp insisted on prescribing clonadine first which did naff all.

Hi @Mabelface (and @safetyzone this should help you too!) I am really sorry to hear this. Every women is entitle to have a full discussion regarding the best management for their menopausal symptoms. Please refer your GP to the latest NICE guidance 2015 and recent 2020 recommendations from the British Menopause Society 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. If you feel you do not get a full adequate discussion, please seek out another GP or menopause specialist.