Hot flushes and HRT: everything you need to know about the menopause explained

T he menopause is something every woman knows she will eventually have to deal with. At what age, how long for and what symptoms she will have, however, vary widely. That's what makes this stage of life so difficult to define, because one woman is nothing like her mother, her sister, her aunt or her friend. Everybody's body and hormonal balance is individual, but we must understand the basics in order to figure out how to best tackle our own reality. The only experience Dubai resident Anna Yates, 66, had of the menopause before she started going through it had been that of her mother's. "She was completely doolally for a couple of years," she says with a laugh. "We never knew what she was up to next – she used to do all sorts of crazy things." That included going to court for shoplifting when she accidentally put a loaf of bread in her own bag rather than the trolley. "Fortunately she had a good doctor who went with her to court to say: 'Look, this woman's going through the menopause, so she doesn't know what day of the week it is, never mind where her bread is'." Thankfully, for Britain-born Yates, who has been going through menopause for the past 15 years, her experience was not like her mother's. "I was not looking forward to it, but it was nothing like that for me." The most inconvenient symptoms she experienced were spotting and night sweats. "It was much easier than I expected it to be." The menopause is the time that marks the end of a woman's menstrual cycles. "Menopause happens to every woman, but very few actually know much about it," says Alexandra Collishaw, a physiotherapist and clinical lead at Dubai clinic O ptimalTherapy. Collishaw has worked in Dubai since 2011 and specialises in women's health physiotherapy, treating complaints such as pelvic floor issues, reduced muscle strength, and aches that can be common during menopause. "We hear stories about hormone replacement and hot flushes, but that is about as much as most women know." Menopause can start, on average, between the ages of 40 and 58, she explains. It starts with the perimenopausal stage, which can last between two and 15 years. This is when a woman’s menstrual cycle becomes irregular. Once you have gone without a period for 12 months, then you will be diagnosed with having reached the menopause stage. “This is associated with hot flushes, poor sleep, weight gain, incontinence, night sweats, emotional changes, dry skin, decreased libido and vaginal dryness, joint pains, headaches and memory loss,” says Collishaw, adding that some of these symptoms will also be present when perimenopausal. “You are post-menopausal when these symptoms start to fade away and you start to get your energy back.” Yates, who is a psychotherapist and hypnotherapist, believes her relatively easy experience of "The Change" has a lot to do with the lack of stress in her life. "My body wasn't so busy making stress hormones and so it could make the hormones to help me get through the menopause," she explains. "There are some women who sail through the menopause because they've got very easy lives. If you've got a stressful life, chaotic husband, crazy kids, stressful job, you're so busy making the hormones to cope with that." Dr Tara Wyne, clinical psychologist and director of wellness clinic The Lighthouse Arabia, agrees that mental health can have a huge impact. "I think going through the menopause is primarily associated with a sense of loss; not having a menstrual cycle means being unable to conceive and a critical shift in identity and status," she explains. "Women often catastrophise and imagine the worst outcomes, like significant weight gain, loss of sexuality and many other visible and humiliating symptoms." Dr Wyne adds that women can often feel inferior to or jealous of others who can still reproduce and having no control over this phase of life makes them fearful. "Lack of acceptance of this phase can result in a less resilient coping response and a much greater sense of impact than is strictly necessary." The other reason Yates found it so easy to cope was because she used hormone replacement therapy (HRT), which can come in the form of pills, patches or creams. At first, she took the regular HRT treatment, but then, seven years ago, her gynecologist put her on bioidentical hormones – man-made hormones derived from plant oestrogen designed to be chemically identical with those the human body produces. "I was told I could stay on it forever if I wanted to, but I thought I'd be sensible and try and carry on without it," says Yates, who was concerned about reports that show oestrogen increases the risk of getting breast cancer. Over the years, HRT has caused controversy, but not all of it is true, says Dr Aagje Bais, a consultant obstetrician and gynecologist at Mediclinic Arabian Ranches. “There was this big study done … when they found people using it had increased risk of breast cancer, endometrial cancer and cardiovascular disease,” she explains. “But we found out that by really analysing the data [that] these ladies were over 60 years of age and used HRT for longer than five years … It is a balance and you have to find what is suitable for you.” Importantly, says Dr Bais, women need to know that they don’t have to suffer through uncomfortable symptoms. “Everybody responds differently to the menopause, everybody has different symptoms. Some people say it is what it is and that’s fine, but a lot of females struggle and it gets in the way of their day-to-day activities. In this case, you should do something about it.” However, this also depends on affordability, as many insurance companies operating in the UAE exclude HRT and menopause treatments in their health coverage. Depending on the troubling symptoms you have, there are a range of treatments to opt for, she adds. One of the most recent interesting advancements in medicine for menopause is vaginal laser treatment, which has been used for vaginal atrophy, she explains. "You have dryness, urinary tract infections, infections, bleeding – that can all be treated quite easily with laser treatment. [It] has