Ladies of a certain age – are you suffering in silence?

Whenever I admit I’ve been a GP in the same inner-city London practice for over 25 years, I immediately qualify it by pointing out that clearly, you only have to look at me to realise I qualified when I was six. In my head, middle age is something my parents are facing – sometimes I wonder how anyone could think I was mature enough to have kids at all, let alone one at university.

But nature has a nasty way of reminding me that even if 50, rather than 40, is the new 30, there are certain stages of life you can’t ignore. Every woman who lives long enough will go through the menopause, and 80% of them will suffer menopausal symptoms including hot flushes, mood swings and vaginal dryness.

The term ‘menopause’ comes from the Greek words for ‘monthly’ and ‘cease’ – but actually, doctors only say a woman is ‘postmenopausal’ when she hasn’t had periods for a year. While hot flushes tend to be worse in the 3-4 years around and just after the menopause, at least 1 in 10 women will continue to get symptoms for up to 12 years. Hot flushes can be scary, embarrassing and unpleasant, while the night sweats that often go alongside make a good night’s sleep a distant memory.

Vaginal dryness is another major issue, leading to painful sex, an increased risk of urine infections and a greater chance of womb or vaginal prolapse – and unfortunately, unlike hot flushes, vaginal dryness doesn’t tend to improve.

After the menopause, the drop in levels of the female hormone oestrogen can also make you more prone to osteoporosis ( , with the attendant risks of fractures – at least 1 in 3 women (and 1 in 5 men) breaks a bone due to osteoporosis during a lifetime.

Until a decade ago, scarcely a working day went by without my having a discussion with at least one woman about HRT, which often ‘magically’ settled their symptoms. All that changed in 2002, with the first of a series of studies linking HRT to a possible increase in the risk of breast cancer, stroke and heart disease. But review of these studies, and better conducted trials which have come after them, have gradually swung the pendulum back towards a more balanced view. Used at the right time and in the right way, HRT doesn’t increase the risk of heart disease, and only 1 in 1000 women will get breast cancer as a result of using HRT every year. In fact, for women who’ve had a hysterectomy and can use ‘oestrogen only’ HRT, or for women under 50, there is little or no increased breast cancer risk at all.

NICE – the National Institute for Health and Care Excellence – has today published its long-awaited guidance on the menopause. After years of confusion, their advice is sensible, pragmatic and evidence based. Among the highlights of their recommendations are:

  1. If you’re over 45 and stop having periods/get hot flushes etc, you don’t need a blood test to check you’re going through the menopause
  2. If your periods stop below the age of 40, you need to see your GP with a view to getting specialist treatment from a menopause clinic. Going through premature menopause greatly increases your risk of osteoporosis in later life, and HRT or the combined oral contraceptive pill will protect you
  3. Oestrogen only HRT (if you’ve had a hysterectomy) has little or no effect on your risk of breast cancer. Combined HRT may increase your risk, but this drops off again once you stop HRT
  4. Just because you’ve got risk factors for heart disease - high blood pressureraised cholesterol etc – you shouldn’t assume you can’t take HRT. If you start HRT under 60, it doesn’t increase your risk of heart disease or dying from heart attack or stroke
  5. HRT will certainly help with hot flushes and night sweats, and may ease mood swings and low mood
  6. For vaginal dryness, low dose vaginal oestrogen – in the form of pessaries, cream or an impregnated ring – can be used for as long as you need it.

When the first worrying study about HRT came out, I was Women’s Health Spokesperson for the Royal College of GPs, and doctor to ITN lunchtime news and Radio 2, so I did lots of interviews on the subject. At every interview I was asked ‘should HRT be banned’ and my response was always the same: Don’t ask me, ask a woman whose life is being made a misery by hot flushes. Now we’ve got the risks and benefits of HRT into perspective, the message is even simpler – don’t suffer in silence.

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Egton Medical Information Systems Limited has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.