Menopause

DECEMBER 2016

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Menopause

WOMENSHEALTHADVICE.CO.UK

Jenny Eclair How to be a middle-aged woman without going insane

THE BASICS

Menopause and common associated conditions P4 PROFESSOR MARY ANN LUMSDEN

What women want when it comes to menopause and work P10

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IN THIS ISSUE

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How to prevent osteoporosis Why oestrogens are the first choice for prevention and treatment of osteoporosis P6

Five questions answered What’s normal and what can you do? A menopause specialist nurse answers P6

Ten facts about HRT Dr Louise Newson debunks some common myths about menopause and Hormone Replacement Therapy

“You can’t just wipe away a taboo” Menopause still carries a stigma in western culture, says the Chairman of the British Menopause Society (BMS), but awareness and communication can change that A BMS survey earlier this year indicates that women are still not sufficiently well prepared for the menopause and the significant effects it can have on their work, social and sex lives,” says BMS Chairman Dr Heather Currie. “They’re still not seeking help. The ideal is that all women are aware about menopause and possible related health issues, and we’re not there yet.”

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Although people are definitely talking about menopause more nowadays, “it’s still perceived as a negative in the western world, which is very sad. There’s still that stigma around the end of menstruation, and symptoms can be perceived as a weakness, whereas other cultures honour menopause as a time of wisdom.”

Currie says “you can’t just wipe away a taboo”, but individual awareness and

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Dr Heather Currie Chairman, British Menopause Society

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communication are vital to changing perceptions.

“Women need to know that it’s not a weakness to have symptoms and seek help.

“It’s most important to understand the effects – not just things like hot flushes, but possible later consequences such as osteoporosis, higher blood pressure, and heart disease. Understand the stages, what to expect, and when to seek treatment.” @MediaplanetUK

Lifestyle is important, and there are also very effective treatments, with individualisation a key element, she says.

“If you’re fit and healthy, with no symptoms, you may not need to do anything,” she advises. “If you have symptoms, there’s plenty of information out there which can make your first consultation with your GP more meaningful. There is no single treatment, it’s all about what’s best for you.”

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INSPIRATION FACTS

Menopause actually means last menstrual period.

Source: Heather Currie, Menopuase book, 2006, ISBN: 13 9781859591550

A woman is definitely post-menopausal when she has not had a period for at least a year.

Most women in the UK go through the menopausal transition between the ages of 45 and 55, with the average age of the last menstrual period around 52.

50/50 menopausal women press play on the vagina dialogue

Source: Novo Nordisk “After the Menopause” leaflet for women

By Ailsa Colquhoun

Vaginal atrophy (VA) is reported in up to 50% of post-menopausal women.

Source: The CLOSER survey: Impact of postmenopausal vaginal discomfort on women and male partners in the UK, Claudine Domoney et, al

The most common VA symptom was vaginal dryness (70%) in European post-menopausal women.

62% of women said VA had a significant impact on the ability to be intimate and to enjoy sexual intercourse (72%)

32% of postmenopausal women were naïve to any kind of treatment.

Source: REVIVE Survey – Climacteric Vol 19, 2016 – Issue 2 Nappi et al, Pages 188-197, Vulvar and vaginal atrophy in four European countries: evidence from the European REVIVE Survey http://dx.doi.org/10.3109/13697137.2015.1107039

Read more on womenshealthadvice.co.uk

of these terms rolls easily off the tongue, which is indeed part of the problem”, she says.

“Women often find it very difficult and embarrassing to discuss gynaecological issues, especially related to the vulva and vagina and confusing terminology does not help.””

There is more to the menopause than hot flushes and night sweats, so let’s start telling the full story, says Dr Heather Currie, chairman of the British Menopause Society.

An estimated 1.5 million women – around 80 per cent of those going through menopause – will experience symptoms such as hot flushes and night sweats – and the media and society in general are getting better about talking about these. However, for the women who suffer the menopausal effect of vaginal atrophy (VA), there is still very low awareness of their problems – with the result that such women can fail to seek treatment and often suffer in silence.

