While the menopause is a natural event in women’s lives, the symptoms may seem anything but natural – hot flushes, night sweats, brain fog and mood swings.
Add to that drier skin, loss of libido, hair thinning and weakening bones, all due to the drop in oestrogen hormone levels in our systems.
So should we be grinning and bearing these symptoms or seeking help?
Dr Shirley McQuade is medical director of the Dublin Well Woman Centres.
“When women come to our clinics, they have often tried homeopathic or over-the-counter menopause products,” she says.
“They may or may not be having periods. Hot flushes and night sweats would be their main problems. They speak of sleep deprivation, which has led to anxiety and irritability, and they are possibly having problems coping with their job.”
Some women only want to check that it is the menopause that’s occurring and nothing else, she says.
“Doctors would usually do some blood tests to make sure nothing else is wrong. Many women are happy that it is just menopause and that their symptoms will settle down. Lifestyle would be looked at first, and exercise recommended along with a good diet and avoiding alcohol and caffeine.”
Many women can self-manage their symptoms, she says. “It’s to do with quality of life, really. If they are able to function then they don’t need HRT. If someone is not able to function, they need to look at treatment options.”
Some women have a terrible time during menopause, she says.
“Their cognitive function isn’t great, they may get depressed and have panic attacks. For those women, HRT does make a huge difference. Hot flushes can be horrible and interfere with their work life, eg concentrating in meetings or giving presentations at work. Those are the kind of women I see wanting to go on HRT.”
How long should you stay on HRT?
“Duration depends on when they go through the menopause,” Dr McQuade says.
“Patients coming in are normally aged 51 or 52. Menopausal symptoms tend to last for eight years but the symptoms are not the same all the time. For some, it goes on for 20 years. I occasionally see women in their 70s who get occasional hot flushes or night sweats.”
Risks related to taking HRT now?
“The NICE (National Institute of Clinical Excellence) guidelines in the UK, published in November 2015, are the most recent guidelines to go by. They are based on a lot of studies done over the last few years,” she says.
“Yes, there is a slightly increased risk of getting a blood clot in your leg if you go on HRT. Interestingly, it depends on whether you take tablets or use patches. The patches don’t increase the risk of blood clotting because they metabolise differently in the system. With breast cancer, there is no increased risk in women in their 50s if it’s (HRT with) just oestrogen, but if they need to use HRT containing oestrogen with progesterone there is a slightly increased risk.”
Complex perscribing process
HRT prescribing is very individualised.
“We are assessing risk all the time, deciding whether symptoms warrant medication and what kind of medication that might be.”
Oestrogen-only HRT is prescribed if the woman doesn’t have a uterus (has had a hysterectomy), she says.
“There are different risks attached to different progesterones as well, so it is a quite complex prescribing process. Some are safer to use than others. We can individualise things and reduce specific risks depending on what way we give the medication. HRT can also be given via a coil. The risk of stroke is not increased if someone is on (HRT with) oestrogen, for example, but it is increased if the person is on (HRT with) oestrogen/progesterone so it differs.”
“A lot of women will look at the risks (see table above) and say ‘I can’t function, I’m not working properly, those risks are acceptable’, and they will go on HRT. It’s about quality of life. Within two weeks, the symptoms start subsiding.”
The Well Woman director does not promote HRT for protection of heart disease or bone density, she says.
“That’s because there are other medications for those, if they are needed.”
HRT for post-menopausal women?
Will HRT help post-menopausal women who are concerned about hair thinning, skin deterioration or bone density and just want to look and feel better?
“The further away a woman is from her last period, the more risk there is attached to starting HRT,” says Dr McQuade. “I’d be reluctant to start someone on HRT over the age of 60. The risks are much higher than in someone close to the menopause. I do have women on it but they are usually women who are continuing it, not starting anew. The ones who stay on it are the women who continue to have symptoms.
“However, patients I see in their 60s and 70s (continuing HRT) don’t tend to need to take full strength. There are lower-dose forms they can take and they don’t have to take it every day.”
Taking oestrogen for collagen in skin is not likely to make much difference, however.
“The woman will already have lost a degree of collagen from her skin and she is not going to get that back.
Starting HRT at an older age is putting a woman at risk of blood clots. She will be taking unnecessary risks for not much benefit, if any at all.”
Hair loss could be familial, she says.
“I would recommend that women over 60 have iron and B12 levels and thyroid function measured so that they know that they’re not lacking in something. In about 5% of women, their thyroid function changes around the menopause. That can cause thinning of hair and make you feel tired and lethargic and out of sorts.
“If you’ve had heavy-ish periods over a long time, your iron levels could be depleted too, without you really noticing it, so a full check-up is a good idea.”
Vaginal dryness
Vaginal dryness can be an issue for older women as well as increased risk of urinary tract infections.
“In this situation, an oestrogen pessary can be used, which gives very low doses into the system that are equal to one HRT tablet over six months.
“Clonidine and some anti-depressants which reduce flushes as a side effect could also be prescribed if you don’t want to try HRT. Overall, there are lots of options.”
Beware - pregnancy can still happen!
The rules are:
If you are under the age of 50 when your periods stop, there is a risk of pregnancy until two years after your last period. If your periods stop after the age of 50, there is a risk of pregnancy for a year after your last period.
