the menopause exchange...the menopause at work 3 ways to stop your symptoms affecting your work and...
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Contents
From the Editorial team
The
Menopause Exchange
Issue 80 Spring 2019
Editorial 1 Welcome to the Winter issue
News flushes 2 Health news hot off the press
The menopause at work 3 Ways to stop your symptoms affecting
your work and how to get help if they do
Non-hormonal prescribed
treatments for menopausal
sweats and flushes 4 Which non-hormonal treatments can
your doctor prescribe instead of HRT?
Bleeding patterns and
the menopause 5 How your periods may change, and
bleeding patterns if you’re using HRT
Your gut bacteria balance 6 All about the bacteria living in your gut
Ask the Experts 7 All your questions answered by our Ask
the Experts panel
Understanding the
Menopause talks 8 Find out how to hold a talk for your
colleagues, women’s group or friends
Membership 8
Join The Menopause Exchange for
free quarterly newsletters via e-mail
W elcome to issue 80 of The Menopause Exchange newsletter. We are
supported by top menopause experts, answering key questions about this
time of life. How can I cope with troublesome symptoms? Will lifestyle changes
help? Should I go on HRT? Should I try complementary medicines or therapies? To
make sure you don’t miss our free emailed quarterly newsletters, sign up through our
website (www.menopause-exchange.co.uk).
On page 3 of this newsletter, Norma Goldman, our founder and director, discusses
the menopause at work. On page 4, Dr Jane Woyka explores non-hormonal
prescribed treatments for sweats and flushes. On page 5, Dr Jeni Worden looks at
bleeding patterns at the menopause. On page 6, dietitian Angie Jefferson discusses
gut bacteria balance. We also have our news page and Ask the Experts page.
The next issue of The Menopause Exchange newsletter will include articles on:
‘Menopause in different cultures’ by Dr Nuttan Tanna; ‘Should all women be using
non-oral HRT?’ by Dr Kathryn Clement; ‘Libido and the menopause’ by Dr Diana
Mansour and Dr Katherine Gilmore; and ‘Vitamins at the menopause’ by dietitian
Gaynor Bussell.
Norma Goldman presents talks and workshops on the menopause. The talks are
interactive and informative, enabling women to make positive changes in their lives
straight away. Norma has a pharmacy degree and is a qualified health promotion
specialist and public speaker. For details, see page 8 of this newsletter. For
information, call 020 8420 7245 or email [email protected].
Back issues cost £2.75 (four for £8.00 or eight for £15.00). If you would like to order
any back issues, please e-mail us your name and address, with details of the
newsletters you would like, to obtain a PayPal Money Request Form. Alternatively,
send in a cheque (payable to The Menopause Exchange) with a completed form to
PO Box 205, Bushey, Herts WD23 1ZS, England.
Happy reading!
Norma Goldman and Victoria Goldman
About us Founder and Director: Norma Goldman BPharm. MRPharmS. MSc. has a pharmacy degree and an MSc. in health promotion. She has a special interest in the menopause and
founded The Menopause Exchange in 1999. Her book ‘The Menopause-ask the
experts’ is published by Hammersmith Press.
Editor: Victoria Goldman BSc. MSc. is a health journalist/editor with over 25 years’ experience of writing for, and editing, magazines, books and websites. She is also one of
Bupa’s freelance health editors and reviews fiction on her website, Off-the-Shelf Books.
Victoria’s book ‘Allergies: A Parent’s Guide’ is published by Need2Know Books.
KEEP IN TOUCH!
Don’t forget to ‘Like’ us on
Facebook and follow us on
Twitter: @MenopauseExch.
The Menopause Exchange
News flushes
Issue 80, Spring 2019
Menopause workouts Looking for a gym workout or exercise
regime designed for menopausal women?
Some of the UK’s fitness providers are
keen to help you stay active while
managing your symptoms.
TenClinical, London fitness provider,
has created a new workout specifically
for menopausal women, working closely
with leading Harley Street consultant Mr
Nick Panay. Rather than offering
standard personal training, TenClinical’s
Menopause Method combines expertise
from specialist exercise physiologists,
physiotherapists and massage therapists.
Key areas of emphasis are blood pressure
management, improving lean muscle and
bone mineral density and managing fat
percentage, as well as showing women
how to exercise safely. Each programme
includes a full assessment every six
weeks to make sure it’s working well.
For details, visit www.ten.co.uk/clinical.
PureGym (a UK-wide fitness provider)
has consulted its female personal trainers
and nutritionists to provide menopause-
specific exercise and nutrition advice on
its website. In a recent PureGym survey,
a third of UK women revealed they have
cancelled a gym class due to their
menopausal symptoms. Yet over 78% of
these women found that when they do
make it to the gym, exercise actually
helps to ease their symptoms. The
PureGym website offers advice for
various menopausal symptoms including
hot flushes/night sweats, mood swings,
cramps, weight gain, anxiety and
depression, loss of libido, heart disease
and osteoporosis. To learn more, visit
www.puregym.com/menopause-nutrition
-and-exercise-advice/).
