I was delighted when Dr Faye Rodger, consultant gynaecologist at the Borders General Hospital, agreed to answer a few questions on the menopause. Dr Rodger’s special interests are reproductive medicine, including fertility and the menopause.
So, here are the questions that some of you have sent in, and I’ve added the ones which commonly crop up when running workshops.
Being a consultant gynaecologist and also specialising in menopause do you find your clinics are filled with the more complex cases or do you still see women who could potentially try and manage their menopause symptoms through lifestyle changes and addressing their diet and exercise habits?
I see a mix of complex and more straightforward cases in the clinic. I’d recommend lifestyle advice for all women with menopause symptoms, complex or otherwise – this might include weight loss where needed, exercise advice or caffeine reduction – which can all have potential benefits by themselves or alongside HRT.
I see my patients with menopause symptoms in my general gynae clinic. I maybe see 3 women a week with menopause problems which in a small health board isn’t enough for a dedicated menopause clinic – and not enough to have a daily clinic. I also answer GP menopause questions about women with menopause problems by email, which often means that women can be treated without needing to come to the hospital clinic.
One of the most common questions that comes up in workshops regarding HRT …
Does HRT just delay your symptoms, meaning, once you come off HRT will your symptoms return and last for as long as they would have done had you not taken HRT?
Symptoms on stopping HRT can be impossible to predict. For many women symptoms don’t come back, or come back at a lower, more manageable level than previously. For some women unfortunately symptoms do come back at the same level as before. There isn’t a test we can do before stopping HRT which will predict what will happen.
‘Since July my menopause symptoms have returned. Get pounding heart beats and feeling hot again very difficult to get to sleep. My GP has now prescribed Evorel Conti patch. Still get symptoms once or twice a week …’
What can be done about my heart symptoms do I need a different patch or another type of medication. Why is it so inconsistent. ?
Heart symptoms – some women have palpitations (an awareness of their heartbeat) during flushes. Sometimes a higher dose of HRT will be helpful if a lower dose does not fully treat these. As palpitations can sometimes be caused by a heart problem rather than menopause, it’s important to get these checked by your GP before starting or increasing HRT.
If you decide to go down the HRT route should you just take HRT and no alternatives or can you carry on using some alternatives wisely as long as you ask you GP /gynaecologist if they will interact or not, for example herbs like sage or evening primrose oil.
Alternative medications can be used along with HRT, but again check with your doctor as these can occasionally interfere with the way HRT or other medication works in your body.
You will obviously have to treat women who have a more complex medical history combined with menopausal symptoms – without trying to generalise too much are there still options available even for these women. For example, women who have had breast cancer but then go on to experience intense vasomotor symptoms, mood swings and vaginal dryness?
There are always options to treat women with complicated medical histories. It’s a good idea for these women to be seen in the hospital clinic for a thorough discussion of potential risks and benefits.
Contraception and HRT – there seems to be a misconception with some women that if you are on HRT you are covered for contraception. This is not the case – could you explain the ins and outs of taking HRT alongside contraceptives please – obviously very different needs for each individual woman but I think a lot of women are still very concerned about taking HRT and then when you add in the fact they still have to cover themselves for contraception with potentially more hormones it can put them off altogether.
HRT isn’t effective for contraception – and additional contraception needs to be used with it. This could really be any of the normal methods of contraception. If you are on the combined pill then you shouldn’t need HRT as well, the combined pill has the same type of hormones as HRT but in higher doses.
Does the menopause still affect your life in varying ways till you die, does it never really end? … ”
Women can experience menopause symptoms for varying amounts of time. It’s currently thought that 7 years is an average, with around 10% of women having them lifelong.
I suffer from awful vaginal problems, have experienced vaginal dryness, irritation, you name it I’ve had the problem – my husband and I went through a tricky time when I just couldn’t bear to have sex it was too painful. My GP was brilliant – took me seriously and was very understanding, prescribed vaginal oestrogen which I combine with a vaginal moisturiser for lubrication, life has thankfully returned to normal and everything feels much better. My question is : will these symptoms last long term, will I have to use vaginal oestrogen for evermore ?
Vaginal estrogens can be very effective at treating vaginal menopause symptoms, and are very different to HRT. For most women these can be used for as long as they are needed with no additional monitoring, and they aren’t thought to increase the risk of breast cancer or blood clots.
I have recently been diagnosed with premature menopause, I am 32 years old and have not yet met anyone I wish to have children with is it possible to freeze my eggs – will they still be fertile? Can I get treatment for this under the NHS?
Premature ovarian failure is difficult to treat from a fertility point of view, as there are very few or no eggs left in the ovary. For this reason, egg freezing isn’t an option. There is the possibility of having fertility treatment using another woman’s egg, which has an excellent chance of success. In some cases NHS funding is available, but usually not for single women.
Would you agree that one of the main problems with the topic of the menopause is to try and find a more successful way of getting the information from experts like yourself down through primary care and to women themselves?
I think that GPS are genuinely in a very difficult position- my husband is a GP and I think his job is really difficult. They have to deal with the full spectrum of conditions which affect the human body and understandably can’t be expected to know very specialised details about every condition. When you also consider that menopause research changes our knowledge very frequently, it can be tricky to keep up. I think it’s difficult to figure out how women can access specialised knowledge tailored to them.
Often time for training and updating can be hard to find in the middle of busy clinics. Perhaps the best way forward is for some GPS within a region to have a special interest in a particular area, and there are some moves to organise GP practices into ‘clusters’ to allow better information sharing. As IT evolves it may be helpful in providing information and decision making tools for women and their GPS
Can you just take testosterone – (instead of lots of HRT) or will that turn you into a Russian weight-lifter?
Hormone and testosterone replacement can help with libido in some women, but female sex drive is complex, and libido issues are not always hormonal. Our initial approach to a sex drive problem would be to take a detailed clinical history, and if it seems as hormonal cause is likely, we’d discuss starting either standard HRT or referring for psychosexual therapy, which often leads to an improvement without needing to give hormonal treatment.
If HRT alone is not effective we sometimes discuss adding in supplementary testosterone. This is used outwith its product license (it’s only licensed for use in men). This again needs careful explanation and discussion, and we use it in a low dose which does not seem to cause side effects in most women who use it. There isn’t any good long term safety or effectiveness data on testosterone treatment in women. We’d always use it in conjunction with HRT, and not by itself. I also get asked a lot about the use of Viagra in women- sadly it doesn’t seem to be effective for female sex drive problems.
I think you would agree an interesting range of questions, many thanks to those of you who sent your questions in and I would just like to say a huge thank you to Faye for taking the time to answer them – I think she probably thought there might only be one or two not this lengthy list when she agreed! I personally feel very fortunate in having met Faye, she is probably every woman’s dream consultant – always puts you at your ease, takes time to explain everything clearly, is always cheerful and friendly …you can come out of her surgery almost thinking you’ve had a pleasant morning out had it not been for having your legs akimbo throughout the chat! Seriously though I would like to add again, as I know I have written this somewhere else along the line, I can’t say enough positives with regard to any of the medical professionals I have come in contact with since starting Let’s Talk Menopause – not only are they genuinely passionate about their chosen speciality but all without fail are approachable and helpful.
British Menopause Society : https://thebms.org.uk/join-us/
Tools for clinicians BMS : https://thebms.org.uk/publications/tools-for-clinicians/