Even though 80% of women going through the menopause will get symptoms, such as hot flushes and night sweats (and in 25% of cases they will be severe enough to affect quality of life), few are confident talking about it. A global industry worth about US$4bn (£3.4bn) flogs books and products, but reliable information is hard to come by. So how can women distinguish fact from marketing hype – and what helps?

Managing the symptoms



Kathy Abernethy, chair of the British Menopause Society, says: “Hormone replacement therapy (HRT) is absolutely the best treatment for hot flushes and sweats that affect daily life. It can also help sleep disturbance caused by night sweats and is one of several strategies to keep bones strong.” Dr Mark Vanderpump, an endocrinologist (hormone specialist), agrees: “If men got hot flushes, they’d be screaming for HRT,” he says. Other options include the non-hormonal drugs clonidine, venlafaxine and gabapentin, or lifestyle measures such as avoiding spicy foods, alcohol and hot places.

HRT and cancer risks



The risk of cancer from HRT is overstated, says Vanderpump. Cancer Research UK puts it in perspective; if 1,000 women start HRT at the age of 50 and take it for five years, there will be two extra cases of breast cancer and one extra case of ovarian cancer compared with among non-HRT users. There will also be some extra cases of heart attack and stroke, but the overall negative effects are small. Avoiding HRT could prevent 1,700 cancer cases a year, but staying a healthy weight could prevent 18,000 cancer cases and not smoking would prevent 64,500 in a year. Women need to be given information and choices, says Vanderpump. Abernethy recommends the Women’s Health Concern factsheets and the website Manage My Menopause, which offers tailored advice.

Natural supplements

Campaigner and author Maryon Stewart advocates a diet rich in plants such as soy that contain oestrogen-like chemicals called phytoestrogens. But Abernethy says we don’t know how much soy you need to eat to get the same effect as HRT. And if phytoestrogens have similar benefits to synthetic oestrogens in HRT, they may share the risks: an increased chance of blood clots and a possible increase in breast cancer.

Dietary supplements containing isoflavones (the active chemicals in phytoestrogens), herbal remedies such as black cohosh and vitamin E are all available over the counter, but there is little evidence about their effectiveness or otherwise, according to the North American Menopause Society.

Eating a varied, Mediterranean-style diet, avoiding obesity, and doing regular weight-bearing exercise will help to minimise the risk of osteoporosis, heart disease, depression and osteoarthritis. Most women don’t need calcium supplements, but those at particular risk of osteoporosis should get specialist advice.

Preventing heart disease and strokes

June Davison of the British Heart Foundation says women need to be aware that their risk of heart disease and stroke increases dramatically after the menopause. Oestrogen, which has a protective effect on artery linings, falls – and other factors, such as high blood pressure, raised cholesterol and the ageing process kick in. Davison says: “Heart disease kills three times as many women as breast cancer does; it’s common and certainly not a male disease. The best approach is to get a health check at your GP, optimise blood pressure, cholesterol and weight, don’t smoke, eat well and exercise. We don’t advise HRT to protect against heart disease; it may increase the risk of thrombosis (blood clots) if you are at increased risk and there is some evidence that heart disease is increased in the first year of HRT use. Women who want to take HRT for other reasons, such as hot flushes, and are at low risk of heart disease, can be reassured that the increased risk will be very low.”

Sex drive and dry vagina

Loss of sex drive is common around the time of the menopause. Low mood, tiredness, hormonal changes and relationship problems may all play a part. It doesn’t help that sex can be painful as the fall in oestrogen levels makes the vagina dry and sore. Non-hormonal vaginal moisturisers such as Replens, lubricants, and oestrogen pessaries (on prescription only) can restore vaginal moistness; the other factors may be more complex to fix.

Supplements for skin and hair

Vanderpump says women and men in midlife often experience thinning hair, rougher skin and various other age-related changes to their looks. But these are more likely to be due to genetics and environmental factors, such as sun exposure and smoking. If you eat a normal, varied diet, there is no reason to think that nutritional supplements will help hair, nails or skin. HRT doesn’t turn the clock back and isn’t recommended for these factors.

How can my employer help?

A government review examined 104 studies and found that the years around the menopause can have a big, usually negative, impact on women’s working lives. Study co-author Professor Jo Brewis of the University of Leicester school of business says: “We need to talk about the nitty gritty of menopause without embarrassment or fear being judged.” Brewis says the analogy is with pregnancy 20 years ago when women feared telling employers that they were pregnant and needed certain reasonable adjustments in the workplace. For menopausal symptoms such as hot flushes, that might include fans, open windows, adjustable air conditioning, non-synthetic uniforms and flexible working hours.

“We need to normalise the menopause, understand that it affects women differently and that many of the problems are relatively short-lived,” says Brewis.

What are bioidentical hormones?

This form of HRT marketed in the private sector claims to offer hormones derived from plants that are chemically closer to the ones that occur naturally in the body. But the US Food and Drug Administration (FDA) is clear that they are no safer or more effective than standard HRT. Vanderpump says that if you find HRT helps symptoms, the exact preparation can be tailored to your specific needs; adding low-dose testosterone (Testim) gel, for instance, may help libido – even though it is only licensed for men.

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