What your GP won’t tell you about the menopause

What your GP won’t tell you about the menopause

When I heard about FlushFest, the UK’s only menopausal festival, my first thought was: I hope they’ve got air conditioning, because I wouldn’t want to

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When I heard about FlushFest, the UK’s only menopausal festival, my first thought was: I hope they’ve got air conditioning, because I wouldn’t want to be in a room with all those hot, angry women if they don’t.

That was quickly followed by: will the women who’ve bought tickets remember to turn up?

It was no cruel mocking of mid-life women (I am one), rather an accurate reflection of my own experiences.

Fortunately, the venue, in Perth, Scotland, was perfectly cool and the event was packed with curious women.

The two-day festival is organised by Rachel Weiss, the person behind Menopause Cafe, a series of pop-up meeting places for women (and men, if they’re brave enough) around the country.

Claudia Connell (pictured left), 53, spoke to author Kelli Jaecks (pictured right), 57, for advice on coping with symptoms of the menopause at FlushFest, in Perth, Scotland

Claudia Connell (pictured left), 53, spoke to author Kelli Jaecks (pictured right), 57, for advice on coping with symptoms of the menopause at FlushFest, in Perth, Scotland

Claudia Connell (pictured left), 53, spoke to author Kelli Jaecks (pictured right), 57, for advice on coping with symptoms of the menopause at FlushFest, in Perth, Scotland

There was a time when the menopause was never to be spoken of, or, if it was, only in whispered tones with reference to ‘the change’. But now, thankfully, attitudes have shifted. Suddenly, being 50-plus isn’t seen as being over the hill.

Celebrities, for whom it once would have spelt career suicide even to mention the M word, are now happy to discuss it. Davina McCall, Gwyneth Paltrow, Zoe Ball and even Newsnight’s Kirsty Wark have all spoken of their menopausal and perimenopausal symptoms.

The 50 to 54-year-old female makes up the largest age group in the UK, so it makes perfect sense that they are no longer prepared to be invisible and suffer menopausal symptoms in silence.

At 53, I’ve been taking HRT for six years but, like many women, I worry about the risks. The Perth Theatre, where the festival is taking place, is filled with women like me: professional, middle-aged, a little confused but eager to learn more about the latest thinking and findings from a host of expert speakers . . .

FOLLOW THESE FANTASTIC FOUR

‘Go meno! Come on, let me hear you shout it,’ yells Kelli Jaecks, a self-confessed ‘loud American’, as she gives her keynote address.

She’s the author of the best-selling Martinis & Menopause, a humorous take on the menopause which is packed with practical tips, and she has flown in from Oregon to participate.

A dental hygienist with a degree in communications, she describes herself as a one-time ‘hormone hostage’, who is now a ‘menopause survivor’.

The super-glamorous blonde swears by her ‘Fantastic Four’ when it comes to beating symptoms. If you experience any combination of what Kelli calls the ‘seven dwarves of menopause’ — Itchy, Bitchy, Sweaty, Sleepy, Bloated, Forgetful and Psycho — then her Fantastic Four could help you. They are:

Kelli (pictured) who gave a keynote address during the UK's first menopause festival, has four tips that she swears by for easing symptoms including exercise

Kelli (pictured) who gave a keynote address during the UK's first menopause festival, has four tips that she swears by for easing symptoms including exercise

Kelli (pictured) who gave a keynote address during the UK’s first menopause festival, has four tips that she swears by for easing symptoms including exercise

1. Exercise

‘This is the queen of the Fantastic Four. Exercise and getting sweaty when you’re having hot flushes may seem like the last thing you want to do, but it makes the world of difference,’ says Kelli. ‘Women who don’t exercise have a much rougher ride through the menopause.’

She advises ‘getting your sweat on’ in order to increase levels of the feel-good chemicals serotonin and dopamine. Both help with mood and ‘brain fog’, and the balancing effect on oestrogen can reduce the severity of hot flushes by 75 per cent. Exercise will also decrease levels of the stress hormone cortisol, which will help to fight the mid-life spare tyre.

2. Food

Women who don’t want to take hormone treatments can improve menopausal symptoms with their food choices.

Trials have shown that diets rich in omega-3 — for example from fatty fish, seeds, nuts and olive and coconut oil — can improve mood, hot flushes and night sweats.

Kelli also advises women to get their blood tested for vitamin D levels, as these naturally decrease during the menopause. She takes a whopping 10,000IU dose of vitamin D daily because Oregon, like the UK, doesn’t see much sunshine. Good levels will improve mood, focus and immunity.