Superdrug menopause support Superdrug has expanded its menopause
product range across 180 of its high street
stores. The stores offer products to help
with symptoms such as hot flushes, night
sweats, vaginal dryness, difficulty
sleeping, low mood and/or anxiety.
Superdrug has also launched its Home
Menopause Test Kit, which allows
women to assess, from the comfort of
their own home, if they are menopausal
alongside thorough feedback and advice
from online Superdrug doctors, who
already offer HRT prescriptions.
Bone health booster TV personality Anthea Turner is raising
awareness about osteoporosis risk factors
after a chance bone scan classed her as
high risk for osteoporosis of the spine and
at risk of osteoporosis in her hips – despite
regular exercise. She has partnered with
bone health brand LithoLexal, which
contains marine plant-based calcium and
has been shown in research studies to help
and support the normal bone building
cycle. LithoLexal Joint Health Advanced
(£29.95 for 60 tablets – one month’s
supply) is available exclusively from
Holland & Barrett.
How heavy is your handbag? Aspinal of London recently surveyed 1000
UK women and found that the average
handbag weighs the equivalent of more
than three bags of sugar. The average
woman carries 17 items with her on a daily
basis. Not surprisingly, 63% of women
experience regular back pain.
2
Crime novel giveaway: Worst Case Scenario by Helen FitzGerald Publisher Orenda Books has very kindly offered subscribers to The Menopause
Exchange newsletter the chance to win one of three copies of Worst Case Scenario by
Helen FitzGerald, the international bestselling author who wrote The Cry. The Cry
was recently televised as a BBC One drama starring Jenna Coleman. Worst Case
Scenario, Helen FitzGerald’s new crime novel, features a menopausal main character!
‘Mary Shields is a moody, acerbic probation officer, dealing with some of Glasgow’s
worst cases, and her job is on the line. Liam Macdowall was imprisoned for
murdering his wife, and he’s published a series of letters to the dead woman, in a
book that makes him an unlikely hero – and a poster boy for Men’s Rights activists.
Liam is released on licence into Mary’s care, but things are far from simple. Mary
develops a poisonous obsession with Liam and his world, and when her son and
Liam’s daughter form a relationship, Mary will stop at nothing to impose her own
brand of justice … with devastating consequences.’
The Menopause Exchange editor, Victoria Goldman, describes Worst Case Scenario
as ‘dark, insane, shocking and highly entertaining – menopausal AND criminal
madness. This is a short book but is hard-hitting and punchy – making up for its size
with its highly memorable characters and gritty writing. You'll need a slightly warped
sense of humour (lots of slapstick scenarios) and shouldn't take anything TOO
seriously. It's pure escapism and lots of fun from beginning to end.’
To enter the giveaway, please email [email protected] with your
name and address and ‘WCS giveaway’ in the subject line. The giveaway is for UK &
Ireland subscribers to The Menopause Exchange only; if you haven’t already signed
up for our free quarterly newsletters, please do so via our website (www.menopause-
exchange.co.uk) before you enter. If you’re on Twitter, don’t forget to follow
@OrendaBooks, @FitzHelen and @MenopauseExch. Closing date for the Worst Case
Scenario giveaway is 1st July 2019. The three winners will be drawn at random and
notified by email after the closing date. Please note: Worst Case Scenario does contain swearing and covers some sensitive topics.
When did you last have your blood pressure checked? According to the British Heart Foundation, four million people under the age of 65
in the UK are living with untreated high blood pressure, and 1.3 million of these are
under 45. High blood pressure often doesn’t have any symptoms. But if untreated, it
can significantly increase the risk of heart attacks and stroke. The British Heart
Foundation is urging people to get their blood pressure tested, whether at home, a
pharmacy or a GP surgery. The charity is supporting May Measurement Month
(MMM), a global blood pressure screening initiative. High blood pressure can be
easily treated, often with a combination of simple lifestyle changes and medicines.
The Menopause Exchange
The menopause at work
Issue 80, Spring 2019
W omen usually experience the
menopause between the ages of
45 and 55, with 51 being the average age
in the UK. The employment rate in the UK
has grown substantially for women aged
50 to 64 in recent years. With around 75%
of women experiencing menopausal
symptoms, which last on average for four
to eight years (and sometimes up to ten
years), it’s not surprising that the
menopause can have a significant effect on
women’s working lives.
Symptom trouble The menopausal symptoms most likely to
affect working women are hot flushes,
night sweats (leading to insomnia and
daytime tiredness) and a lack of
concentration, causing problems with
making decisions. Other symptoms that
could affect work include headaches,
aches and pains, palpitations, low mood,
memory loss, brain fog, irritability,
anxiety, depression, needing to go to the
loo regularly and period problems.
Maria Goldby, senior occupational
advisor, says: “We often have employees
referred to us who are suffering with hot
flushes and night sweats. Hot flushes often
affect them at work. Night sweats causing
fatigue the next day, and hot flushes, can
lead to changes in their confidence and a
lack of concentration. We see them to
discuss which options may help, including
telling them to see their GP and contacting
The Menopause Exchange for advice. We
also give overall support.”