In its first guidelines for treating the menopause, UK medicines’ watchdog the National Institute of Health and Care Excellence (Nice) makes clear that women need to talk with their clinician if they need advice – and that it’s very important that the discussion they have includes all relevant options, including drug and non-drug treatments, as well as lifestyle changes.

Up to 50 per cent of all postmenopausal women can experience symptoms of VA, which are caused by the effect of

Dr Heather Currie Chairman, The British Menopause Society

declining and low levels of oestrogen on the vagina. But this figure is probably the tip of the iceberg, believes Dr Heather Currie, Associate Specialist gynaecologist, at the Dumfries and Galloway Royal Infirmary, chairman of the British Menopause Society and MD of Menopause Matters: many women simply do not report symptoms, making this figure almost certainly an underestimate.

One reason for the underreporting is that symptoms only become noticeable a few years after periods or treatment with Hormone Replacement Therapy have stopped.

The stigma of vaginal problems is another. Dr Currie’s view is that the terminology used in VA has a lot to do with this. Vaginal dryness or atrophy, vulvovaginal or urogenital atrophy and, most recently, genitourinary syndrome of the menopause (GSM)… “none

But talk women must.

The symptoms of VA can include vaginal dryness, irritation and pain during sexual intercourse, as well as reduced sensation and response. Women with VA can also be at increased risk of vaginal and urinary infections.

All these symptoms can cause significant discomfort and distress to the woman, and can have a massive effect on a woman’s confidence and self-esteem, as well as their personal and sexual relationships. These are also symptoms that will not usually resolve on their own and, in fact, will usually gradually worsen with time – so much so, that Nice recommends that treatment should be “started early before irreversible changes occur”. Currie says: “Women need to be aware of VA, to know the signs, and to feel able to seek help and treatment. We are getting better about talking about this condition, but we can’t be complacent – there is still a lot of work to do”.

Have you experienced vaginal dryness?

Start Talking VA

Vaginal atrophy (VA) is a common and chronic, yet treatable, condition of menopause caused by a reduction of estrogen.

Left untreated, VA worsens over time.

You are not alone. VA 1 in 2 women within three years of menopause.

burning & itching

dryness

Common Symptoms

urgency with urination urinary tract infections

urinary incontinence

87% 76% 57% say VA makes them feel old

avoid sexual intimacy fearing it will be too painful

Managing Your Symptoms NICE guidelines advise that if you have vaginal dryness you should be offered vaginal oestrogen, which can be used for as long as you need to.

Your symptoms may come back when you stop using it.

Speak to your doctor about your symptoms to ďŹ nd the best treatment for you.

Visit www.menopausematters.co.uk for more information This is an advertorial commissioned and funded by Novo Nordisk Health Care AG Further reading: National Institute for Health Care Excellence. Menopause information for the public. NG23 2015. http://www.nice.org.uk/guidance/ng23/ifp/chapter/Managing-your-symptoms

feel VA has a negative impact on various aspects of their lives

Date of preparation: November 2016 UK/HRT/0215/0003(3)

intimacy, relationships, self-conďŹ dence and overall quality of life. As revealed by surveys of British postmenopausal women:

painful intercourse

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INSPIRATION

EXPERT TIPS

Kathy Abernethy Menopause specialist nurse

Menopause – What’s normal and what can you do?

1

What happens at menopause?

2

Do I need a blood test?

3 4

Menopause, when periods finally stop, usually occurs between 48-54 years. You may get physical symptoms like tiredness, hot flushes or waking at night in a sweat. Some may notice psychological symptoms such as mood swings, irritability or poor concentration. You may just notice a change in your periods and feel generally untroubled, wondering what all the fuss is about. This is all normal.

Oestrogens as first choice for low bone density in the under sixties

By John Studd

Most women do not need a blood test, unless you are under 40 years. Diagnosis is made based on how you are feeling, along with signs such as missed periods and symptoms.

What are my choices?

If you are facing menopause at the natural time, it is your choice how to cope with it. Your choice to make healthy lifestyle changes that will improve health, your choice how to manage symptoms naturally and your choice whether to use HRT.

