How Can I feel Better?

What can be done to alleviate these symptoms? What is HRT and is it safe?

First of all, let’s talk about the lifestyle changes that can be made:

1. Avoid caffeine, alcohol and spicy foods if these aggravate your hot flushes

2.Wear loose clothing and sleep with a fan or AC

3.If you are overweight, hot flushes can be worse than if you are a normal weight, so weight loss can help.

4, Exercise helps to relieve some of the mental health symptoms of the perimenopause such as low mood, low energy and brain fog.

5. Keeps your bones healthy by doing weight bearing exercise such as walking/running/aerobics. Make sure you get enough Calcium in your diet. Take Vitamin D3 10mcg daily.

6.Don’t smoke. This increases your risk of an early menopause and increases your risk of cardiovascular problems and cancer.

What Is HRT? 

HRT (Hormone Replacement Therapy) replaces the lack of estrogen that is causing all these awful symptoms. So, it always contains oestrogens. If you have a womb still, it will also need to contain another hormone, progesterone too. The one exception is vaginal oestrogen which can be given alone for vaginal atrophy.

The oestrogen can be given by mouth, alone or in combination with progesterone, or we can give it through the skin using a patch, gel or spray. It can also be given vaginally.

Progesterone can be given by mouth, or via a Mirena Intrauterine system. It can also be given vaginally. Progesterone is not however, as well absorbed through the skin.

There have been some HRT scares in the past:  Older, flawed studies, especially one called “The Women’s Health Initiative Study” back in 2002 scared the living daylights out of doctors and patients alike….I will talk more about that in another article.. However, we now realise that this study was done on older women taking older types of HRT. More modern HRT is safer, especially if given in more carefully selected women without heart disease or uncontrolled hypertension. Oestrogen is safer through the skin too.

What if I can’t Take HRT?

Some women Can’t take systemic HRT. This includes.:

1. Women with unexplained bleeding

2.Women with a cancer that may be oestrogen dependent like Breast cancer or Womb cancer.

3.Women with a personal or close family history of deep vein thrombosis or Pulmonary Embolism (Clots on the Lung)

There is still help for these women… and this comes in a “side effect” of another commonly prescribed class of drugs…SSRI antidepressants. Yup. SSRIs like Fluoxetine (Prozac) Venlafaxine (Effexor) Sertraline (Prozac) for example can stop hot flushes. This is an unlicensed but relatively safe use of commonly prescribed antidepressants; they might help with the mood swings too! Some but not all of these can interact with breast cancer drugs like Tamoxifen so tell our doctor if you are on Tamoxifen so she can choose one that does not.

Other classes of drugs can help too.

What about Herbal remedies? 

Red Clover can help with hot flushes, but it reacts with many drugs including Blood thinners, Tamoxifen etc. It does have weak osteogenic properties, so we do not know if it is safe to take without progesterone. It can also be dangerous with breast and womb cancers.  Black Cohosh has similar properties and can cause liver failure, Herbal remedies are not subject to the same scrutiny and label warnings as pharmaceuticals so their dosage can vary even within the same brand. So, be wary of herbal remedies without talking to your doctor first.

Stay tuned for the next article on HRT Benefits and Risks.