Sarah Says

Dr. Sarah Jarvis' health & wellness blog on Patient.co.uk

Menopause - when symptoms don't go

Keeping cool won't stop your hot flushes, but may make mild ones bearable.
The symptom: hot flushes

About four in five women get hot flushes, but they tend to be worst in the two to three years around the menopause. Bouts of sweating, especially at night, are also common. For many women, they're a bore - for a few, they can make life a misery.

The options:

  • Keep cool! - keeping cool won't stop your hot flushes, but it may be enough to make mild ones bearable. Turn the thermostat down; wear natural fabrics that let your skin breathe; and invest in a thinner duvet, as we tend to get hottest at night.
  • Hormone replacement therapy (HRT) is by far the most effective treatment for hot flushes and sweats. There has been a lot of anxiety about a possible link between HRT and breast cancer. Taking HRT for two to three years doesn't seem to increase your risk, although using HRT for five years may increase your risk by 0.5% (for every 200 women who take it, one will get breast cancer who wouldn't have done) and taking it for 10 years may increase your risk by up to 2%.
  • Antidepressants - although they've had something of a bad press over the years, most antidepressant medicines are safe and effective. As well as helping with depression, they relieve hot flushes in more than half of women who take them.
  • Natural remedies - see below.

The symptom: vaginal dryness

After the menopause, your body's levels of the female hormone oestrogen drop. Among its many other jobs, this hormone helps keep your vagina lubricated. It also helps to keep the cells that line your vagina 'plumped up'. Hardly surprising, then, that so many women suffer from vaginal dryness after the menopause.

For many women, vaginal dryness is mainly a problem in the bedroom. Intimate relations can range from less stimulating to frankly painful because of the extra friction caused by dryness rubbing the thinner, post-menopausal lining of the vagina. However, it can cause non sex-related soreness, and can also make you more prone to inflammation and infections, including urine infections.

The options:

  • Topical HRT - there are several creams and pessaries containing oestrogen that you can apply from once a day to once a week to relieve symptoms. Doctors recommend you tail them off every few months to check if you still need them. There is also a vaginal 'ring' which your doctor can fit, which releases small amounts of oestrogen.
  • Replens ® - this is a non-hormonal vaginal moisturising cream which you apply every three days. It works much better than water-based gels like K-Y Jelly® and is available from your pharmacist as well as on prescription.

The symptom: mood swings

Irritability, mood swings and depression have all been linked with the menopause. It's hard to tease out which symptoms are due to swinging hormone levels and which are down to life changes that often occur at this time of life.

The options:

  • Embrace the change - many women feel, often subconsciously, that the menopause makes them 'old' because they can no longer have children. Think about all the positives - no more periods, no worries about pregnancy, more time for you now the children are off your hands.
  • Antidepressants - since they work for hot flushes too (see above) don't dismiss antidepressants out of hand if your GP suggests them.

Hormone replacement therapy (HRT) - is there an alternative?

Only a few decades ago, HRT was seen as the answer to every woman's prayer. It was not just a cure for the miserable hot flushes and mood swings of the menopause - it was also the elixir of eternal youth.

But in the last four years, all that has changed. Firstly, a study suggested that far from reducing your risk of heart disease or stroke, HRT could actually raise your risks. Then a British study suggested that HRT increased the risk of breast cancer. In just five years, the number of women taking HRT in the UK has halved, from two million to just under a million.

But what is the truth behind the headlines? In fact, if you take HRT for just two or three years around the menopause, to relieve your hot flushes, it's probably perfectly safe. Likewise, if you're otherwise healthy, HRT probably doesn't actually increase your risk of heart disease or stroke.

But if you take it for more than five years, you may increase your risk of breast cancer. In real terms, the risk is still small - about 49 out of every 50 women who take HRT for ten years will have no problem. Some women find that without HRT, their hot flushes make their lives a misery for years. For them, the relief that HRT affords is worth this extra risk.

But many other women are turning to other options, like herbal remedies. While some women swear by them, many have been found to be no more effective than 'placebo'. That means that women who take a remedy with nothing in it will feel they get better if they don't know there's nothing in it and believe it will help. All of them are available from health food shops and some pharmacies.

Menopause - keeping it natural

More and more women are turning to natural remedies for the menopause. Among the ones with the best evidence are:

Black cohosh (a member of the buttercup family) may help relieve hot flushes. Do choose a licensed preparation like MenoHerb®- there have been occasional cases of serious side effects, including liver damage, with unlicensed versions. It shouldn't be taken if you have any liver or kidney problems.

Red clover - this remedy seems to have natural oestrogen-like properties and 60-80 mg a day of red clover isoflavone may help with hot flushes. There have been no safety concerns about using it.

Evening primrose oil - although it's widely used, there is no evidence that this option helps with symptoms of the menopause.

With thanks to 'My Weekly' magazine where this article was originally published.

Posted by Dr Sarah Jarvis
Dr Sarah is unable to provide medical advice or respond directly to questions concerning your health. If you have health concerns we recommend contacting your GP.