had some good results so far. Of course it's not been on the market that long, but as far as I can see, people are happy with the effects." Another recently announced treatment by British company ProFam that caught the medical industry’s attention promises to delay the onset of menopause by as many as 20 years. However, it will be a few years before this kind of procedure, which involves performing keyhole surgery to remove a small piece of ovarian tissue, is available in the UAE. Yates, for one, highly recommends seeking medical advice when it’s necessary. “If you’re struggling, then look for help,” she says. “If the first doctor you go to says get on with it, then go somewhere else. Wait until you find a doctor who is sympathetic with the challenges of going through the menopause – not all doctors are.” Some women prefer to go through it alone and tackle this natural biological process without medicine. Paula Newby, 60, an entrepreneur who lives in Dubai, has been going through the menopause for the past 10 years. Before she started, she’d had her uterus removed, so her doctor suggested oestrogen patches instead of full HRT to manage her menopause symptoms as they have a lower cancer risk, Newby explains. “I tried them, but I didn’t sense there was any real impact. I’m not a pill-popping person. If I don’t need something, I don’t take it … I come from a family who generally don’t reach for the medicine cabinet very quickly. We tend to crack on and get on with it.” So, Newby turned to natural remedies, such as evening primrose oil and the herb, black cohosh. "I'm afraid I was too impatient with those. They take a while to take effect." Instead, she reduced her alcohol and coffee intake, adopted a primarily vegetarian diet, and started intermittent fasting, which she's found has helped enormously. "I've battled through, really." Dr Marilyn Glenville, a leading nutritionist in the UK who specialises in women’s health, is a big proponent of diet and lifestyle change when it comes to managing nasty symptoms. “The more you can look after yourself, especially during those early perimenopause years, the more comfortable and easier the transition through the actual menopause can be,” Glenville explains. “The menopause is a time of change and the female hormones are going to be fluctuating up and down at this stage. What you eat as you go through [it] can make the difference between having a difficult or easy menopause.” Research has shown that eating oily fish, which contains omega-3 essential fatty acids, could delay the menopause by three years, Glenville says. “They stimulate antioxidant capacity in your body and antioxidants help to slow down the ageing process in general and that would include your ovaries, too.” Eating a good amount of legumes, beans and soya products, which are phytoestrogens, are also thought to help delay onset, cushioning the effects of the “hormone roller coaster” women go on and helping to balance hormones, she adds. On the other hand, “eating a diet high in refined carbohydrates can cause you to reach the menopause a year and a half early”. This is because foods such as white rice and white pasta can cause problems with blood sugar and lead to insulin resistance, she explains. Collishaw, who recently completed a postgraduate course focusing on the menopause, also has plenty of advice for women going down the all-natural route. “Ensuring that your levels of vitamin D and vitamin B are optimal can assist in improving your liver function, which is important in optimising your hormone balance,” she explains. “Vitamin C can help to improve your gut microbiome thus helping with mood by optimising the gut-brain axis. “Curcumin has been reported to help aches and pains, sage with hot flushes and rosemary for brain function – so these may all be things to introduce into your diet along with the polyphenols, such as dark berries, to help modulate inflammation in the gut.” Whether you use pills or not, Newby says she feels strongly that these things need to be talked about in a more open forum so that women, when they get to a certain age, are going in with their eyes open. “When they do find themselves waking up to start the day and feeling terribly emotional and tearful, they don’t have to feel like they’re going mad.” Collishaw agrees that education is key, as a study by BodyL ogic MD Survey in 2018 found that only 19 per cent of perimenopausal women were moderately aware of menopause expectations, she explains. That same study showed the 53 per cent of women who were not informed, felt angry about what was happening to them. "We know that knowledge is power and acceptance, and an understanding of menopause often leads to feelings of healthiness and relief … So it is vital that we get the information out to ladies about what is happening, and empowering them so that they can control their own symptoms and make informed decisions regarding areas such as hormone and supplement therapy." Dr Bais’s advice is simple: “Discuss it. Discuss your situation with someone who you trust or you like – a doctor or a friend or family – to see how other people experience menopause and do realise everyone is different. They might have some tips on how they dealt with certain complaints.” Above all, don’t be shy and don’t feel ashamed, she advises. “There are solutions. Sometimes it’s not easy to find the right solution and it takes time, but there are always solutions.” From a mental health standpoint, Dr Wyne echoes this sentiment. “I encourage women to be radically self-compassionate, understand that menopause may cause some struggle and suffering, but that they should meet this with kindness, a lack of judgment and acceptance that this is part of our journey and our identity. Women need to uphold that their life experience can still be enriched and we can still be of great value and experience joy, despite menopause.” And that’s whether you accidentally steal a loaf of bread or not.

Hot flushes and HRT: everything you need to know about the menopause explained

Doctors, women’s health specialists and those going through it give a clearer picture of what to expect from the menopause