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e-Health Matters | Episode 10 | Menopause & HRT
Confused about menopause and hormone replacement therapy (HRT)? In this episode, we sit down with Aisana and Dr. Charlotte to discuss everything you need to know about managing menopause symptoms and making informed decisions about your health. 🌸 What actually happens during menopause? 💊 What is HRT, and how does it work? ⚖️ The benefits and potential risks of HRT 🤔 Is HRT suitable for everyone? 🩺 How to manage common menopause symptoms 💡 Debunking myths and misconceptions about menopause and HRT 📍 Where to get support and treatment in the UK Whether you're approaching menopause, going through it, or supporting someone who is, this episode gives you the facts you need to take control of your health and wellbeing.
Transcript
Welcome to another episode of E-H Health Matters. I'm Isana, clinical lead for e surgery. And today I'm joined by Dr.
Charlotte. Charlotte, welcome. Um would you like to introduce yourself? Yep. So I'm um Charlotte. I am a uh
doctor who specialized in women health. I have done for a number of years and I am in particular fascinated by the
menopause which is what I'm going to talk about today. It's um a really really important topic um not something
that is talked about um as much as we would like it to be talked about. So um
why are we here? Why are we why are we discussing menopause? Why is this so important? So I think that's a really
great question. So menopause affects around 50% of the population. Um and there's currently there's about 13
million people in the UK that's currently going through menopause. Um and that includes permenopause going
through the menopause transition or postmenopausal. and actually you spend a third of your life postmenopausal. So it's a really important stage in your
life that you go through. Um it's important for me um to educate others. I
think there's a lot of misinformation out there. Um and there's a lot of horror stories that you can have and
even if you're not going to go through it directly, you will know someone who's going going to go through it, whether that's colleagues, whether that's
friends or family members. And it's really important to be able to get the right support for those people.
Amazing. Thank you. Um so there was a lot of words um referring to menopause. Yes. And obviously it's the topic. So
tell me what is menopause? Um there is you refer to permenopause and premenopause and actual menopause. Uh
just yeah just tell me what each of them actually mean. Typically menopause happens around the age of 51 in the UK
and it happens when you stop having periods for around a year. When you are around 45 to 55, your
hormones start to be more erratic and at that point you have changes in your symptoms and changes in your periods and
that's what we call the permenopause. Before the age of that, so around kind
of 45 or less that tends to be premenopausal. So you don't have any symptoms, your periods are regular or
your cycles are regular. And then postmenopausal is when you've had finished your periods onwards. So you
normally that's typically from the age of 55 onwards. So basically it's one year of not having
any men menstrual bleeding and you will be considered um menopausal.
Yes. So postmenopausal after that means you're not able to have any more children. Okay. So are there different types of
menopause? Um does it naturally happen to us or does it um do you have to have
a kind of a surgical intervention? No. So menopause naturally happens um to every person who's born with ovaries. So
it will happen uh inevitably uh and that's called the natural men menopause. You can have certain situations where
that happens at different times. So um and you can have a natural menopause that happens earlier. So if it's if
you're around the age of 40 to 45, that's what's classed as an early menopause. Um but under the age of 40, that's
classed as a premature um menopause. And that's also known as premature ovarian
insufficiency, which sounds like a very scary term, but basically it means that your um ovaries aren't working as they
should do a lot earlier. You can also have kind of unnatural causes in the menopause. So that's things like surgery
or medications. Um again, these can happen at any point during your kind of reproductive life. Um so you can have
surgery um for different gynecological conditions um which then will have an
impact on your menopause. So for example having your ovaries removed or having your womb removed or called a hyerectomy. Um so there surgical methods
you can also have um medical kind of management as well. So that's things like chemotherapy sometimes can affect
um how you experience menopause. Um in addition to if you have conditions like endometriosis that we induce a menopause
in those patients so they no longer have those symptoms. They don't have their pain and they don't have the heavy bleeding anymore.
Okay. That's really interesting. So um yeah, it can literally happen at any stage of the life to any of us. Yes.
Um and we eventually will go through it as well. It's a bit scary, isn't it? It can be scary, but I think I mean and
a lot of people there is so much misinformation, so many horror stories um that actually it is an inevitable
process and and we're kind of I I would like to empower women to have that knowledge to know exactly what is
happening to their body and it's nothing to be scared of. It's completely normal, but there are things that can help.
Yeah. Um I think it's something that myself and probably most of kind of um
my relatives, friends that I've ever discussed kind of menopause, we all
we're almost terrified of reaching that stage. As you said, it's such a taboo thing as well. Um
and we need to kind of just get rid of that stigma. Yeah. And change the narrative, right?
Yes. Yeah, definitely. I think there's so much thinking about menopause. so much unknown about female health anyway in
particular there's you know there's there's very limited research and very limited funding into what happens in the menopause um which is a real shame
because like I say it does happen to pretty much half of the population and it you will spend your life
postmenopausal so it's really important that we are able to kind of understand what happens why
it happens and therefore because of that then how we can help those women who who suffer from those symptoms
yeah no that's very very true Um let's just kind of recap and um if you could
kind of help me have a better understanding of from the moment that we are born as um as women as females um
what happens to our physiology what do we go through that eventually leads to
this stage of our life which is menopause. Okay. So I like to think of it as menopause is is a book end for your
reproductive life. At one end you've got puberty which is the start of your reproductive life all the way through to
menopause which is the end. So when we are born we are born uh if you're born
with ovaries you are born with all the eggs that you're ever going to have which is around 1 to 2 million eggs. By
the time you reach puberty that is a lot less about 100,000. Um and when you hit puberty what happens
is that is when you start your periods but how that works is that you have hormones that are released from the
brain. They then go to your ovaries and your uterus to switch them on essentially to get ready for a pregnancy.
