Menopause webchat with Dr Rosemary Leonard - 1pm 10 August

Judi123

I asked for HRT and was refused I'm 62. Being so so tired all the time I gave up work and am living off savings. Still get the odd hot flush, still tired. My question is as follows; most of my pubic hair has disappeared as has underarm hair, head hair is thin and sparse, is this normal?
I take 50mg thyroxine daily 25mg alternate days, and 10mg of citalopram daily, like the lady ready to jump off a bridge I too feel there is nothing in life but eat, sleep and drag this body around.

Yours is one of many posts about loss of pubic hair after the menopause - oh, how I wish we talked about this more. In the same way that secondary sexual hair grow at the time of puberty, especially armpits and pubic hair, when oestrogen levels fall at the menopause, so secondary sexual hair thins. This happens to all older women, but because we don't talk about it, it always seems to come as a shock. It's just a normal part of ageing. The good side of course, is that you won't need to shave your armpits quite so often and you won't need a trip to the beauty salon to get a Brazilian before your holiday!

Tiredness can have lots of different causes. One of them is an underactive thyroid but it sounds as if your doctor is controlling your replacement dose very well. I see that you are on citalopram, which is an anti-depressant and it may be that your tiredness is linked to your underlying mood. But, that said, it would be worthwhile having blood tests done to check you are not anaemic and also, your vitamin D levels.

Deny

I am experiencing Hair loss and have about 4 bald patches. I didn't know that the Menopause could be a cause of this and I am in the Menopause now................
Can anything be done to sort this out?
It is making me lack confidence and is getting me down a lot..........

Thanks
Denise

While we're on the subject of hair, some thinning of scalp hair does happen gradually after the menopause. The reason for this is that testosterone, which is produced by the adrenal glands, becomes the dominant hormone in the absence of oestrogen. This leads to slight male pattern-type balding and also the unwelcome appearance of that fuzz on your upper lip. However, hormones cannot be blamed for bald patches. These are more often due to an auto immune disorder where your own immune system attacks hair follicles. I suggest you see your GP.

Belleringer

Hi Deny - i found my hair got very thin when I was in my late 50s but a blood test showed my iron reserves were very low. Obviously this won't always be the cause of thinning hair but it might be worth getting checked.

My big problem now is hot flushes - I can control them with a low dose of HRT, but I just cannot wean myself off it. I had to come off cold turkey when I had an op last year and thought that would be the ideal time to give up, but after 6 weeks I was ready to jump off the nearest bridge and went back on in desperation. The relief was indescribable. I'd rather run the small risk of something nasty developing than live my life going from drenching sweats to chilled and nauseous every 15 minutes.

There have, perhaps not surprisingly, been more questions about flushes than anything else. Even now the exact cause of flushes in the menopause is not known, but it's thought that the brain's internal thermostat becomes much more sensitive to minute changes in the outside temperature, or in your own body temperature as a result of stress. Some women never have any flushes and others continue having them for years and years. Another common pattern is to sweat far more during exercise, than before. It's as if the body just can't adapt so well. The best treatment for flushes and sweats is HRT, but though this is no longer thought to be the real baddie it once was, even pro-HRT doctors like me are reluctant to prescribe it once you're past your mid-sixties. The increased risk of breast cancer and stroke just make it medically inadvisable. If you are on HRT, then it is very important to come off it very slowly so your body can adapt to not having oestrogen again.

A good alternative to HRT is SSRI and SNRI anti-depressants. They seem to stabilise the brain thermostat in some way. When I suggest these drugs I am commonly met with the response "but I'm not depressed", but the thing to remember is that they are being used for another reason. They are not addictive - there's no compulsion to take an extra dose - but like HRT, you need to come off them slowly to avoid dizzy spells and electric shock sensations in your fingers.

marmitetoast

Hi Dr Rosemary, I am 52 and I have a mirena coil which means I have no periods - so I can’t use their absence/lightening to ascertain whether or not I am menopausal. In the absence of any bleeding what signs should I looks for?

Mirena coils are great because they can help control the menstrual chaos that can occur at around the time of the change. They slowly release progesterone into the womb lining, which thins it dramatically and this often means no periods. But of course the downside to this, as you have discovered, is that you do not necessarily know when you are going through the change. Flushes, sweats and mood swings can be a giveaway, but lots of women don't actually get these. The average age of the menopause is 51 in the UK, so the chances are you are now menopausal. However, before you have the coil removed, I suggest you have a blood test to check your hormone levels, especially your FSH level. If this is above 50 then you're almost certainly safe to have the coil removed.

