Set just off Sloane Street is The Bronte Clinic, an evidence-based women’s health destination founded by Dr Samantha Brown and Dr Fiona McCarthy to compassionately and meticulously address the medical concerns of women, among which peri- and post-menopause play a large role.
Anya Hindmarch asked the founders of the clinic to speak about improving sleep challenges when she opened Anya’zzz, her sleep-centric space in the Village, earlier this year. We asked Dr Sam to share her insights on all things menopause because even though there are approximately 13 million people in the UK experiencing peri- or post-menopause, there is still so much uncertainty about how women should best approach this time in their life.
Read on for Dr Sam’s expert knowledge on menopause and be sure to make an appointment at The Bronte Clinic if you’d like to talk through your particular concerns in a supportive environment with doctors who genuinely care about helping women to feel the best versions of themselves.
CAN YOU EXPLAIN THE THREE STAGES OF MENOPAUSE?
Perimenopause, which means “around menopause”, is the time during which women’s bodies make a natural transition to menopause, marking the end of the reproductive years. Perimenopause is also called the menopausal transition.
Perimenopause can start at different ages. You may notice signs of progression toward menopause, such as menstrual irregularity, sometime in your 40s but some women notice changes as early as their mid-30s.
During perimenopause, the level of oestrogen in your body rises and falls unevenly so your menstrual cycles may lengthen or shorten, and you may begin having menstrual cycles in which your ovaries don’t release an egg (ovulate).
Many women also experience symptoms including hot flushes, poor sleep, tiredness, headaches, low mood and anxiety, brain fog, irritability, joint pains and palpitations. There are many more symptoms that can be caused by the hormonal fluctuations that happen at this time.
It’s important to look at lifestyle management of symptoms by optimising diet, exercise, sleep and stress management. Women should also consider medical management of symptoms in the form of HRT (hormone replacement therapy) as, for most women, the benefits outweigh the risks.
Menopause is diagnosed 12 months after a woman’s last period. In the UK, the average natural age of menopause is 51. After this, the body continues to produce a form of oestrogen called estriol that helps to reduce the symptoms.
The time after menopause is known as post-menopause.
WHAT DO YOU RECOMMEND TO STRENGTHEN THE PELVIC FLOOR MUSCLES?
Later in life, especially if a woman has given birth, stress incontinence can develop. This is when sudden extra pressure on the bladder from coughing, laughing or exercising can cause urine to leak but strengthening the pelvic floor muscles with kegel exercises can often cure the problem.
To do them correctly, imagine you are trying to stop a stream of urine while you’re on the loo. You will feel the muscles at the front of the pelvic floor tighten. These are the ones to work on strengthening. There are clear instructions on patient.info.
HOW CAN A WOMAN KNOW WHICH MEDICATIONS ARE RIGHT FOR HER BODY?
Blood tests are not useful to advise on medication in the perimenopause as the results can fluctuate, so women should talk to a qualified health professional and discuss previous conditions and medications, allergies and family history. All of that informs the options for treatment.
Also be aware that bio-identical – or compounded HRT – is not regulated or recommended by The British Menopause Society.
WHAT ARE THE RISKS ASSOCIATED WITH TAKING HRT?
The newer types of body-identical HRT, which are plant-based, are not associated with any increased risk of heart disease or clots. There is a slight increased risk of breast cancer when you are on HRT after the age of 50, but recent studies have also shown that the body-identical micronised progesterone that we now use in preference to the older types of HRT is neutral for breast cancer risk when taken over 5 years.
There is a much higher risk of breast cancer with being overweight, not exercising or drinking alcohol every day than there is with HRT.
WHAT CAN YOU TELL US ABOUT BIO-IDENTICAL HRT?
Bio-identical or compounded HRT is not regulated or recommended by The British Menopause Society – and I do not prescribe this. The progesterone in bio-identical HRT may not be adequate to protect the lining of the womb from the effects of oestrogen and women often then have to have additional scans and checks for this.
WHAT ARE SOME OF THE BIGGEST MYTHS SURROUNDING HRT?