So those hormones include the most kind of well-known ones estrogen and progesterone. So with estrogen that
helps prepare the egg ready for a pregnancy. Yeah. But also the progesterone helps um
thicken the lining of the womb and again ready for implantation for a pregnancy. Yeah. So when you start your uh menstrual
cycle, you release an egg. that egg hopefully would meet a sperm um and
fertilize and that would result in a pregnancy. If that is a pregnancy then it would implant into the line of the womb which is nice and thick and juicy
ready for the kind of a a good healthy pregnancy. And if that doesn't happen then that line in the womb sheds every
month and that's what is a menstrual period. Yeah. That happens again and again and again
until you stop having any more eggs. Do you literally just run out of stock?
Yes. That's it. It's like finished. Okay. That's really interesting. Um I just I
always assumed it would be low amounts of eggs, but like you literally run out of eggs. Yeah. So
normally so in your 30s you're probably down to about 10% of the eggs that you had when you started puberty. And those
eggs um are normally low so low in number but also low in quality. So they're they're less um likely to result
in a pregnancy or a healthy pregnancy. So when you are more towards the
menopause um the hormone levels change because of the quality and the number of those eggs and therefore with that then
you have symptoms of menopause. That's really interesting. Um I feel like I'm going to get um kind of
sidetracked by by a different topic by exploring this a little bit more but let's say you are um getting closer to
the 40 age mark. Um are there kind of blood tests to say what how like how
long you've got left till you reach your menopause? So there are loads of blood tests that you can do. Um the problem with blood
tests is that they are uh your hormone levels fluctuate all the time. So that if I took for example your blood one day
and I took it again next week, it could be completely different and therefore I would have no idea where you would be in
your cycle or how many eggs you would have left. We don't tend to test as as clinicians,
we don't tend to test for menopause. um unless you're under the age of 45, but if you're between 45 and 55, you have
symptoms of the menopause, it's likely that you're kind of permenopause or going through the menopause. So, we don't tend to test for that. The only
thing we do test for are things that mimic the menopause. So, things like hypothyroidism or problems with kind of
vitamin levels like vitamin B12, vitamin D, in which case then we would test for those to rule them out and and get you
the right support. But on the whole, particularly if you're around that age, we don't tend to test for menopause.
That's interesting. And um when you do test for the menop for to have a blood test, are we looking at estrogen and
progesterone levels or are they different types of hormones that we're looking at? It's normally different type of hormones. So it's normally things like
um what we call FSH and LH, which is um follicle stimulating hormone or lutinizing hormone and they they help
prepare the eggs. There's another hormone um called antimmalarian hormone uh which looks it's meant to look at the
um amount of follicles that you have left but it's quite unreliable and again we don't really test for it um unless
you were perhaps having an early or premature menopause. Okay, that's really interesting. So
don't bother again a kind of blood test it's not going to really help. It's not going to tell you any much more than
just having a conversation with your healthare professional. And I think you're if if you're going through those symptoms around that age, I think you
have to listen to your body. Your body's trying to tell you, okay, this might be a change there. That's interesting. Thank you very much for that. Um, so what are the symptoms
of menopause? Um, I think one of the things that we always hear is hot flushes. That is one of the most common
ones, but I'm sure there is a whole long list of menopausal symptoms. That's right. There are around 30 menopausal
symptoms or even more. They're they're kind of most recognized. Um and around kind of threearters of people who go
through menopause will have symptoms and one quarter of those will be de debilitated by them. And it's really
important to know that actually you have estrogen and estrogen is the main hormone related to kind of um problems
or symptoms in the in the menopause. Um you have estrogen receptors in pretty much every organ system in your body. So
it affects pretty much everything. And you're very used to have it when you when you're um when you're kind of
premenopausal. You're used to having lots of estrogen. So when you don't have estrogen those things those organ systems start to change. So the most
common symptoms are does tend to be um hot flushes and night uh hot flush and the night sweats which um happen to
about 75% of people and that is the one that causes the most distress. There are other symptoms as well. So trouble
sleeping is a huge one. Um a lot of people don't realize that that is a symptom of the menopause but it definitely is and that again is affected
by things like night sweats if you've got a decrease in your mood or change in your mood but also kind of other
stresses in your life. Again, they can all play a part in in problem sleeping. Um things like uh changes to your skin
and your hair, changes to your joints, so you can get joint pain um is another one and achy joints. You can have
problems with vaginal symptoms or urinary symptoms. So you can get vaginal dryness or itching. Um you can also get
kind of symptoms of UTI or urine tract infections and um urgency as well that you need to go to the toilet more often.
Um and uh the other one is kind of mood changes and changes in libido. So mood changes is a really interesting one. So
around 70% of people will report mood changes but again it's not necessarily related to menopause or they don't think
it's related to the menopause. It's more to do with life stresses. You know you're taking care of your kids. You're
taking care of your parents. You know you've got work stress all that kind of stuff. Um so that can change mood. Uh and again
kind of sex changes as well. So you often have a loss of interest in sex and again that affects about 50% of women.
um which is a massive thing that isn't reported, it isn't talked about, but it can be a huge um stress on their
relationship. Um and I think in terms of their symptoms, a lot of these we're
just kind of guessing as to kind of amount of people that are suffering from them because we don't we don't really know.