The author (pictured) has been taking bio-identical hormones for ten years, she has her prescription adjusted each year according to the results of a blood test

The author (pictured) has been taking bio-identical hormones for ten years, she has her prescription adjusted each year according to the results of a blood test

The author (pictured) has been taking bio-identical hormones for ten years, she has her prescription adjusted each year according to the results of a blood test 

3. Sleep

Insomnia is a symptom many older women experience, and Kelli believes this can be relieved by adopting a 30-minute ‘wind down’ period before bed.

No TV, no phone. She recommends an eye mask for total darkness and to establish your own pre-sleep ritual.

Here’s hers: at least one hour before bed, she doesn’t drink any alcohol. Instead, she drinks a large glass of water, stops answering the phone and stops eating.

Before bed, she applies scented lotion to her skin and once in bed she makes a mental list of everything she is grateful for, then reads until she’s ready for sleep.

4. HRT

KellI says it quite simply changed her life. At 57, she’s been taking bioidentical hormones for ten years, her prescription being equal measures of oestrogen and progesterone and a ‘teeny weeny bit’ of testosterone.

She sees a menopause nurse and has her blood tested once a year and her hormone prescription is adjusted accordingly. She is slowly decreasing her dose and is yet to decide whether she will ever come off it altogether.

Research shows using HRT for more than seven years can reduce the risk of suffering fractures from falls (file image)

Research shows using HRT for more than seven years can reduce the risk of suffering fractures from falls (file image)

Research shows using HRT for more than seven years can reduce the risk of suffering fractures from falls (file image) 

HRT: THE TRUTH ABOUT THE RISKS

It was the controversial Million Women Study of 2002 that appeared to establish a firm link between HRT and breast cancer.

The data of one million 50-plus women in the UK was analysed and researchers declared that those using combined progesterone and oestrogen HRT (the most common type) doubled their chances of getting breast cancer.

The study sent shockwaves through the country with HRT prescriptions dropping by 50 per cent. Re-analysis of the data ten years later proved the study to be flawed. But today, fears linger and only 20 per cent of menopausal women use HRT.

Today’s research shows women aged 50 to 59 have a 23 in 1,000 chance of getting breast cancer anyway. For those taking combined HRT, there’s a 28 in 1,000 chance.

A slight increase but, to put it into perspective, women in that age range who drink more than two units of alcohol per day have a greater risk of contracting breast cancer, while overweight women double their risk.

The good news is that women taking HRT for more than seven years had a reduced risk of suffering fractures in falls.

HOOKED ON HORMONES?

The latest NICE (National Institute for Health and Care Excellence) guidelines state there is no limit to how many years you can take HRT — news that has yet to trickle down to many GP practices, including my own.

After six years, I am being encouraged to come off it, despite still experiencing the occasional hot flush and night sweat.

Claudia discovered at the festival that 'bioidenitical' hormones are not licensed by the NHS because they haven't been subjected to rigorous testing (file image)

Claudia discovered at the festival that 'bioidenitical' hormones are not licensed by the NHS because they haven't been subjected to rigorous testing (file image)

Claudia discovered at the festival that ‘bioidenitical’ hormones are not licensed by the NHS because they haven’t been subjected to rigorous testing (file image)

Ruth Devlin, a nurse and the founder of letstalkmenopause.co.uk, says: ‘Any GP pressuring patients to quit taking HRT when they’re not ready to should be pointed towards the latest research. There’s no need to come off it after five years. That’s very outdated thinking.’

Dr Laura Jarvis, a menopause specialist, delighted me further by stating that the years you start using HRT before 50 are no longer counted. So, in medical terms, I’ve been on it for only three years.

Contrary to belief, HRT doesn’t stop the menopause. ‘Not unless you’re taking movie-star doses of oestrogen,’ explains Kelli. ‘You’re topping up your depleted levels, so you’re still going through it, just more gently.’

BODY IDENTICAL vs BIOIDENTICAL

Anyone who has read anything about HRT recently will know that ‘bioidentical’ has become a menopause buzzword, as it’s the type most enthusiastically endorsed by celebrities.

I always thought it was what I took, until I discovered at FlushFest that it’s not licenced for use by the NHS because it hasn’t been subjected to rigorous testing.

Bioidentical hormones are ‘compounded’, meaning they are custom-mixed. The only way you can take it is to see a private doctor. Instead, I take what is referred to as ‘body identical’ HRT, meaning the hormones are derived from plant sources but have the same molecular structure as the ones your body naturally produces.

Synthetic oestrogen, derived from equine urine and administered in pill form, is no longer widely used. Instead, oestrogen is most commonly given in a gel or patch for better absorption and reduced side-effects.

A recent study revealed that the most common menopause symptoms which affect work include insomnia, hot flushes and problems with recall (file image)

A recent study revealed that the most common menopause symptoms which affect work include insomnia, hot flushes and problems with recall (file image)

A recent study revealed that the most common menopause symptoms which affect work include insomnia, hot flushes and problems with recall (file image)

HOW TO COPE WITH SYMPTOMS AT WORK

Women over the age of 50 make up the fastest growing group of workers in the UK, and 13 million women are going through the menopause.