Coping with bothersome symptoms Watch for ‘triggers’ that might worsen symptoms, for example: alcohol, caffeine, spicy foods, sudden changes in temperature and feeling stressed. Consider supplements, either to supplement dietary deficiency or to help mild flushes and sweats. If your symptoms are bothersome and affect your daily life, you may want to consider HRT. Doses and types should be individualised to your needs.

5

PHOTO: ALAN BOYDE

Osteoporosis occurs at times of oestrogen deficiency such as premature menopause

Where to get help For medical help, your GP will usually be the first point of contact. Do your homework beforehand, look at recommended websites and prepare the questions you have to get the best from the consultation.

Kathy can be contacted through the charity Women’s Health Concern womens-health-concern.org/ help-and-advice

Transdermal oestrogens are recommended as first choice therapy for the prevention and treatment of osteoporosis in women. Such therapy also has other benefits of reducing menopausal symptoms, improving energy and mood and libido and almost certainly reducing the instances of heart attack and strokes.

There was a time thirty years ago where HRT was the only available treatment for the treatment and prevention of osteoporosis. Physicians were never comfortable with hormone therapy because they had little experience from this treatment so they welcomed the arrival of bisphosphonates, PTH, Strontium etc, or non-hormonal preparations with frequent side-effects.

The bad news from the 2002 Women’s Health Initiative was welcomed by osteoporosis doctors because it justified their refusal to use oestrogens, but over the last ten years all of the problems from this study have been corrected. Even the

John Studd, DSc, MD, FRCOG Professor of Gynaecology and Vice President, National Osteoporosis Society

authors are now queuing up to apologise for the damage that they have done to millions of middle-aged women who have been denied the treatment for their menopausal symptoms and above all therapy for the treatment and for the prevention of osteoporosis.

Osteoporosis occurs at times of oestrogen deficiency such as premature menopause, early hysterectomy and oophorectomy, anorexia and very thin “exercise freaks” who not only have little fat which produces oestrogen but often miss their periods and lose the ovarian supply of oestrogens. We now know that

the safest way to give oestrogens is by the transdermal route in the form of gels or patches or occasionally implants as these do not produce any of the excess thrombosis that occurs with oral oestrogens. We know that we should avoid daily progestogen because that is the single risk factor for any increase in breast cancer. Women having transdermal oestradiol and merely seven days of a mild natural progesterone have considerable protection and effective treatment for low bone density without the side-effects or oral oestrogens whether it is in HRT or the birth-control pill.

Such long-term therapy improves mood, energy, and libido and removes the one in three risk of elderly, or not so elderly women developing an osteoporotic fracture. Apart from being safe it is also very inexpensive and should be first choice for the prevention and treatment of osteoporosis in women. It is hard to understand why any other non-hormonal treatment is regarded as suitable for this problem which is called by long-term oestrogen deficiency.

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Osteoporosis: strengthening the connections

By Tree Elven

Women lose about 1 per cent of bone density every year after the age of 45, increasing the likelihood of fractures and other complications. We look at how best to reduce your risk.

“Loss of bone density and strength quickens during menopause,” explains consultant rheumatologist Professor David Reid, who’s specialised in osteoporosis and bone densitometry for 30 years. “Women 1015 years ago were more concerned about the link between menopause and osteoporosis, and bone clinics were full of women looking for guidance on Hormone Replacement Therapy (HRT). Nowadays, it tends to be mainly those who have already suffered a fracture who come in.”

Women may have drifted away from HRT because the risks have been over-stressed, he says. “Most bone specialists would be happy to discuss relatively short-term HRT for women under 60 – it’s as effective as anything else. The primary treatment for osteoporosis in over-60s advised by most guidelines are the bisphosphonates, which are also suffering from scare stories about long-term usage. We are beginning to see an increased number of fractures as a result of patients not taking drug treatment but the benefits greatly outweigh the very rare negative effects.”

A DEXA bone scan is available at private clinics for anyone with concern re osteoporosis and often on the NHS for women over 50, who have strong risk factors such as having already suffered a fracture over the age of 50.

Professor David Reid Consultant Rheumatologist and Osteoporosis Specialist

“Be aware,” advises Reid. “if your mother or grandmother became very stooped or lost height in older age, or can’t reach up to shelves they used

to reach, they may have had spine fractures and you too may be at risk.