Yeah. Yeah. Okay. Um I'm just trying to digest this is this is a lot of symptoms
one one might go through. Yeah, absolutely. There's actually quite a lot. Um, and I'm just trying to think,
so let's say, um, I'm going through some of these symptoms. I'll go and see my GP. Um, and I've heard kind of so many
stories where patients have referred to their kind of GP and they either have come out with antibiotics for UTI or
anti-depressants because they think that they've got depression. So, what I'm trying to say is that a lot of these
symptoms can be overlapping with other health conditions. How does one kind of
get the help that they actually need without getting dismissed when they have those conversations to say actually we
need to dig deeper um into into your symptoms. This is this is not just you know signs of depression or frequent UTI
um you're in infection um what what kind of what would you recommend? I think you
definitely right. I think a lot of women either don't recognize it in themselves, which is why I think education,
particularly education about symptoms and what is normal, typical for menopause is so important. Also, health
care professionals often aren't uh well educated in menopause and menopausal symptoms and how to help. So, we know
that um if you do go to the GP or healthare professional, um only around
45% of women will actually go with these symptoms. Um and when they do go, we know that a proportion of those will not
either be believed or they won't necessarily uh be treated um that they
are kind of in that menopause transition. It is important to say that you know you may have symptoms of
depression, you may have symptoms of hypothyroidism, low thyroid hormone and those things need to be ruled out and
those things need to be treated correctly. However, you have to look at the patient as a whole. What has
changed? What has happened? What is their age? where you know where are they in their family life all of those things
kind of point towards whether this could be menopause or not and it's always worth thinking um in the back of your head could this be something like that
so it's really important when you if you do go and see your GP or healthare professional that you keep a symptom diary um and ideally to say you know
what symptoms you're having when what have you tried for it um but also how is
this in affecting your quality of life because it's all about how this is affecting you yeah no that's really really important
it's um kind almost you don't want to put the
pressure on the GPM like you know you're misdiagnosing patients because I mean to be fair they've got a 10 10 minute slot
and as you said you have to look at the patient as a whole right and that's sometimes not achievable within a
10-minute time slot with the pressures that the kind of the GPS are currently facing. So probably not very fair to
kind of put the blame on them. I'm sorry GPS if I'm doing that you're doing a great job. Um however it is also really
really important as you said to do as a patient to to have the awareness as you
said maybe keep a diary um really kind of try and analyze what time of day for
example you're experiencing these symptoms are you are you experiencing any other kind of um drastic changes
within your day-to-day lifestyle as well because dayto-day life pressures can also have an effect on us as as a person
right and that they can contribute to our symptoms. So yeah, to look at it as a whole. Definitely. I think I think you're right
in the fact that actually as women, we do tend to put things off and we do tend to kind of be focused or be busy with
other things. And like I say, you know, the the generation that going through the menopause, you know, 45 to 55, they
normally are taking care of the kids or the kids are leaving home. They have, you know, a lot of pressure with their work life. They have an active social
life and they have relationships. Um, so all of those things can actually impact
on um how they're feeling anyway and can add to the kind of that stress level, but there will become a point where
actually that isn't necessarily what's always going on. It's also their physiology as well. Yeah. No, absolutely. So, what are the
long-term consequences of menopause? How is this going to affect us in the long
term? So, as I've already said, there are estrogen receptors in pretty much every organ system in your body. So,
your body is used to getting estrogen. when it doesn't get it, it does kind of look for different uh ways of getting it
or it just doesn't do as well without it. So things that are at higher risk of
having in the menopause, not necessarily you will develop it, but definitely a higher risk of developing things like osteoporosis and that's um when your
bones are less dense, so they get thinner and so you're more at risk of kind of having fractures if you fall over. Things like cardiovascular
disease, that's heart attacks. Particularly in women, they present slightly differently. Um and so it's
really important to be aware of those and kind of risk factors for those as well. Things like um stroke uh and blood
clots. Um the other big thing that happens um during kind of that middle portion of your life uh is weight
changes. So it's it's important to note that that is a normal physiological thing that happens. So a lot of women
talk about having a spare tire which is basically where they have um a lot more weight around their waist. That's where
they carry it more. And that does change kind of as you get older. And there is a physiological reason for this and that
is because your estrogen levels changing fat cells have more estrogen. So when you break down your fat cells you
produce more estrogen. So your body who isn't now getting more estrogen or isn't used to that level of estrogen try to
seek it out. So when you eat then it turns more of your um the food that you
food that you eat it turns it more into fat cells particularly around your middle and therefore uh it releases it
should release more estrogen. So there is a reason why um you do have that
spare tire. Um having said that you are because it's kind of long-term risk
having that additional weight can cause things like type 2 diabetes, more like to have high blood pressure, more like
to have high cholesterol. So it's really important in those in in that period of your life that you are doing things to
kind of counteract those changes. I see. Okay. Um so you don't necessarily
should be I mean should we expect to get at least one of these conditions? No.
So, so and I'm just like, oh my god, am I going to get all of these conditions as I get older?
I know. And it's and it's really it's a really scary thing to read about or to kind of talk about because you think, oh, you know, all of these things going
to happen to me and basically your body's just going to shut down. That's not true at all. There are lots of things that can happen and like I say,
it's a risk that these things happen, but it's not a definite, it's not a guarantee. And actually, there are lots of things you can do before you reach
that age or even when you're at that age that you can um counteract those risks.
So um lifestyle measures um kind of losing weight, make sure you keep a healthy weight, those kind of things
definitely will mitigate those risks. I see. Okay. Um let's talk about um the
things that we can do then a little bit. You briefly just touched up on it as well. Um what can we do to kind of
reduce these risks? Um one of the I think my mom always said make sure you
drink your milk. Um because as you get older you will end up with osteoporosis. Us women always get osteoporosis. So I
think there's this kind of um old wives tales. I don't know sometimes it's true obviously.
Yeah, there is there is a seed of truth in that actually. So so when as as we get older we we do our metab metabolisms
change and your your mom is right. Um so it's really important particularly with diet when diet's concerned um we eat
things like less carbohydrates because again that can be converted into fat. Um but also we have a diet high in fiber
but also the calcium and vitamin D and that the calcium and vitamin D is key to protect bone strength and bone health.