While the menopause is a natural event in women’s lives, the symptoms may seem anything but natural – hot flushes, night sweats, brain fog and mood swings.
Add to that drier skin, loss of libido, hair thinning and weakening bones, all due to the drop in oestrogen hormone levels in our systems.
So should we be grinning and bearing these symptoms or seeking help?
Dr Shirley McQuade is medical director of the Dublin Well Woman Centres.
“When women come to our clinics, they have often tried homeopathic or over-the-counter menopause products,” she says.
“They may or may not be having periods. Hot flushes and night sweats would be their main problems. They speak of sleep deprivation, which has led to anxiety and irritability, and they are possibly having problems coping with their job.”
Some women only want to check that it is the menopause that’s occurring and nothing else, she says.
“Doctors would usually do some blood tests to make sure nothing else is wrong. Many women are happy that it is just menopause and that their symptoms will settle down. Lifestyle would be looked at first, and exercise recommended along with a good diet and avoiding alcohol and caffeine.”
Many women can self-manage their symptoms, she says. “It’s to do with quality of life, really. If they are able to function then they don’t need HRT. If someone is not able to function, they need to look at treatment options.”
Some women have a terrible time during menopause, she says.
“Their cognitive function isn’t great, they may get depressed and have panic attacks. For those women, HRT does make a huge difference. Hot flushes can be horrible and interfere with their work life, eg concentrating in meetings or giving presentations at work. Those are the kind of women I see wanting to go on HRT.”
How long should you stay on HRT?
“Duration depends on when they go through the menopause,” Dr McQuade says.
“Patients coming in are normally aged 51 or 52. Menopausal symptoms tend to last for eight years but the symptoms are not the same all the time. For some, it goes on for 20 years. I occasionally see women in their 70s who get occasional hot flushes or night sweats.”
Risks related to taking HRT now?
“The NICE (National Institute of Clinical Excellence) guidelines in the UK, published in November 2015, are the most recent guidelines to go by. They are based on a lot of studies done over the last few years,” she says.
“Yes, there is a slightly increased risk of getting a blood clot in your leg if you go on HRT. Interestingly, it depends on whether you take tablets or use patches. The patches don’t increase the risk of blood clotting because they metabolise differently in the system. With breast cancer, there is no increased risk in women in their 50s if it’s (HRT with) just oestrogen, but if they need to use HRT containing oestrogen with progesterone there is a slightly increased risk.”
Complex perscribing process
HRT prescribing is very individualised.
“We are assessing risk all the time, deciding whether symptoms warrant medication and what kind of medication that might be.”
Oestrogen-only HRT is prescribed if the woman doesn’t have a uterus (has had a hysterectomy), she says.
“There are different risks attached to different progesterones as well, so it is a quite complex prescribing process. Some are safer to use than others. We can individualise things and reduce specific risks depending on what way we give the medication. HRT can also be given via a coil. The risk of stroke is not increased if someone is on (HRT with) oestrogen, for example, but it is increased if the person is on (HRT with) oestrogen/progesterone so it differs.”
“A lot of women will look at the risks (see table above) and say ‘I can’t function, I’m not working properly, those risks are acceptable’, and they will go on HRT. It’s about quality of life. Within two weeks, the symptoms start subsiding.”
The Well Woman director does not promote HRT for protection of heart disease or bone density, she says.
“That’s because there are other medications for those, if they are needed.”
HRT for post-menopausal women?
Will HRT help post-menopausal women who are concerned about hair thinning, skin deterioration or bone density and just want to look and feel better?
“The further away a woman is from her last period, the more risk there is attached to starting HRT,” says Dr McQuade. “I’d be reluctant to start someone on HRT over the age of 60. The risks are much higher than in someone close to the menopause. I do have women on it but they are usually women who are continuing it, not starting anew. The ones who stay on it are the women who continue to have symptoms.
“However, patients I see in their 60s and 70s (continuing HRT) don’t tend to need to take full strength. There are lower-dose forms they can take and they don’t have to take it every day.”
Taking oestrogen for collagen in skin is not likely to make much difference, however.
“The woman will already have lost a degree of collagen from her skin and she is not going to get that back.
Starting HRT at an older age is putting a woman at risk of blood clots. She will be taking unnecessary risks for not much benefit, if any at all.”
Hair loss could be familial, she says.
“I would recommend that women over 60 have iron and B12 levels and thyroid function measured so that they know that they’re not lacking in something. In about 5% of women, their thyroid function changes around the menopause. That can cause thinning of hair and make you feel tired and lethargic and out of sorts.
“If you’ve had heavy-ish periods over a long time, your iron levels could be depleted too, without you really noticing it, so a full check-up is a good idea.”
Vaginal dryness
Vaginal dryness can be an issue for older women as well as increased risk of urinary tract infections.
“In this situation, an oestrogen pessary can be used, which gives very low doses into the system that are equal to one HRT tablet over six months.
“Clonidine and some anti-depressants which reduce flushes as a side effect could also be prescribed if you don’t want to try HRT. Overall, there are lots of options.”
Beware - pregnancy can still happen!
The rules are:
If you are under the age of 50 when your periods stop, there is a risk of pregnancy until two years after your last period. If your periods stop after the age of 50, there is a risk of pregnancy for a year after your last period. 
SHARING OPTIONS