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FAQ with Menopause Specialist, Dr Sam Morgan 

We sat down with Menopause Specialist, Dr Sam Morgan, founder of Rethink Menopause and asked her to answer the most commonly asked questions by her patients.

Dr Sam Morgan

FAQs

When will my menopause happen?

The average age of menopause in the UK at the moment is 51 but 1 in 20 of us will be menopausal by age 40-45, and 1 in 100 by age 40. We are more likely to have an earlier menopause if we smoke, have a lower body mass index, and have certain medical conditions. Often I’m asked if our Mum's age of menopause predicts our own age of menopause, and there is some truth in that.  The age of our sister's menopause seems to be even more predictive. There are cultural differences too, for example, the average age of menopause in those from South East Asia is 46.

How will I know when I’m in perimenopause?

The perimenopause is the time leading up to the menopause and is defined as a change in the menstrual cycle plus symptoms. Symptoms can begin suddenly or creep up on us gradually, and can then continue persistently or be intermittent. The best way to know is to try to tune in to your cycle and experience. Trackers can help some people to notice patterns. If you have a hormonal coil and no periods it can be much harder for both you and your GP to work out what’s happening.

What about blood tests?

I completely understand the rationale behind people asking for blood tests in an attempt to understand if perimenopause is the cause of their symptoms. Unfortunately, blood tests just aren't always helpful. Our hormone levels fluctuate significantly, and the test doesn't give an overall level or average over the past 24 hours, it is literally the level when the test was taken and a few hours later it could be completely different. So if we are over the age of 45 and symptomatic, we can diagnose perimenopause without the use of blood tests. Blood tests can be useful between the ages of 40 and 45, especially if we have symptoms that could be hormonal but could also have another cause. Blood tests are essential for those under the age of 40 who may have premature ovarian insufficiency, POI.

What are the most common symptoms?

So whilst there is no typical perimenopause, what is initially most common is a cycle that changes, and worsening PMS. Hot flushes and night sweats are the most well-known of the symptoms, and the genito-urinary symptoms are still the least talked about. Many people will notice more anxiety about the everyday, brain fog, tiredness, poor sleep, and changes in body composition and energy levels, reflecting the metabolic changes that are beginning to take place and have a significant impact on health for the future.

I’ve heard that menopause increases our risks of certain medical conditions, what do I need to know?

Yes, our symptoms are usually what we notice but there are lots of other changes happening on the inside and, for our health, these are important. Our metabolism changes, with an increase in fat stores and rising inflammation levels. This increases our cardiovascular risk, and when we consider the top 3 causes of death for women are dementia, heart disease, and stroke the significance of these changes becomes clear. Also, our bone density reduces. We reach our peak bone mass in our 30s and can lose up to 20% of our bone mass in the 5 years after our last period. Very few people tell me they worry about developing osteoporosis unless they've seen a relative experience it, but up to 50% of us will break a bone postmenopausally. Some of these fractures, such as those affecting the hip or spine can be serious and significant, impacting our independence and quality of life. Let the writing speak for itself. Keep a consistent tone and voice throughout the website to stay true to the brand image and give visitors a taste of the company’s values and personality.

When can I stop thinking about contraception?

So not all of us will need contraception, but it's important to remember that even long cycles over 50 days can be ovulatory, so we can still conceive at this time. The advice as to when we can stop using contraception, using age alone, might surprise you as being at age 55. Before 55, if we are not using hormonal contraception we can stop contraception 1 year after our last period if this happens over the age of 50 and 2 years after our last period if this is before the age of 50. HRT itself is not contraceptive, unless we are using the hormonal coil for the progesterone component.

Should everyone take HRT?

I’m a big fan of HRT, I’ve seen it transform people's lives. I don’t however believe there is any drug or medical intervention that is always right for all of us. Still, I strongly believe everyone should have access to accurate information to make their own informed choices. There has been a lot of misinformation about HRT over the years, and there are now lots of types of HRT that are very similar to our natural hormones that have a better safety profile, for example not increasing the risk of blood clots. I would strongly advise anyone with POI to take HRT until the natural age of menopause, to protect their long-term health. Local HRT is very low in dosage and can be used long-term to support the genito-urinary symptoms of menopause.

What about breast cancer? Can I take HRT if there’s breast cancer in my family?

Breast cancer is the most common cancer in women, and our lifetime risk is 1 in 8, so many of us know someone close to us who has been affected. Breast cancer is age-linked, with the highest rate of diagnosis being at age 85-89. Genetics can affect our background risk, so an assessment of family history is important and your GP will be able to guide you as to whether your family history is high risk. Other factors are important too, such as being overweight, smoking, and drinking alcohol increasing our risk, and exercise decreasing our risk. In terms of HRT, the risk relates to the type of HRT we use, the dose, and the length of time we use it. So it’s a personal decision.

If I pay attention to my lifestyle can I minimise the symptoms I’ll experience at perimenopause?

In my menopause talks and consultations, I use a lifestyle framework of sleep, nutrition, movement, rest, and connection, which are all areas that can impact both our symptoms, aswell as our long-term health and well-being. For me, lifestyle always comes first, but sometimes our symptoms are so impactful that we may know exactly what we want to do but don’t have the energy or ability to put this into place. For other people I’ve worked with they’ve still been symptomatic despite great nutrition, regular exercise, daily meditation, and sleep support. I see HRT and lifestyle measures as being complementary to each other in supporting not only symptoms today but health and well-being for the future.

What about other options like supplements or non-hormonal treatments, do they help?

In terms of dietary supplements, I would always advise a food-first approach. Our bodies get so much more from plants than the individual nutrients packaged into a supplement and if we eat a diverse whole food plant-based diet we will usually meet our nutritional needs, including protein and calcium. Current advice in the UK is for all adults to supplement with vitamin D through the Winter months. People following a vegan diet may be advised to take B12. There are many supplements sold to support symptoms. In terms of the current evidence, Black cohosh, Red clover, and St John’s Wort may help hot flushes but are not suitable for all people e.g. those with breast cancer or on certain medications. If you are planning on trying a supplement my advice is to try one thing at a time, for up to 3 months, and note any impact it has. Most supplements are not designed to be used long-term. There are also some non-hormonal prescribed treatment options. Most of the evidence is in supporting vasomotor symptoms, so hot flushes and night sweats. Antidepressants are the most widely used group of medications. Others include treatments for blood pressure and urinary symptoms. The exciting new development is an entirely new class of drug, the NK3 antagonists.

Resources

Supporting Menopausal Women​

Resources

Supporting Menopausal Women​

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