So really important that's addressed. Other things for bone health as well things like exercise. So ideally we
should all be doing 150 minutes of moderate physical activity a week. So
that's about 30 minutes uh five times a week. Um and some of that should be weight bearing again to protect those
joints. Of course. Other things that we can do um so we've kind of talked about um diet and exercise but actually maintaining
that healthy weight. So if you maintain a healthy BMI so that's a normally a BMI less than 25 um it not only reduces the
symptoms you will get from menopause but it also reduce all of the kind of risk that we will talk about those long-term consequences those so things like type
two diabetes but in particular things like all the different types of cancers generally in the future um you are
you're massively um at risk of if you're overweight. Other things um things like stopping smoking really key. I mean we
smoking is you you'll always be told Yeah. You'll always be told not to smoke
but um even kind of vaping and things like that. It's really not very good for you. Um it increases your cardiovascular
risk and also it will increase the amount of symptoms that you have and the severity of your symptoms of menopause. Um particularly those kind of hot
flushes and the same um with alcohol. So a lot of people again um don't tend to
think too much about alcohol and how much they consume. But it has a massive effect on all types of cancers particularly breast cancer. So you drink
a moderate to high amount of alcohol. It massively increases your risk of breast cancer. But it also increases the uh
severity of the symptoms you will get. So all of those things that we can think for lifestyle wise um is really key. The
other things I haven't talked about are the things that are harder to to kind of manage and that's stress management and sleep. So, you know, sleep hygiene is is
key and, you know, we should be going to bed at the same time each night. No kind of screens and we should have a relaxing
routine, all those things. Um, but also with the kind of stress management, it's very easy for me to sit here and say,
"Don't have a stress." Yeah. But actually, it's really hard in in in practice. So, um, all those things can
help um with those symptoms as well. When you say it can help, does it significantly reduce your symptoms?
Yes. So it's been proven that particularly stopping smoking, maintaining a healthy weight. So that's with diet and exercise normally and
reducing your alcohol, they have a huge impact on the um on the severity of your
symptoms for the menopause, but also those long-term risks. Interesting. Um obviously we we will
talk about um the kind of um kind of HRT and other treatments um to to manage
symptoms of menopause. But would you say implementing these
this kind of the whole list of the lifestyle changes would they affect your or would they manage your symptoms on
its own? So that's a really good question. I think if you have any of those um symptoms, I think it would all
be always be good to try and maintain a healthy lifestyle, you know, stop drinking, stop smoking, all of those
things. And I think those you can definitely see patients who have had the have, you know, been overweight or have
been smoking and they have symptoms. If they stop that, they do have a reduction. It's not going to be, you know, it may not stop them completely,
but it will definitely help. It's like an adjunct, right? And it's and it's and it's a good thing to do for long-term health as well.
The other things that we can also do um is about education. So for for me it's
really important that um people get the right education and the right um
knowledge about what's happening in their body um particularly regarding to the hormones and the um because of that
then they get on the right treatment or they get on the right pathway to reducing the amount of symptoms that
affect their quality of life. Interesting. Where can people get help um or information about how to manage
their symptoms or what would the next steps would be for them? I think for me I'd always say go and see
a healthare professional. So that's either their GP or a menopause specialist. I think it's really important that they get the right information and and it's evidence-based.
It's really scary going to GP sometimes especially when you have that fear of not being believed. There's so much
stigma around menopause and about aging women in particular. um which is really frustrating but and it's it's really
important that you're able to kind of seek that help when you go to GP. They might ask you lots of personal questions
particularly about sex lives and you kind of your bowel and your bladder and things like that which again can be really offputting but actually they're
only there to help you and they're not there to judge you at all. A lot of like I say a lot of women go through this at
some point in their lives or all women go through this at some point in their lives and so it's really important that GPS are aware and they are very very
professional at kind of dealing with these kind of symptoms. The other thing is they are a vast you know there's a
vast knowledge um from them to signpost you to the right uh resources. So things like the British Menopause society also
on the NHS website there's lots of information about how uh how the menopause can affect you and and where
to get further help from. That makes sense. And um I've also noticed that within uh workplaces there's also lots
of campaigns going on how to support women when they are going through these changes in their life as well because um
I mean growing up u even with the menstrual cycle that you know as one
goes through I always wondered why doesn't anyone take this into account and it always kind of bothered me like
I'm in a lot of lot of pain there's lots of hormonal things going on like this is actually affecting my concentration, my
productivity, no one seems to talk about it um within family setting as well. Um
usually the the kind of whether it's your father figure or your brother or your husband. Um do they actually also
know what you going through as well? I think that's also really really important um to kind of address that
it's not just about us as females being educated but it's also to educate
everyone um so that they can support us and have that understanding as well. I think I think you're absolutely right. I
think it's not just um education for women or people that go through menopause. It's actually for those
people that support us as well. And we know that there are workplace champions and that a lot of workplaces now are
kind of developing that awareness that actually menopause you you will still work when you have the menopause. You know, you still go through and actually
a lot of people who experience kind of sickness or um kind of absences when they are menopausal will lie about why
they're not in work because of the stigma attached to menopause. So around kind of 40% of people won't actually say
that they're menopausal on their sick note. It will be that you know they're depressed or anything else. So it's really important that we aware of these
changes and then we make allowances for these women so they can continue on their work and they can continue with
their livelihood um for the for the for the rest of their working life. Yeah. No, that makes sense as well. Um
and I suppose this is more than just addressing menopause. It's more of a
society change and how things have changed. If you look back 50 years ago,
I don't I mean this might be a little bit um unfair to say, but majority of
women weren't in what they were the kind of the housewife type, right? Um so you were in a kind of workplace environment
and now majority women are kind of in the similar positions. Um but nothing
has changed. You still have the same expectations um but you don't have the support.