There are a lot of myths surrounding HRT. Some of these are:
HRT causes blood clots
HRT is dangerous
HRT causes weight gain
If you need HRT then you don’t need contraception
HRT delays the inevitable
HRT has the same risks as the contraceptive pill
Natural methods are safer than HRT
You can only have HRT for 5 years
HRT has a vascular risk
DO YOU RECOMMEND THAT MENOPAUSE SHOULD BE MANAGED NATURALLY?
There is not a great deal of good evidence for managing menopause with herbs and supplements but some women prefer to try this, especially if their symptoms are mild. I recommend a holistic approach to the management of menopause and making sure women are aware of all the options available to them.
It is important that any supplements are marked with the THR logo for traditional herbal medicine. These products have been approved and you can be sure that the product has the correct dosage, is of high quality and has suitable product information. The NICE guidelines also recommend that many available herbal medicines have unpredictable dose and purity and some herbal medicines can have significant drug interactions.
WHAT DO YOU SUGGEST TO HELP WOMEN DEALING WITH HOT FLUSHES?
The gold standard treatment would be HRT; it can really help with the hot flushes. If a woman does not want to take HRT (or can’t take HRT), then other medication such as SSRI, which is used to treat depression, can be helpful. We also sometimes recommend the anticonvulsant Gabapentin, blood pressure medication Clonidine and some herbal supplements.
Cognitive behavioural therapy (CBT) has also been proven to be effective for the treatment of hot flushes.
HOW DOES MENOPAUSE AFFECT SLEEP AND HOW CAN IT BE HELPED?
Menopause can cause poor sleep even in women who have never struggled with sleep before. This can be caused by hormonal changes, hot flushes, anxiety and depression, and a reduction in melatonin.
HRT can help as it deals with the hormonal imbalance that is causing poor sleep and also reduces other symptoms such as hot flushes, anxiety and frequent urination that may be affecting sleep quality. Utrogestan, which is body-identical progesterone, can be helpful if taken as part of your HRT as it is a natural sedative.
Sleep can be helped by keeping your bedroom cool, avoiding hot drinks before bed and avoiding caffeine and alcohol. Trying to establish a routine for sleep and management of stress is also helpful. And keep phones out of the bedroom.
Melatonin is not very commonly prescribed but can be used occasionally such as for disrupted sleep caused by jet lag. It is best to avoid prescription sleeping medications such as zopiclone and diazepam, as these are very addictive.
WHAT CAUSES THE MIND FOGGINESS?
It is thought that the perimenopausal brain fog that happens to around two-thirds of women is caused by the interaction between oestrogen and neurotransmitters in the brain. A reduction in progesterone can cause sleep disturbance and this can also contribute to brain fog.
In my experience, from both my private clinic and my NHS menopause clinic, brain fog and irritability are extremely common and often cause the biggest impact in terms of wellbeing, relationships and work.
HOW CAN WOMEN IMPROVE BONE DENSITY AND REDUCE THEIR RISK OF OSTEOPOROSIS?
It’s important for women to get regular exercise, especially weight-bearing or resistance training. Lifting weights is a great option. We also recommend that women get adequate calcium (around 700mg per day), which you should be able to get from your diet. Green, leafy vegetables like broccoli, Brussels sprouts, collards, kale and mustard greens are high in absorbable calcium.
Make sure you’re getting enough vitamin D (10mcg/day), stop smoking and reduce alcohol, as it can weaken bones.
WHAT DO YOU RECOMMEND TO PRESERVE THE COMPLEXION AND HAIR?
During the hormonal changes of perimenopause, you might find that your skin gets red from hot flushes and you may also find that skin that was balanced previously, starts to get dry or oily and break out in acne. Then, the decrease in oestrogen when menopause is reached can cause skin to become dryer and thinner.
We recommend that our patients wear sun protection every day, as the sun’s UV rays cause oxidative stress and inflammation, which accelerate the signs of ageing. Gentle cleansing that doesn’t strip the skin of its oils is advised, as is a richer moisturiser. You may even want to consider medical-grade skincare and Dr Fiona McCarthy at The Bronte Clinic can advise on a regime according to skin type.
And, again, choose a healthy diet, and avoid oxidising alcohol and cigarettes to help keep skin supple.
