Not all women need or want to take MHT and some have medical contraindications. Most of the symptoms (apart from the vaginal, vulval and urinary ones) do settle eventually without any treatment but it is very variable how long they last. The average is about 7 years. If not taking MHT, any vaginal, vulval or urinary symptoms do need to be treated with long-term local oestrogen when possible or they will only get worse with time.
There is now a big market for products aimed at menopausal women but please don’t spend lots of money on these. Most women who eat a healthy and varied diet including all the food groups will not need lots of supplements. Those with restricted diets or certain health conditions may need some supplementation e.g. iron and B12 for vegans.
We should all be having a daily vitamin D supplement (800 to 1000 i.u. daily dose), especially from October to the end of March as the sun in the UK is not strong enough during these months to help our bodies make vitamin D. We need to be taking enough calcium in our diet – you can check your intake via an online calcium calculator.
Lifestyle changes can improve perimenopausal and menopausal symptoms whether you are on MHT or not – see separate box.
We do also have non-hormonal options that can be prescribed in low doses to help with hot flushes and night sweats. These include venlafaxine, escitalopram, gabapentin, pregabalin and oxybutynin. A new class of drug for treating hot flushes and night sweats has recently been developed. The drugs are called fezolinetant (Veozah) and elinzanetant but they are not available on the NHS at present. They are a non-hormonal option and trials on breast cancer patients are currently being run.
Tips for managing hot flushes and night sweats:
- avoid triggers such as alcohol, caffeine, spicy foods and smoking
- drink cool rather than hot fluids and keep well-hydrated
- wear cool, loose fitting layers of clothing, consider sweat-wicking clothes
- avoid sudden changes of temperature eg. hot baths or hot rooms
- you can use fans, cooling bedlinen and other items such as pillows
- consider a separate, lower tog duvet just for you
- keep the bedroom cool with an open window if possible
- allow plenty of time for tasks to avoid extra stress
A type of cognitive behavioural therapy specifically designed for menopausal women has been shown to help with hot flushes and night sweats as well as the sleep issues caused by the menopause. I recommend the book ‘Living Well through the Menopause’ by Myra Hunter and Melanie Smith which is an evidence-based self-help guide using this CBT approach. Some areas now offer group CBT for these symptoms.