Exactly. Well, hopefully the support is coming soon. Yeah, exactly. And you know, you do have those additional pressures like being
able to, you know, you know, particularly women in in higher power jobs, but any women who work, if they
work in an environment where particularly when there are different people or men involved and they don't quite understand what's happening, um it
is really scary for them and and you know, all the other symptoms, you know, things like it's not just the hot flushes and things, but it's also the
brain fog and the cognitive decline as well. um that really affects women and
they you can often find that you know around 10% of women will actually leave their job during the menopause because
of their menopausal symptoms because they just feel like they can't cope and those people sometimes don't even know they're going through the
menopause. They just think it's part of getting older or they think it's dementia related which is not
necessarily true. So it's really important we educate everyone about the symptoms of menopause and then
how we can support them. So let's talk about treatment. um what can we do other than the lifestyle changes that we
talked about um what are there any medication that we can take? Yes. So as I've talked about kind of
lifestyle measures the other things that we can take are medications. So we know that there's a lot of evidence for lots of different types of medications. We
tend to group them into hormone replacement therapy or HRT and the non hormone replacement. So um with those
things um particularly with HRT there's lots of different options with both and we just as health care professionals
when we're prescribing them we look on to your symptoms we look up to your background your lifestyle and see which
one may be best for you and do most women who seek HRT end up
actually taking HRT and staying on it as well. So it's it's a really interesting um
question actually. So um around kind of 20 years ago there was a big paper published um a lot of research and it
actually scared a lot of people off HRT because there was some evidence suggests that it causes an increased risk in breast cancer. Now that is a that's been
debunked and and there is that although there are risks involved with taking HRT actually there are a lot of women who
are not taking HRT at the moment that perhaps could benefit from it. We know that only about 14% of people in the UK
who are going through menopause are actually on HRT. And we know that it should be offered at every every
healthare professional visit if you're going through symptoms of menopause and you're around 45 to 55 you should be
offered HRT. But we know that doesn't happen. It happens about 40% of people. And why is that? Why is such a low
figure? Because menopause is a really good mimic. H a lot of people don't know the symptoms of menopause or don't
necessarily attribute to a natural process. A lot of people think there must be something wrong with me because I've got all of these symptoms and
actually it's just a natural process. Interesting. Um and that that's not sorry that's not
necessarily just because of um it's not on the patient, it's not on the woman. It's also on healthare professionals.
They also don't always recognize it. They don't get very well trained on it. So like you say, you know, 10-minute
appointments, you've got a long list of problems. You won't necessarily think, ah, that's the menopause. That's the menopause. Yeah. No, I get I
understand that. Um what in terms of you obviously we would talk about the HRT but other non um kind
of uh HRT so um let's talk about like natural supplements you walk into a
pharmacy there is a whole kind of section an aisle of menopausal supplements and
you know there's so many forums um online that would recommend women to take X Y and Zed which are natural
supplements to get them through menopause. Um and again I feel like they play on the kind of the stigma of being
at the HRT. Um tell me more about that. I mean there are if you like you say if you go into any kind of um healthy shop
or natural shop or um like say any pharmacy there are dozens and dozens and dozens of products marketed towards
menopause. Some of them are great and there are just vitamins. Some of them are slightly more problematic. So things
like natural remedies or herbal remedies or even uh nowadays it's the bio identical hormones. there are some there
are some issues with them. So things like um black kohash, red clover,
phytoistrogens, ganda I think is a new one. Yeah. Um all of those ones um they're meant to be
natural. They're meant to be herbal. Um but and and there is no evidence. There's no regulation. There's nothing
to say that these actually work. So just be very very careful if you are taking any of these. If you find they're
helpful, great. But if you don't find them helpful, definitely stop them. But the most important thing is with any of
these things, you need to tell your health care professional if you are then going to have any treatment for anything else. It's really important because a
lot of these medications can interfere with other medications that you might be on. Uh and then talking about kind of bio
identical hormones, um there are lots of different things in the press and the media about different things. Yeah, these are non-regulated. There's
no evidence for them at the moment and we are not supporting them uh to be prescribed. However, a lot of people
will go and get them. And again, it's really important if you're on these medications to go and seek medical
advice if you have any problems with them, side effects with them, but also if you're going to go on to different
treatments because it will have an impact on them, right? And the this is not the kind of
the vitamins. Um, so like as we refer to calcium, vitamin D, um, so the kind of
the vitamin you I mean I don't want to name brands, but there's certain brands that says menopause 50 plus. So those
ones are okay. Yeah. So they're normally kind of multivitamins that you would normally get. So they're necessarily, you know,
they're not necessarily harmful. Definitely, you know, if you are going for different consultations, definitely tell them you're on kind of over the
counter stuff, but no, they're not necessarily more uh problematic. It tends to be the ones
that are um from health food shops um or online that perhaps you don't always
know what you're taking. Those ones can be really really problematic. The Instagram pop-ups sponsored.
Yes. Yeah. Says, "Are you going through menopause?" Yes, this can help you. Yeah, no, I get those. Right. So, the kind of exciting
part of this would be HRT. Yes. Tell me what exactly is HRT, please. So,
HRT is exactly what it says it is. So, it's hormone replacement therapy. So, you are replacing those hormones that
are naturally occurring in your body. So, estrogen and progesterone. Um, you can also have testosterone as well, but
estrogen and progesterone, you're replacing them back to their normal levels. So, you're not raising the levels. You're not kind of having lots
and lots of estrogen and progesterone. it's back to your normal levels. So, a lot of women um have real uh you know,
real benefit from on HRT, but it has to be the right amount of hormones at the right time for the right person,
right? And what are the kind of different types of HRT then? So, I mean it is it is quite when you're
when you're going through it and you are a patient or even a healthare professional, there's so many different types and it is quite overwhelming to
when you think of it. So the different types basically boil down to estrogen and progesterone. So the naturally
occurring hormones. Now you can have estrogen and progesterone together something called combined or you can
have them separately. So as I said before estrogen is something that normally causes the symptoms. So when you have a lack of
estrogen that's when you have the symptoms of menopause. So if we replace that you'll have less symptoms. Also
they estrogen is protective against all those long-term consequences of having the menopause. So things like cardiovascular disease, bone health,
dementia, all those kind of things. So progesterone um you purely have progesterone as that kind of endometrial protection. So that protection for your
uterus to stop developing it stop developing complications. So if I was just to give someone with a uterus if I
was just to give the estrogen what would happen is the lining of the womb that the um the endometrium would grow and
grow and grow and grow and those cells would become atypical. So they become abnormal and then they could develop into a cancer.
