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One of the themes that runs through my life as a GP is that I never cease to be amazed at the rollercoaster lives that so many people seem to have – I have witnessed rags to riches – and riches to rags – stories that would sit very comfortably in any women’s weekly magazine, and been personally involved in stories that would be dismissed out of hand by the director of any soap opera on the basis that they were so far-fetched as to be utterly ridiculous. And yet they happen, day in, day out, year in, year out while I sit at the same desk giving the best care I know how to, often able to do little more than observe as the drama unfolds.

Some things, however, are pretty predictable. The heavy smoker who I have been cajoling for years to quit the evil weed finally goes for that chest x-ray and gets the dreaded diagnosis that they have spent the whole of their life telling themselves would happen to someone else. The very overweight person ultimately has to start treatment for diabetes. And women of a certain age eventually give up fighting on their own and drop in to discuss their ‘hormones’.

While it is true that some women sail through the menopause with very few issues, most find that it interferes with their daily lives on some level, ranging from minor irritation through to full blown disaster. According to the aptly named website there are – you guessed it – 34 separate symptoms that can be caused by the menopause. The most common ones are hot flushes, night sweats, irregular periods, loss of libido, vaginal dryness and mood swings, and of these hot flushes and mood swings tend to be the ones that bring people to my door most often, along with difficulty in sleeping or concentrating on things which can be equally destructive.

The menopause happens when the levels of oestrogen and progesterone (hormones responsible for regulating fertility) become gradually lower, and it is the changes that result in most of the menopausal symptoms. Once the hormone levels have reached their lowest levels and stabilise again the symptoms tend to disappear, and most women who have these symptoms will notice them for a maximum of five years in normal circumstances.

As most of the symptoms of menopause are related to falling hormone levels, treatment has traditionally been in the form of hormone replacement therapy or HRT – a combination of oestrogen and often progesterone taken in tablet form or applied to the skin in the form of a patch or gel. As with so many other medications, it is very effective but also comes with some significant long term problems in that it has been found to increase the chances of heart disease, stroke and breast cancer, so is generally best avoided unless really necessary.

My own viewpoint about HRT – and please listen to your own doctor who knows you rather than me if you are not sure about this! – is that if the menopause is basically manageable for you, then taking medication that benefits you only slightly but that increases your risk of heart disease, stroke and cancer, however minimal that increase may be, is not wise. However, if menopausal symptoms are making life unbearable and taking a pill every day makes everything better then a small increased risk of long term health problems may be a price worth paying as long as you are in generally good health. It is a very personal decision and one that you may need to think long and hard about!

There are other prescription medications that have been shown to reduce hot flushes, which is the main thing menopausal women find difficult – these include low doses of some antidepressants and clonidine, which is a rarely used treatment for high blood pressure. If you are reluctant to take hormones then these could be options, while they are less effective than HRT they may help just enough to make life manageable again.

In terms of alternative therapies, the two that have been found to be most effective are black cohosh and vitamin E. Both come with possible side effects if taken at high doses for too long, but they may be worth considering.

Many people recommend eating natural plant foods that contain plant oestrogens or ‘phytoestrogens’ as a way of combating menopausal symptoms. While there is some evidence that soy products in particular may help with hot flushes and some other menopausal symptoms, a number of medical studies have found that soy made no difference. Also, the issue about whether or not soy consumption increases breast cancer risk, mainly in women from Western nations, is still being hotly debated by the experts and there is no definite answer yet. Other forms of phytoestrogens may be helpful in the form of various nuts and seeds, and there are plenty of recipes for ‘HRT cake’ on the internet that many women find helpful. Essentially these recipes are all variations on a theme involving large quantities of nuts and seeds that contain significant levels of phytoestrogens, but also significant levels of calories – at a time when most women begin to struggle with their weight more than ever – so it would be important to eat less of other things to avoid weight gain if HRT cake is a possible option for you.

Thankfully, almost all menopausal symptoms are treatable to a point where they are not a problem – the main issue to consider is how much you are prepared to take risks, albeit fairly small ones, with your long term health to improve your quality of life now. If you are not sure which is best for you then your GP or practice nurse would be happy to help, so don’t suffer in silence, it’s good to talk!

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