Menopause and misery need not go hand in hand. Surrey GP Anita Indrakumar has some top tips for keeping the symptoms at bay.
One of the biggest and most empowering shifts that I have seen as a GP over the past decade is the rise in the number of women accessing help for their menopause. Yet despite an ever-increasing volume of information, many arrive in my surgery confused, frustrated or even blindsided by their symptoms.
Here are some of the questions I’m most frequently asked...
Are my symptoms due to menopause?
In my experience, many women clearly recognise classic menopausal symptoms such as hot flushes and vaginal dryness. However, a significant number present with non-specific symptoms, such as feeling irritable or tearful, struggling with sleep or a decline in libido. For women over 45, a blood test is rarely needed to confirm perimenopause. If menstrual cycle changes are present alongside typical symptoms, a clinical diagnosis is usually sufficient.
Can lifestyle measures help?
Many women are surprised by the degree to which small, consistent lifestyle changes ease their symptoms. Stopping smoking, avoiding caffeine, alcohol and spicy foods and drinking 1-2 litres of water a day can make a real difference. Exercise is also a powerful tool: walking for 30 minutes daily, along with yoga or Pilates, should help to reduce night sweats and improve sleep. For mood changes mindfulness can be remarkably effective, while menopause-specific Cognitive Behavioural Therapy (CBT) assists with managing mood and sleep.
Do I need supplements?
While a balanced, varied diet is the best foundation for health, some supplements may help women through the menopausal transition:
- Vitamin D & calcium are essential for maintaining bone strength. The UK government recommends a daily 10µg (400 IU) vitamin D supplement from October to March. Most people can meet their calcium needs through food.
- Iron supports energy. Women with ongoing periods need 14.8 mg daily, while postmenopausal women need 8.7 mg. Heavy periods in perimenopause can lead to low iron levels, so speak to your GP if you’re feeling unusually tired.
- B vitamins, especially B6, B12 and folate, may support energy, cognitive function and heart health, although more evidence is needed. They’re often taken together as a B complex supplement. Good sources include fish, poultry, dairy, eggs and fortified cereals.
- Magnesium may help with sleep, particularly when combined with
B vitamins, though more research is required. And for any supplement, always use a reputable source. If you have a health condition – especially kidney disease – or you take medication, consult your doctor before you start.
Is bioidentical HRT better?
Standard HRT comprises oestrogen and, in most women, some form of progesterone. ‘Bioidentical hormones’ are man-made hormones, usually extracted from plants and designed to be chemically identical to the hormones produced by the body. Some people consider them a more natural alternative to standard HRT.
However, they may not actually be any safer. In fact, the British Menopause Society does not currently recommend their use, as there is insufficient evidence to validate either their safety or their effectiveness.
Do I need testosterone?
Testosterone levels decline during menopause, alongside oestrogen and progesterone. Testosterone replacement is one option for women experiencing low libido – but only once they have optimised their HRT.
Note that if a blood test reveals that levels are low, it doesn’t mean that treatment is required. Decisions are based on symptoms and overall health. Currently, testosterone is prescribed by hospital specialists rather than GPs on the NHS, though this may eventually change.
Anita Indrakumar is an Epsom GP