Tools are available with some newer DEXA scanners which can measure directly if a fracture is already present or improve risk assessment” Reid says that much can be done to improve bone health: a good level of Vitamin D is critical. “We just don’t get enough from our winter sun. A supplement of 400iu is a good standard, and those at high risk or already diagnosed with osteoporosis should be on 800iu.”

Weight-bearing exercise is also useful for the legs, but “we’re struggling to think how to strengthen back bones,” he says. “They need to be strained a bit to improve the density.” There’s some early evidence that power plates and vibration therapy may help strengthen the spine, but more research is needed to prove their value”.

Be as well as you can be The specialist women’s clinic at 25 Harley Street is where leading medical consultants offer a discrete service from a single centre of expertise. The private clinic provides the very latest in high spec facilities, and covers the therapeutic areas of osteoporosis, menopause, gynaecology, rheumatology, endocrinology and emotional wellbeing. Patients can receive on-site diagnostics including the latest lab tests and a full body DEXA scan, all in a single visit. A proud member of the National Osteoporosis Society Bone Health Network 25harleystreet.co.uk / 0203 8839525

COMMERCIAL FEATURE

The MonaLisa touch

By Tree Elven

Loss of oestrogen caused by menopause can trigger symptoms such as painful intercourse and urinary incontinence. A ‘life-changing’ but little-known treatment is now available.

“Vulvo-vaginal atrophy (VA) is experienced by about 50 per cent of post-menopausal women,” explains Dr Suren Naidoo, a GP and specialist in the MonaLisa Touch (MLT) laser treatment for Vulvo-vaginal atrophy, which is now available in the UK. “It can occur as a consequence of natural or induced menopause, or treatments such as chemotherapy for breast cancer. The vagina becomes narrower and drier as it loses its natural mucus production, and sexual intercourse can become difficult or painful as a result.

“Furthermore, loss of acids in the vagina can reduce protection against urinary tract infections, which

cause itching, burning, and urgency.

Because many GPs don’t realise that this is due to VA, they might prescribe antibiotics, which have their own side effects and don’t address the VA.” These urogenital complications can have a serious impact on a woman’s life, Naidoo says.

The MLT laser treatment works by stimulating the vaginal lining to help restore mucus production, both eliminating symptoms of urinary incontinence, and easing sexual intercourse.

“The MLT is a straightforward and quick procedure, rather like having a smear test,” says Naidoo. “After examination of the patient’s history and vaginal acidity level, the procedure itself involves the patient lying back on a couch while the probe is inserted – there may be a little discomfort during those seconds, but then she will only feel a slight, painless vibration. It takes about five

Dr Suren Naidoo General practitioner and aesthetic practitioner

rsnaesthetics.co.uk tlvac.com BMI Cavell Hospital, Enfield EN2 7PR

minutes to complete.”

The patient returns six weeks later for a further follow-up consultation and a repeat of the probe procedure, and then there is a final review six weeks after that to complete the treatment. Currently only available privately at Naidoo’s Harley Street clinic and a few others, the treatment costs around £3,000.

“The MLT treatment is very popular in the USA and in Italy, where it originated and where I trained in it,” says Naidoo. “In the UK we’ve had extremely good results. As well as women in menopause, we get younger women referred from Oncology – they can safely have this procedure after cancer treatment.

“I am passionate about getting the word out about MLT. Many ladies are suffering in silence – they have no idea that there is a life-changing treatment available.”

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INSPIRATION

How to be middle-aged without going insane Self-confessed ‘Grumpy Old Woman’ and comedian Jenny Eclair talks car rage, mismatching underwear and the hobbies that saved her life as she struggled with her menopause

By Ailsa Colquhoun

C

omedian and novelist Jenny Eclair speaks about the menopause not as an expert but as a woman who has experienced it, and who thinks it deserves to be aired.

“It’s never been a taboo subject for me,” says Jenny, who describes her decision to take Hormone Replacement Therapy as “that or Holloway”, due to the extreme rage - “car rage.. .danger to myself rage” – she experienced as a result of her hormone changes. Of the medication, she says: “It‘s turned me into the woman I should always have been… but with the thickest hair and nails”.