Pittcity

I am almost 53 and believe that I am perimenopausal. My periods are still regular but they are heavier than ever and the PMT has worsened considerably. I keep a diary and the symptoms are the same every 4 weeks. At present I can cope with extra rest, ibuprofen and super plus tampons. Do I need to consult my GP? I am not good at taking medication, even vitamins make me ill so I would prefer to go it alone.
Surely this is just a natural part of life and not an illness.

Many women notice that their periods change in the run up to the menopause. In particular, their cycle shortens, so instead of having a period once every 28 days, it shortens to once every 25 days. However, this situation can go on for many years. The real sign that you're in the change is a hopelessly erratic cycle, missing periods and then having two in a row. At the moment, it doesn't sound as if you are there yet, but your heavy periods could be making you anaemic. You say you are not good at taking medication, but tranexamic acid can reduce period blood flow and only needs to be taken on the heavy days. It may be worth talking to your GP about this.

grandmasheila

Someone has recommended Mexican Yam to me to relieve symptoms. I have family history of breast cancer so can't (don't want to ) take HRT but are remedies like Mexican Yam just more "natural" and potentially less tested versions of the same hormones?
Cheeky second question is there anything you can do in perimenopause to lessen the symptoms/ effects of menopause?
Many thanks and so glad someone is talking about this!!

Mexican Yam contains small amounts of natural chemicals with oestrogenic properties and some women have found it helpful for menopausal symptoms. However, there are no trials on longterm safety, particularly with respect to breast cancer risk. In terms of reducing the effects of the menopause, the best thing to do beforehand is lose weight, as any extra pounds will act like a insulator and make hot flushes worse. It's also a good idea to get in the habit of taking regular exercise, as this has been shown to help reduce mood swings, tiredness and can also reduce the severity of flushes and sweats.

sharonc10

I am now in my early 60s and from the age of 58 have had regular and repeated bladder infections- UTIs. After about a year of repeated antibiotics I did have investigations which cleared me of anything serious, thankfully, and was started on a course of oestrogen pessaries and cream. Am still using the cream, twice a week. I have tried, unsuccessfully to reduce or stop using it but still get infections, when I do. Is there any problem using oestrogen cream long term?

Urinary tract infections become more common in women after their mid-sixties. Dryness of the genital tissues, due to lack of oestrogen, is usually to blame as this makes the whole area more susceptible to inflammation. Topical oestrogen in the form of small pessaries is a very safe way of treating this, but there seems to be some confusion how long these can be used on their own. The main problem with oestrogens used in the genital area is that they can cause thickening of the lining of the womb, which can eventually lead to bleeding and occasionally the development of abnormal cells. Pessaries can be used safely on their own for two years, but after this time many doctors give a course of progesterone once every six months. This will trigger shedding (in the form of a period) of any build up of the womb lining. But if you use progesterone then you can carry on using oestrogen for many years.

sweetsusie

I know the feeling about the "flashes." I'm 67 years old and STILL having them. They are torturous and my quality of life is zero. No doctor will give me HRT because of the "risk" of cardiac arrest, which I think in the future, they'll find out that's totally bogus...and that women have suffered needlessly all these years because of this stupid belief. I hate my life and am ready to jump off a bridge.

Hotmama

Hi Sweetsusie and Nondeplume, welcome to the club of the never-ending menopause! I'm 65 and after 12 years of every menopausal symptom under the sun and hot flushes and night sweats every hour day and night I was ready to end it all. My last chance try was to go see a private gynae who has put me on an HRT patch. It's a tiny dose of HRT but has reduced the flushes considerably and I feel I can live my life again. Had tried every alternative remedy going. I'm willing to take the risks for a bit more quality of life.

As we are living longer nowadays I am hoping that GPs will become more clued up about the menopause and its disastrous effects on SOME women.

Nomdeplume

Gardenoma, above, is the first person I have come across who has had menopausal symptoms for nearly as long as I have. Mine has been going for 20 yrs and I feel as it will never ever stop. On HRT for 8 yrs at one time, and now still get hot flushes throughout the day and wake up every night too. Get very nauseous sometimes before a hot flush. Have tried most remedies and acupuncture helped. Do not have caffeine. Am at my wits end really with it all. Would welcome some advice. Thanks.

I come across a lot of women who find that their body thermostat changed at the menopause and shows no sign of returning to normal, so they are forever getting hot flushes and sweats. There is no easy answer to this. Certainly losing weight and taking more exercise should be the first things to do and also simple lifestyle measures like wearing layered clothing and avoiding anything with nylon and polyester (this is an age when Lycra is not necessarily your best friend!). If you're doing exercise, wear wicking fabrics. Because type 2 diabetes is so common in older people, it is always worth seeing your GP and having your blood sugar levels checked, as this can cause sweating. And while you're at it, have your cholesterol level checked too, as levels often go up after the menopause. HRT can help with sweats but as I said before, it's really not a good idea to take this when you're in your late 60s or older. Anti-depressants can be helpful and make life much more bearable. Some women have mentioned clonidine and this can take the edge off symptoms and as long as you don't have any blood pressure problems, it can be taken longterm.

