How to make the menopause a little easier

Half of all biological women go through the menopause - on average at around 52 years old. However, anything from 45 is normal and it can happen earlier in some.

Is HRT right for you?

In years gone by, doctors were quick to recommend HRT as the treatment for menopausal symptoms, on the basis that it relieved menopausal symptoms more effectively than anything else and helped protect against osteoporosis, or thinning of the bones. Two major studies then suggested a link between HRT and breast cancer, as well as a possible increased risk of heart disease. Not surprisingly, prescriptions for HRT plummeted.

Since then, further studies have shown that HRT doesn't carry any increased risk for heart disease for women in their 40s and 50s - in fact, it may even protect your heart at this age.

Some HRT can also increase your risk of a clot on the leg - a deep vein thrombosis - or the lung. Body identical oestrogen creams or gels don't, and they may not carry the same risk of breast cancer. Examples include Sandrena gel, Oestrogel or Estradot patches.

Vaginal dryness is a very common side effect of dropping oestrogen levels at the menopause. Unlike hot flushes, it doesn't settle with time. Along with soreness and painful sex, it makes you more prone to urine and vaginal infections.

Topical oestrogen in cream, pessary or hormone-releasing vaginal ring form can plump up your vaginal tissues without any of the risks of regular HRT. Because the hormone is delivered straight where it's needed, the dose is tiny and you can use if for as long as you need. One form of topical oestrogen is now available to buy at your local pharmacy.

Non-hormonal vaginal moisturisers are an effective alternative to topical oestrogen. There are several available in the pharmacy and they're different from lubricants designed just for sex. Your pharmacist can advise.

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How can you prevent osteoporosis during the menopause?

Osteoporosis is a health condition that weakens bones and may cause them to fracture easily. Menopause can increase your risk of developing osteoporosis. This is because menopause causes oestrogen (a hormone that protects bones) levels to drop. But is osteoporosis during the menopause inevitable, and can it be prevented?

by Emily Jane Bashforth

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Perimenopause

Perimenopause refers to the transitional phase that occurs before menopause. It typically begins several years before menopause, although the exact duration can vary from woman to woman. During perimenopause, a woman's body undergoes hormonal changes as the ovaries start producing less oestrogen. Symptoms include hot flushes, night sweating, mood changes, vaginal dryness, and changes in libido.

by Dr Hayley Willacy, FRCGP

Bio-identical HRT

Body identical HRT is HRT which mimics your body's own natural hormones - contrary to popular belief, many forms of body identical HRT are available on the NHS.

These are different from compounded bio-identical HRT products, which are only offered by private providers. NICE advises that compounded bio-identical hormones are unregulated - meaning the same checks on quality and safety are not in place - and "the efficacy and safety of unregulated compounded bio-identical hormones are unknown".

n the UK there have been shortages of many forms of HRT available on the NHS.. That means that your doctor may need to change the form you take if you're already on HRT, and the choice of options they can offer you is currently limited.

What about herbal remedies?

If you're looking for herbal alternatives, there are several on the market. However, because they aren't regulated in the same way medicines are, there have been concerns about safety with some.

Look for a Traditional Herbal Remedy (THR) logo on the packet - your pharmacist can advise - so you know they're safely manufactured. NICE highlights black cohosh - I recommend Menoherb one a day - and Red Clover Isoflavones - I recommend Promensil 40-80 mg a day - as alternatives with the best evidence. Do let your doctor or pharmacist know you're taking these herbal remedies - they can interact with other medicines.

There's also good evidence that increasing the soya in your diet may help with hot flushes. Tofu is an obvious source - and it's also a tasty, heart-healthy, meat-free alternative for stir fries! But soya beans or soya milks and yoghurt can be easily incorporated into your routine, too.

Of course, lifestyle tips can help as well. Wear layers or loose clothes in natural fibres, and keep a sheet under the duvet so you can throw the duvet off in the night. Spicy food, caffeine, alcohol and smoking can all worsen flushes and night sweats, so cut out one at a time to see if you're less troubled. And remember, those hot flushes do usually settle - it just takes a while!

Thanks to My Weekly where this was originally published