So when you have progesterone we add it in to stop that from happening. It keeps the little line in the womb nice and thin and therefore it stops you from
bleeding but it also stops you it helps prevent against those kind of cancers. Right? So if you have a uterus then we tend to
give estrogen and progesterone whether combined or separately but we but if you don't have a uterus we tend to just give
estrogen. Okay. Now there are lots of different roots of the hormones. So when I talk
about roots is that's how you take it. So most commonly you can have kind of oral. So they're tablets and again you
can have estrogen and progesterone. The next ones are kind of what called transdermal. So they go through the skin
and they are patches, gels, sprays, creams. There's lots of different options. And then you can also think
about having kind of implants. That's things like the myina coil or the kind of a hormonal coil.
And you can also have kind of more locally active ones. So if you have any vaginal symptoms or urinary symptoms, you can have vaginal creams or peseries
and things to help. Yeah. So, they're the different kind of roots. They're also ones that if you are
still bleeding or still having periods or even though if they're erratic, um you can be on what's what we call sequential HRT, which is basically when
your hormones mimic what you would normally have in the cycle. So, there are when you have your um menstrual
cycle, your hormone levels change throughout the cycle depending on where you are. And so, when you have sequential HRT, that mimics that so you
have higher levels of progesterone or estrogen towards the cycle, right? You can also then have continuous um HRT
which is basically a low level completely just constantly and they're normally for women who are either older
or definitely women who don't have periods any longer. Right. So just to clarify to make sure
that I I understand this correctly um it's probably goes back to one of the stigmas as well. So when you're on HRT,
even though you haven't had periods for a year, let's say, because then you'll be a menopausal,
when you start having HRT, do you end up having your periods?
So that's a really really interesting question. So when you when you have stopped having your periods, so when
you're postal, so you you've stopped having your periods for over a year, we tend to start with the continuous, so
it's a low dose of estrogen and or progesterone. With some women, we do find that their
periods can come back and they do experience vaginal bleeding is normally within the first kind of 3 to six months. If it's longer than that, then
definitely go and seek help with your GP again or your healthare professional who whoever's prescribed it. You can still
have HRT even if you're permenopause. So, if you're still having symptoms of the menopause, but you're still having
periods, you can definitely take HRT. There's no barriers to that at all. You don't have to have gone through it all and then I see
you can take it before you reach that point. carry on having your period then? Yeah, you can do. Yeah. Okay. Um and
again, we normally kind of allow that until you've reached kind of 51, 52, sometimes up to the age of 54. So, it
just depends on where you are, your personal history, that kind of thing, depending on how long you stay on the sequential and then we switch you to
continuous. Right. So, in terms of the health impact that it's having on your body,
is it good or bad? I don't know if you can categorize it but is it good or bad to stop your periods essentially
or not stop it? So in terms of kind of physiologically stop it so everyone goes through you
know all people born with ovaries they will go through the menopause. So it's
important to know that this is a natural process. You would expect that if you were if you were on HRT and to have your period that
that's quite normal. So it's not bad at all. It's not good or bad. It's just something that does happen. What we want
to make sure is that if you do start bleeding on HRT, if you've had a period of stopping, so if you've not had a
period for a year over a year and you start bleeding again, that can be normal when you start HRT, but then if it
persists kind of longer than six months, it's definitely worth getting investigated to see if there's any other cause. It could be like a polip or or
something benign, but it could be something more sinister. Okay, thank you for that. Um, so the
important question, I think we briefly touched on this um about the stigma around HRT.
um and how safe it is should be be worried. Um you mentioned
there was a paper which kind of scared everyone off and said oh HRT is bad it's going to give you cancer but obviously
that was not the truth behind the research and the narrative is changing
now so who should stay well away from HRT who is not suitable for and um what
would your recommendation be so I think it's on a case by case basis it's all to do with the kind of individual um person
it's to do with their background their family history um their kind of symptoms
but also what are their preferences and what are their what are the risks involved. So is it safe? Um for the
majority of women who are less than 60 or within 10 years of having the menopause HRT is very very safe. The
benefits outweigh the risks and those benefits are for long-term. So things like osteoporosis, cardiovascular
health, cognitive kind of function. We do find that there are um there has been
research and there has been evidence as I I kind of previously mentioned um there was a big paper published that
kind of scared everyone off HRT because they said that it definitely causes breast cancer massive increased risk but
actually that's been debunked and that's been um disproven now and actually when we look at the data and the data since
there is a very small risk of breast cancer a very small increased risk of breast cancer if you're on HRT compared
to women who aren't on HRT. However, that risk is actually less than
if you smoke 10 cigarettes a day or if your BMI is over 30 or if you drink a
moderate amount of alcohol. So, actually, it's all relative. Um, in terms of kind of other safety things, there are people who perhaps uh
need to have alternatives to HRT or maybe on a different route of HRT. So, things that go through the skin rather than kind of oral. And they're uh for
people particularly who have a personal or family history of cancers or or hormonal cancers in particular. So
breast or endometrial cancers but also um women who've had heart attacks in the past my cardio unfortun
people who've had blood clots um what's called a venos uh venus throbo embolism so that's either a DVT in the leg or a
pulmonary embism PE in the lung so and those those women need to kind of have uh definitely a consultation about the
kind of risks and of HRT which can increase your risk of having blood clots um if you take it orally but not if you
have it through skin. Um but also uh women who have liver disease definitely need to uh be cautious about the type of
HRT they take. The other kind of people that we talk about HRT in are those younger women. So the women who are less
than 45 who perhaps are going through the menopause and early menopause. Those women if they want to preserve
their fertility. So if they want to carry on and have have more children then for those women
again we need to discuss the type of HRT they're having. So HRT isn't a contraception. That's a big myth. So HP
is not a contraception. So if you are sexually active and you are kind of still having periods, there is a chance
you become pregnant. So with those women, we do do need to talk about contraception as well. But for those
women who want to preserve their fertility, there are different types of um HRT that they can have.