Yofab

I'm 64 and went on HRT in my 40s after having my womb removed. In the last two years I have gradually diminished and now stopped all HRT. I now find myself loosing my hair (I am not anaemic as I have had blood tests) but have grown a great deal of facial hair which I find quite distressing. What , if anything, should I do?

Extra facial hair, especially above your upper lip, is a really common problem after the menopause (see earlier reply to Deny). You can use any method to remove it, from hair removing creams to waxing. Just be aware that your skin is much more fragile than it was when you were younger. Laser treatment can permanently destroy hair follicles, and can be a good longterm solution but it's not available on the NHS. If you decide to go down this route, be sure to go to a very reputable salon. This is one area where it pays to get the best.

Pumpkin123

For those suffering with hot flushes try eating soya beans. I soak them dry them and then roast till crisp. Having 3 or 4 small handfuls a day has greatly reduced my hot flushes. I read somewhere that Asian women who eat a lot of soya don't get hot flushes.

My main symptoms are tiredness, struggling to remember things and feeling more anxious than I used to. Can't believe I ever managed to multitask.

I am 51 and have zero libido. Does that ever come back ?My husband is brilliant and we have a good relationship but I can't imagine ever wanting sex again.is it a case that for some women / couples a sexless marriage is the way forward and other aspects of the relationship become more important?

Also my armpit hair has vanished.

It's true that women in the Far East who eat a lot of soya apparently have fewer hot flushes, though whether this is just that they are genetically not prone to them or it's due to their diet really isn't known. However, soya can be a very good ingredient of a healthy diet, so I always encourage menopausal women to try and eat it as much as possible.

Tiredness can simply be caused by the drop in oestrogen and constantly disturbed sleep by hot sweats doesn't help either. It's always worth seeing your GP to have blood tests done to check you are not anaemic and also to check your thyroid hormone levels, as an underactive thyroid is surprisingly common in mid-life women.

The libido issue is another common one that is not talked about. Again, it's due to the fact your ovaries aren't working any more. In addition to oestrogen, the ovaries also produce a small amount of testosterone, which is very important for libido. Though some testosterone is produced by the adrenal glands after the menopause, it's not enough to make up for the loss of ovarian testosterone. HRT can help reboot libido, but is rarely given for this reason alone. Some specialists are also willing to prescribe testosterone, however, there is no formula that is licensed for women in the UK, so it means using a tiny amount of the gel designed for men. Not surprisingly, this is something that most GPs won't prescribe for you. It can be tough being a woman!

mummsymags

At 52 I was having very heavy periods to the point that I was given a blood transfusion! Subsequently told I was too fat to have a hysterectomy(?) - I was 5'7" and 13.5 stone. Switched consultants and was told after ultra sound that I had multiple tiny fibroids all over lining of uterus but that they would respond well to intensive HRT high dose injections, given monthly.
After 6 injections I saw the consultant himself (I had been seen by his team prior to that) and he was furious! On reading my notes he realised that I had been given 6 instead of 3 months treatment (3 months should be the max).
I don't want to put anyone off HRT but 4 months later I was diagnosed with breast cancer and had a lumpectomy and radiotherapy. I have just finished chemo for a recurrance of breast cancer, following a single mastectomy (same breast). These things may not be related but all things considered I would advise anyone thinking of HRT to insist on seeing the consultant first and to make sure you understand exactly what the treatment is, how it works and how long it should last. This happened in a reputable teaching hospital.

The injections you were given were very unlikely to be high dose HRT as these do not exist. I think it is far more likely that you were given zoladex, which contains a hormone which switches off the pituitary gland. This is used to stop the ovaries working so oestrogen levels fall and this can also lead to dramatic shrinkage of fibroids. It's zoladex injections that are given for three months prior to a hysterectomy for fibroids, to make the operation technically easier. Because zoladex switched off the ovaries, if anything it reduces the risk of breast cancer so I suspect your unfortunate experience was just coincidence, but I do hope you are feeling better now.