For a woman who has made a living about sharing life experiences with audiences numbering into hundreds, it is hardly surprising that Jenny doesn’t find it difficult to share her own menopause experience. Of course, she can understand why others do. “There are still some very old-fashioned attitudes,” she says, citing a GP who referred to her

vagina as her ‘downstairs’. However, once you start to talk about the menopause you realise there is a very wide spectrum of experience, she says. “The most important thing to remember is that if you need help with your menopausal symptoms, make sure you get it.”

Jenny describes as her “lifesaver” hobbies such as art and embroidery, and spending time in or near water. She says: “It’s hard to be bad-tempered in water.”

She has also taken a lot of pleasure from being able to do charitable work, such as supporting a prison charity.

Equally important, she believes, is to be able to surround yourself with a good social support network. When asked about the upside of middle age, Jenny says that women become more supportive to each other: “We have stopped being in competition with each other, we don’t want that dream job or man anymore –even if they were still up for grabs.” She also reflects that by middle age, there is shared experience of the ‘big life’ stuff, like parents

dying, children growing up, the heartbreak of downsizing or of not being able to downsize because the children won’t or can’t leave home. And, she says, there is shared sympathy with the “haunted-looking” middle-aged woman in the supermarket on late Christmas Eve or early Christmas Day, who’s clearly forgotten to buy the turkey…

For women of this “certain age”, Jenny’s latest show ‘How to Be A Middle Aged Woman (Without Going Insane)’ is not only entertaining, it’s a safe haven almost universally made up of women of the same certain age. Here, women can share their

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Julie Dennis The Menopause Coach

Cool down, calm down and break through the brain fog admiration for 56-year old Jenny who appears in publicity material for the show dressed only in bra and mismatched knickers. Together they can enjoy Jenny’s characters such as Menopause Woman “who would fly around the world in her bra and pants with a pinny tied under her chin like a cloak”, or whose hot flushes can be put to good use by getting rid of those expensive patio heaters in pub gardens and employing middleaged women to circulate around to heat things up.”

In the middle-aged woman’s world, the idea of being paid for that in Chardonnay tokens will always go down well.

Read more on womenshealth advice.co.uk

T

he quickest and most effective way to get control of your menopause symptoms is to calm down – it’s easier to do than you think!

Stress is everywhere in the 21st century: emails, traffic jams, toxins, certain foods, annoying colleagues and even the wrong type of exercise.

Whilst you can’t avoid stress what you can do is learn how to quietly and confidently manage it. And once you manage your stress you get control of your symptoms too.

Start by tracking your triggers. Indulge in your stationary habit and buy a beautiful journal or tap the information straight into your phone.

You’ll find caffeine and alcohol can spark hot flushes, mood swings and energy bombs.

Gradually reduce your consumption for relief from the worst of your symptoms.

Certain types of exercise make your menopause symptoms intensify. Cardio workouts increase your cortisol levels which makes sleep and weight loss really difficult. A mix of HIIT and restorative exercise are perfect for ladies of a certain vintage.

Avoid drinking water out of plastic water bottles. It’s not the water that’s the issue.

In fact it’s extremely important to stay well hydrated. However, plastic bottles are full of xenoestrogens, a chemical substance that mimics natural oestrogen and disrupts your hormones so drink out of bottles marked BPA free.

Manage your night sweats with a shopping trip and buy your own duvet – separate duvets mean you’re not impacted by your partner’s body heat.

Next you time you sense a hot flush, menopausal rage or anxiety attack building simply breathe. Yes it really is that easy. Six deep belly breaths can switch off your stress response and switch on your parasympathetic nervous system which serves to slow your heart rate and helps you to power down.

Menopause is a complex condition but it doesn’t have to be complicated to manage.

Track your triggers and adjust your lifestyle to cool down and calm down through your 40s, 50s and beyond.