I'm so glad you touched on contraception because it's similar hormones in kind of contraceptive medication as in HRT. So
it can be kind of misconstrued for um for as a contraceptive method.
Yes, that's right. I've seen that from so many patients as well actually. We actually use um there are some
contraceptive pills um so the combined contra contraceptive pills that we actually use in patients who have
premature ovarian insufficiency as a HRT. Yeah. So is completely right that they
are very bio very bio kind of similar um kind of preparations but we have to be
mindful of this is not a contraceptive yeah so it's not there is that obviously
risk of pregnancy yeah that makes sense and let's say we are um kind of one one
is on HRT going back to the kind of the the long-term effects that we talked about
earlier the kind of the risk of osteoporosis the weight gain um and so on. If you are on HRT, would
the um would having these kind of um hormonal replacement therapy prevent you
or reduce your risk of having those conditions? Absolutely. So if so, if you have it at the right time,
so if you start HRT less than 60 Yeah. or within 10 years of your menopause,
then absolutely it will reduce all of those risks then. And it will also help with your symptoms, which is a majority
of reasons why women have it. Yeah, if you have it over 60 or prescribed over 60 or after 10 years, there is no
benefit for those long-term. So there's no additional risk that they will happen, but there's no benefit. So you
won't have those kind of that reduction in risk, but you will have a symptom reduction.
Right. Okay. That's really interesting that you mentioned the age um gap. So
can you can anyone take it up to any age to be honest? Is there a kind of the hard stop if should you be so lucky to
live to 100? Um would you would you carry on taking it till then?
So I I have had patients who have been in the 90s and still taking HRT. Um so
there used to be a thought that you you should only really be on it for 5 years. Yeah. However, um if you're still having
symptoms and you still have annual reviews with your healthcare provider to make sure that you're kind of they're
aware of all the risk factors and to make sure that you're kind of healthy otherwise, so you haven't developed any
medical problems that could interfere with your HRT or your HRT could interfere with them. Um and you're well
aware of everything that could happen, then there's no reason why you can't continue HRT long term.
Long term. Okay. What we do suggest for women is to have those annual reviews, to have those checkups to make sure that
this is a safe thing for them. We know that women typically take it for years. Um, particularly if they're having
symptoms. You can have a trial off it and see if your symptoms come back. Sometimes they do. Sometimes they go back on them. They go back on the HRT to
help with them. It's it's really an individual choice. The only thing I would say is definitely make sure that you are if you are going to take HRT
that you have regular check-ins with your healthcare provider. Right. Um, and would um what are the
side effect profile like with HRT? With HRT. Yeah. So, it's really interesting actually.
There are side effects with HRT. Um, and it's very similar to how you would feel around your period because we're
replacing those hormones. So, back to that level. So, some women when they have their period would get kind of
headaches, mood swings, breast tenderness, all those kind of things. And that happens with HRT or can happen.
It's more likely to happen when you first start HRT. Um but if it does happen and it and it's becoming more
problematic or you're getting a bit fed up with those kind of side effects, you can either change the the root. So if
it's oral, you can change to um like a patch or gel um or you can change the type. So there are different types of um
synthetic progesterones in particular that we can change to that have a better side effect profile. The other thing to
consider is as we've already touched about um is that with HRT, some HRTs can
make you bleed which can be alarming. Yeah. So, and talk about kind of vaginal bleeding. So, it's it's not necessarily
a period. It's just called a withdrawal bleed. So, it's a physiological process because of the hormone levels. That can
happen when you start HRT. What we try and tell women is if it start if it happens when you start HRT. Um, that's
normal for the first six months. After that, definitely not normal. You need to go and see someone. And it may be that you just need to have a full MOT just to
check out if there's anything more sinister going on. If not, then they might change the the different dosage or the different type of um hormones. If
you develop if you're on HRT long term and then suddenly develop bleeding. Yeah. That is definitely a red flag. That's
definitely something you need to go and see your healthare provider about because that is not normal to suddenly just start having that suddenly start bleeding. So if you've
been on it for 6 months or more and you've not had any bleeding then suddenly develop bleeding definitely go and see someone. Yeah. So side effects I'm assuming would
happen in the early stages of the treatment. Anything else if you've been on it for like 3 months or so, six
months and suddenly start having that's more than just a side effect. Yeah. So if it's over six months definitely. Yeah, definitely that's not
normal. If it's within those first six three to six months, yeah, that's abnormal. But we normally when we start people on HRT, normally what we do is we
review them at three months anyway to to check how they're getting on any side effects and things like that. So, it's a
good it's a good kind of stopping point at that point. And don't be dis I suppose the message from this is that don't be disheartened if you um if you
don't get on with it, if you experience side effects. As you said, there's so many different types and um there are
obviously more specific. So for example, if you're having vaginal dryness, then I'm assuming you will have the topical
treatments for it. So um it might be that you don't really generally need um kind of systemic
systemic. No. So when we talked about kind of different kind of roots of HRT, there are there are some women who don't
like the idea of taking hormones systemically. So taking a tablet or affects the hormones all over the body.