Although we are working longer, 25 per cent of us consider leaving work because of our debilitating symptoms.

Today’s working woman can expect better maternity rights, but while one in four women doesn’t have children, all will go through the menopause. Does that mean we should be giving menopausal workers the same consideration we do expectant and new mothers?

Dr Vanessa Beck, a senior lecturer in work and organisation at Bristol University, and her colleagues conducted a government-funded study into the menopause. The top six symptoms that affected work were: fatigue, hot flushes, difficulty focusing, anxiety, insomnia and problems with recall.

The study found that 45.8 per cent of women disclosed their menopause status at work. Of those who chose not to, most considered it to be a private matter, while about 16 per cent believed they would be perceived negatively and have their ability questioned.

Kathleen, 51, one of the FlushFest attendees from Edinburgh who worked in marketing, told me: ‘It’s my female colleagues who are the least sympathetic.

‘They’ve either been through it and think I’m making a fuss, or are years off and don’t understand. I asked about moving desks once, to be closer to a window, but it caused such bad feeling and led to so many jokes about hot flushes that I kept quiet after that.’

Claudia says a recurring theme from the women at the festival was the difficulty to find GPs that understand the menopause and how it can be treated (file image)

Claudia says a recurring theme from the women at the festival was the difficulty to find GPs that understand the menopause and how it can be treated (file image)

Claudia says a recurring theme from the women at the festival was the difficulty to find GPs that understand the menopause and how it can be treated (file image)

However, 77 per cent of women wanted menopause information to be provided at work.

Nearly every woman in the room was unaware that they are legally entitled to request a menopause risk assessment, where an employer is obliged to make adjustments such as providing a fan and access to drinking water or considering reduced hours.

STRUGGLING WITH UNSYMPATHETIC GPS

A recurring theme from the women at the festival was how clueless many GPs seemed to be about the menopause and how to treat it.

As one struggling attendee said: ‘I listed all of my symptoms and said I was at the end of my tether and my GP said: “You’re 50 —what do you expect? It doesn’t last for ever.” ’

Most admitted to struggling for two years before even seeking help. Dr Laura Jarvis advises: ‘Don’t procrastinate, especially if your symptoms start before you’re 50.’

A show of hands revealed that one-third of the room had been offered anti-depressants when they went to see their doctor about menopausal symptoms that left them unable to cope.

Today, many NHS trusts run menopause clinics. The bad news is that you have to get a referral from your GP, and many GPs seem unaware they exist.

The British Menopause Society offers a search facility that will tell you where your nearest clinic is. A quick search revealed that there’s one less than a mile from where I live in Brighton.

I had no idea it even existed, but intend to ask for a referral so I can get my HRT prescription re-evaluated.

After two days, my menopausal mind was buzzing with new information. I vowed to increase my exercise regime, buy some vitamin D tablets and refuse to bow to pressure to come off my hormone treatment.

Ringing in my ears were Kelli’s words: ‘Go meno!’ Then I returned home to be greeted by a neighbour who told me I had left my house keys in the door.

All in the mind? 

Cognitive Behavioural Therapy (CBT) is the latest way to ease menopause symptoms. ‘No, this doesn’t mean they are all in your mind,’ assures Emma Persand, a nurse and CBT specialist.

CBT is a way of helping people tackle problems by changing the way they think about them.

It’s free of any side-effects, suitable for everyone and is recommended by NICE (the National Institute for Health and Care Excellence) as an alternative menopause treatment.

CBT can have a biological and physical effect by changing our thought process. As part of an exercise at FlushFest, we were all given a scenario: you are walking along the street when we see an old friend — you are just about to say hello when the friend crosses the road and walks away from you. How do you feel?

An overwhelming majority of women had a negative response, saying they would feel hurt, humiliated or embarrassed. Only a small number had a positive response, thinking that perhaps the person didn’t have their specs on and just hadn’t seen them.

Our brains tend to catastrophise situations.

A woman experiencing a hot flush in public may initially panic, then feel self-conscious and then, convinced everyone is looking at her, ashamed — when, actually, most of the time no one notices.

CBT techniques, which aim to reprogramme your response to menopausal symptoms, can be taught in one-to-one or Skype sessions, and many women notice an improvement within four weeks.

A study conducted by Professor Myra Hunter, from the Institute of Psychiatry, and Dr Melanie Smith, a clinical psychologist, on behalf of the British Menopause Society produced startling results.

Menopausal women who practised CBT reported a reduction in symptoms, improved mood and sleep, and better social functioning.

For more information, go to menopausecafe.net

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