For more information go to: www.juliedennis.net

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INSPIRATION COLUMN

Professor Mary Ann Lumsden Trustee of Wellbeing of Women and Senior Vice President at the Royal College of Obstetricians and Gynaecologists (RCOG)

What women want when it comes to menopause and work

S

ymptoms can cause discomfort, tiredness and embarrassment for some of the 3.5 million working women aged 50-65 in the UK. We look at what’s being done to improve things.

“Hot flushes and night sweats can affect quality of life for 20-25 per cent of women and they are harder to deal with at work,” says Professor Mary Ann Lumsden, a Senior Vice President at the Royal College of Obstetricians and Gynaecologists (RCOG). “Severe insomnia is awful, and some working conditions can make symptoms worse.”

Positive measures already being worked on include flexible schedules, time off, desks by open windows or fans, and, vitally, better understanding through communication.

A 2016 RCOG study called Menopause@ Work, which was supported by the charity Wellbeing of Women, drew “overwhelming” interest from women and employers, says Lumsden. “This research has the potential to make a real difference to women’s lives.

We need solutions, and research evidence shows us what works and what doesn’t.”

“Pregnancy can be talked about openly in the workplace, but women in menopause often feel they can’t talk about their symptoms,” explains Lumsden. She’s run discussions on menopause within companies and says it’s “great fun”.

Male employees should definitely be invited to such events. “They’ll come and be interested –menopause is a perfectly natural phase, and men are involved through the women in their lives. Women need to be given the confidence and conditions to work through the different stages.”

She believes the way forward is for companies to be receptive and women to be aware and communicate.

“After all, what women want at menopause is to continue to achieve their best.”

Read more on womenshealthadvice.co.uk

Ten facts regarding HRT that every woman should know

By Louise Newson

8. HRT is associated with a risk of breast cancer in younger menopausal women

HRT causes so much confusion and anxiety. For the vast majority of women under the age of 60, the benefits of HRT outweigh any risks.

There are numerous studies and guidelines which support this.

1. You have to wait for your symptoms to be really bad before taking HRT

FALSE

Dr Louise R Newson BSc(Hons) MBChB(Hons) MRCP FRCGP

Women under 45 years should be given replacement hormones until they are 51 years.

This helps to reduce their risk of osteoporosis, heart attacks and psychological disorders.

Any risks of HRT do not apply to younger women taking HRT.

FALSE

This is not the case as HRT usually helps even if you have mild symptoms. Also, there is increasing evidence that starting HRT early leads to greater protection from osteoporosis and heart disease.

2. HRT delays the menopause

is actually less that for women who are obese or drinking a couple of glasses of wine each day. When you stop taking HRT, any increased risk of breast cancer reduces. However, taking oestrogen only HRT does not seem to be associated with this risk.

FALSE

5. HRT causes clots

Any symptoms you have after stopping HRT are menopausal symptoms you would have experienced if you had never taken HRT. Without HRT, some women have menopausal symptoms for numerous years.

for some types of HRT If you take tablet HRT then there is a very small increased risk of a clot developing. However, taking oestrogen part of HRT as either a gel or a patch reduces this.

3. You have to stop HRT after 5 years

6. HRT will cause heart attacks

FALSE

FALSE

FALSE

The length of time you take HRT for is an individual choice and depends on your individual health.

Taking HRT when you are under 60 years of age does not increase your risk of developing a heart attack.

4. There is an increased risk of breast cancer with all types of HRT

7. You can not take HRT if you have a migraine

FALSE

Some types of HRT are associated with a small increased risk of breast cancer. This risk

9. Using oestrogen vaginally for vaginal dryness has the same risks as taking HRT FALSE

Vaginal dryness is very common and using oestrogen as a vaginal tablet, cream or ring can be really effective. This is not the same as taking HRT and does not have the same risks associated with it. These products can be safely used by most women and regularly over a long period of time.

10. Natural treatments for the menopause are always safer than HRT FALSE

Many women want to take natural products for their menopause but the definition of “natural” can be unclear.

Deadly nightshade is a plant so is natural but clearly not safe. Many of the hormones in HRT prescribed are natural as they are derived from yams.

FALSE

Migraines can worsen during the menopause and can improve by taking HRT. The oestrogen should be given as gels or patches.

Find more information on www.menopause doctor.co.uk