RebaMac

My periods stopped five years ago, i'm 49 was told that I was too young for menopause by Doc, but they didn't know what was going on sent for a scan i have a mass that's not attached to anything but looks fine cant take out as the walls are too thin so they thought this was the problem.
Waited two years was sitting in gp waiting room found out from another ladies conversation you can get a test for the menopause so asked GP reluctantly she agreed, it came back borderline, so again told no not the menopause, cut long story short had scan of head found out something wrong pituitary gland ah Doc says that's why they have stopped but consultant at hospital just laughed when I asked him he said its your age dear your going through or have had the menopause. I don't get any other symptoms perhaps joints as knees and hip are bit bad go Physio, don't get hot flushes but I sweat out the blue at times only its not just perspiration, its like someone turning on a tap at top of my head and water flooding down. So please can you tell me is this the menopause or have I had it
I still have no clue
Thank you so much

Though it's unusual, the ovaries can stop working in the early 40s and sometimes even earlier. The only way to know whether you are menopausal or not is to have a blood test to check your FSH levels. In the perimenopause, levels can vary hugely from day to day, but once the level is above 50 then it suggest your ovaries have actually stopped working and you are menopausal.

sharkgirl

I am reluctant to admit this, lest things change dramatically, my periods just stopped after some pretty heavy months five years ago (I am now 55) and apart from putting some weight on around my waist that's it, my hair is actually a bit thicker and more manageable and my bust measurement has improved. So have I really finished with the menopause or is it likely to come back and bite me hard? How long does this phase actually last or is it individual and a prediction impossible?

Yes, you have finished with the menopause. Like a lot of women, you've not had too bad a time and in fact some go through it without a single a flush or sweat, it;s just we tend to hear about the ones who are having an awful time. Putting on weight around the waist is very common and in fact it is a mistake to try and stay too thin at this time of life. Fat cells can convert hormones produced by the adrenal glands into oestrogen so in fact having a little tummy is good for your health and your mood.

Forgetful53

Hello I wondered how long surgical menopause with no HRT lasted? Mine is still going strong eight years after having my ovaries out. I don't take anything just put up with it.

Thanks

When your ovaries are removed (a surgical menopause) oestrogen levels plummet suddenly and menopausal symptoms can be really severe. It's like the natural menopause though - some women get over it very fast, while others have symptoms for years. If you are still having flushes and sweats then do go and see your GP to see if there is any medication that can help you.

cullenskink

I am 51 and apart from a lower back problem after an accident I am fit, healthy and active. I have had a mirena coil since October 2014. For the first three months I had continual pain and bleeding and since Christmas no bleeding at all. However for the last few months I have been suffering from period-type pains. Not severe and not constant but often and annoying.

I regularly find myself stopping to do something like drying my hands, taking stock and realising the pain is still there. As I say - it's not severe but it's definitely there. Heat helps.

About three weeks ago I also started getting what I would describe as bad PMT symptoms. Excruciating breast pain (taking my bra off would have me in tears) which lasted about a week. Bloating, fatigue. moodiness, food cravings which have been ongoing on and off. I am definitely not pregnant! So I am wondering - is the pain because of my back (referred?), a bowel issue (sometimes it seems to go deep into my buttocks although this isn;t all the time) or is it, as I assume because of the second list of symptoms, hormonal - in which case is it likely to be down to the coil or the menopause? Apologies for the length of this question but I would be grateful for your opinion.

Any woman who develops pelvic pain for no reason should go and see their doctor. The fact that your coil appeared to settle in and you had a pain free spell suggests that it's not this that is to blame. It could be related to your back but you need to get this sorted properly, so go and see your doctor.

mib

Since I became menopausal I have a new and embarrassing problem which is making me unhappy. I get hot, not flushes exactly but when I am warm I am very warm indeed. The problem is sweat. So, for example,the other morning I got up and had my usual shower and applied my usual spray on deodorant. I then walked 20 minutes to meet a friend for coffee. It was a warm day, not boiling and I walked at a moderate but not fast pace. By the time I arrived I was conscious that my arm pits were so sweaty and that the sweat really smelled bad. I thought it was only stale sweat that smelled but I had showered and used a strong deodorant. I shave my under arm hair. Please help this is making life a misery for me as I can’t bear for people to think I have poor personal hygiene. I am 52.

You may find it more helpful to use a roll on antiperspirant rather than a spray deodorant. Ones containing 2% aluminium chloride are particularly effective. However, having body odour after the menopause is actually quite unusual. Most women find they just sweat all over their bodies, especially their head, so your makeup drips! If you are worrying about body odour then ask a close friend whether you do smell or not. It may be you are worrying over nothing.

salleee

Like the above poster I do not have periods due to my contraception. I have noticed recently however changes that may or may not be indicative of the menopause. Or they could be post viral. They include tiredness, poor sleeping (nothing on my mind, just wake up a lot and take time to get back to sleep) and restless arms. Thank you

You don't say how old you are but it's quite possible your symptoms are due to the menopause. The only way to sort this out is to have a blood test to check your FSH levels. And even though you have a Mirena coil in place, this will give a good indication of whether your ovaries are still working or not. But don't go and rush and have the coil removed. If you decide you'd like HRT, then the Mirena coil can help protect the womb and all you will need is oestrogen, which can be given in the form of gel or patches, as well as tablets.