And one of the common things that we see is that particularly women who have problems with their vaginal dryness or
vaginal symptoms. So that's things like dryness, that's problems having sex, that's kind of irritation, um that
feeling of kind of grittiness down there. That's that's how it feels. And so with those women, they don't have to
have a systemic hormone for that. And actually, we've noticed it's actually better to have a vaginal um vaginal
estrogen. So that's a a estrogen that's applied. It's normally a cream or a pesery that's inserted into the vagina
or around the vagina that can then help with those kind of symptoms. Um they are
very very safe vaginal estrogens. they're not absorbed systemically. So ladies with breast cancer, ladies with liver problems, all these people that
have problems who can't take HRT can definitely take vaginal estrogen. Right. That's really reassuring. And um
just to briefly touch up on the um um I suppose some some patients who are
already on HRT would be aware that there is a lot of stock issues um in terms of
accessibility to HRT. um my community's um um my background is community
pharmacy and um there was so many um kind of months where patients really
struggle to to get their kind of regular HRT patches. Um what would your
recommendation be when there are kind of stock availability? So once you find the
medicine or the type of patches that actually works for you and then they go out of stock for months, what would be
the alternative? So, it's it's really interesting you say that because there are when you when you start on HRT,
you're normally given a brand or you're giving a certain type of estrogen and a certain type of progesterone. Um, and
they are can be from different brands, but they tend to be the same. If you are finding that you're having problems with that certain type of HRT, what you can
do is kind of make a switch with your healthcare provider um to switch onto something very similar and they should
have a similar hormone kind of level and a similar uh you know, side effect profile. If there are problems with
that, then you can change to different routes. But what we normally say is once you've stuck on something that's good for you and it's taking account your
risk and your profile and also kind of your lifestyle as well um because you know if you're swimmer you might not
want a patch and and things like that. So so with any of those um issues then we tend to keep on the same route if it
works well for you. Interesting. And um what would someone do if they didn't want to be on HRT?
What would be the alternative? Um we mentioned not to go near any of the kind
of herbal things that is not evidence-based. Um they don't it might be that it's it's contraindicated so
they're not actually suitable for having HRT. What would they do then? So there are are loads of alternatives that you
can have. Um if you're not suitable for HRT or perhaps you're worried about going on HRT there's there's lots of things you can try and with lot good
evidence as well. So things to kind of try that are non-medication related are things like uh CBT, cognitive behavioral
therapy and hypnosis. So they've got really good evidence behind them to reduce particularly for hot flushes and
night sweats. So we know that particularly with CBT, it can reduce symptoms by about 83%.
Wow. Which is massive. And so you and again you can have this in combination with HRT as well or or not if you're suitable
for HRT. Um so CBT is really or hypnosis are really good options. Um other things you
can try so they've got limited evidence um is things like acupuncture and things but there's limited evidence to support
that. If we're now talking about kind of medication wise there are loads of different medications and again your health care provider will be able to
kind of prescribe the right one for you and the right one for your symptoms as well. So there's things like clonodine
there's things um uh called gabapentine which is a typical painkiller. You can
also have um anti-depressants. So the ones called SSRIs or SNRI. So they tend to be um
prescribed for patients not just for mood but they can also help with those menopausal symptoms as well. But the the
most important thing is for any of these things is that it's the right one for you and your symptoms at that time.
Yeah. Okay. That's really interesting. So if someone's listening um uh and they
are really interested in pursuing HRT treatment,
how would they get this help? So where do they go? So uh the first protocol would be um so educate yourself but also
go and seek help from a healthare professional. So either that's your GP or a menopause specialist or an online pharmacy.
Um I think a lot of there's a lot of information out there and like I like I said before there's a lot of options and
it can be very overwhelming. So, it's really important that you're aware of the different options that might be
suitable for you and you seek the help from those people that then can uh advise you on the best one for you. The
other thing is you can um on the NHS you can get a HRT prescription and you can actually have a one-off uh prescription
cost that you can have unlimited HRT products. So, there are uh there are options available for you um should you
wish to to go kind of down the NHS route. I'm glad you mentioned that because obviously the the prescription
um kind of costs are not actually cheap. So, and if you're having this as a regular treatment, um that could be a
factor in some people. Um I've been in that situation in the past where I'm like, "Oh, actually, I'll just put up
with the pain and not get a prescription treatment because it can be very costly." Um so, I'm glad you mentioned
that. So, this is the um prescription prepayment um spec specifically for um
Hati. Yeah. So it's available in England at the moment, but they are looking to expand it to the rest of the UK. I see. Um but yeah, so especially because you
might have different products. So you might have a vaginal cream, but then you might have a patch, but then you might have um you know, a tablet if you have
estrogen kind of orally, but you might have a patch of progesterone, but you might have a vaginal estrogen cream. So there's lots of different options and it
can be very very expensive. Yeah. Um so it's if you have that one-off cost actually for a limited stuff, you can
trial trial and error. Try and error. Yeah, that makes sense. Um, I was going to, um, kind of bring this together and
say, what would you recommend to someone who is feeling overwhelmed, but right now I'm feeling really overwhelmed by
all this information. So, what would you advise me? I think I think the most important things um that I want to get
across is that you're not alone. So, there are women out there who think they're completely on their own. This is the only thing, you know, they're the
only one to go through all these symptoms. They're the only one that's affected. But actually, lots of women go through very, very similar things. and
to go out there and realize that you're not alone. There are support groups and there are there is help available for
you is is key. Um the other thing is that if you are going to seek treatment for kind of symptoms and things that you
get it at the right place, you get it at the right um time uh for you um but also
you seek out help when it when when you need it. Okay. Well, thank you so much for that, Charlotte. Honestly, that has been
probably one of the best discussions that I've had and obviously this is such a um a close topic um to to to myself as
well um being a woman as well um and having a daughter as well and I would love to for the next generation to also
provide that education for for our future. Thank you so much for that. Um
really appreciate you joining us and um shedding light on the whole um menopause
topic. really appreciate it. Thank you.
Mental Health
e-Health Matters | Episode 9 | Anxiety & Propranolol
Anxiety is one of the most common mental health challenges, yet still one of the most misunderstood. In this episode of e-Health Matters, we’re joined by Rayco León, mental health consultant, to unpack the realities of anxiety — how it shows up, what it feels like, and how it can be managed with the right support. We also explore the role of propranolol, a beta blocker that can be prescribed to help manage the physical symptoms of anxiety - How it works, side effects, and more. 🧠 Whether you're living with anxiety or supporting someone who is, this episode offers practical insights, compassion, and clarity.
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Superintendent Pharmacist: Justin Dicks 2038305
© Total Access Health LTD. All rights reserved.
Pharmacy Address: 42 Barnard Road, Norwich, NR5 9JB