Stress effects Stress at work can make some menopausal
symptoms worse. The effects of this can
be increased by having to make decisions
about how to cope with the menopause
and taking extra time off work to consult a
doctor. Some women who take time off
won’t attribute it to the menopause when
giving a reason for their absence (unlike if
they suffered, for example, from asthma,
diabetes or arthritis).
Older working women may feel that
they’re in competition with younger
colleagues. This can lead to a loss of self-
esteem and low mood.
The menopause often comes at a time
when other changes may be taking place
in a woman’s life, such as those involving
friends and relationships. Some of these
may affect her menopausal symptoms. In
addition, women may belong to the
sandwich generation, having to juggle
elderly relatives, children and even
grandchildren. Because they work, more
coping mechanisms come into play.
Menopause at work In 2017, Professor Myra Hunter,
Professor Amanda Griffiths and Dr Claire
Hardy, at the Institute of Psychiatry,
Psychology and Neuroscience at Kings
College London and the Division of
Psychiatry & Applied Psychology at the
University of Nottingham, conducted
research into ‘What do working
menopausal women want?’ Their survey
revealed that the menopause can be
difficult for some women at work and
many women want: (1) better knowledge
and understanding of the menopause; (2)
goo d emplo yer and manager
communication skills and behaviours; and
(3) more helpful and supportive policies.
The workplace can affect a woman’s
experience of the menopause in several
ways. Issues that may need looking into
include:
sharing offices
working in fixed positions
being able to position a desk near a
window that can be opened
sitting away from a radiator
having adjustable temperature and
humidity controls in the room
being able to use electric fans
having a lack of ventilation in the
work environment
flexible working hours
having access to cold drinking water
needing regular toilet breaks, which
may cause problems if working to set
targets or deadlines
wearing synthetic or tight uniforms
that can increase sweating
Workplaces vary immensely, and the
situation in an office will differ from that
in schools, hospitals, shops, the police,
fire brigade etc. Shift work can cause
additional problems.
3
Making changes at work may lead to
fewer days off work, maximise
productivity, reduce stigma and
embarrassment when women are in the
company of colleagues, managers and
clients, improve job satisfaction and
wellbeing and make the workplace
environment as comfortable as possible
for menopausal women.
Help at work The workplace needs to be proactive in
helping women cope with troublesome
menopausal symptoms. If there’s no
occupational health department, women
may find it difficult to speak to their line
manager (especially someone who is
male and younger than them). If this is
the case, it may be more appropriate for
them to go to the human resources
department, a welfare officer or health
and safety advisors.
Managers, health and safety officers
and also colleagues need to know all of
the health implications of the menopause.
Employers should include the menopause
in a health and safety policy and in risk
assessments or guidance because they
need to make sure that working
conditions don’t worsen a woman’s
symptoms. Managers may benefit from
formal training to enable them to take the
menopause seriously and so that they can
offer the necessary adjustments to a
woman’s working environment.
Women helping themselves Women shouldn’t be embarrassed to
bring up the topic of the menopause at
work. This will help to reduce the stigma
of the menopause and make sure work
colleagues know about menopausal
symptoms (including what hot flushes
are) and its impact on all aspects of life.
By Norma Goldman, founder and director of The Menopause Exchange
Get help from
The Menopause Exchange Norma Goldman (B. Pharm MRPharmS MSc.) gives presentations to workplaces
about the menopause. She is the founder and
director of The Menopause Exchange. She
has a degree in pharmacy and an MSc. in health promotion and is a qualified health
promotion specialist. For more details about
her presentations, visit page 8.
The Menopause Exchange
Non-hormonal prescribed treatments
Issue 80, Spring 2019
H ot flushes and night sweats are
experienced by most menopausal
women for an average of seven years, and
for some, these can last a lifetime. HRT is
the first choice of treatment but some
women with certain medical conditions
shouldn’t be prescribed hormone-based
treatments. By caring for breast cancer
survivors, doctors have extended their
experience in prescribing alternative
medicines for the menopause.
The prescribable alternatives are limited
to their effects on vasomotor symptoms
(hot flushes and night sweats), and in some
cases on mood and sleep. The National
Institute for Clinical Excellence (NICE),
which evaluates the effectiveness of
treatments, has included some of these
prescribed drugs in its assessment of the
response to hot flushes and night sweats.
This involves assessing the effectiveness of
the medicines in reducing the severity and
frequency of flushes rather than clearing
them up completely.
These medicines have been developed
for other medical conditions, such as
epilepsy, pain or high blood pressure, but
have also been found to have a beneficial
effect on hot flushes and night sweats.
They include clonidine, antidepressants,
gabapentin and pregabalin.
Clonidine Clonidine is the only medicine with an
indication or ‘licence for use’ in managing
flushes and sweats. It’s an old-fashioned
blood pressure-lowering medication that’s
hardly ever used in blood pressure control,
as there are now much better medicines
available. Clonidine may not work at lower
doses so the dose is increased slowly over
two-week intervals.
The higher the dose, the more likely
clonidine is to work, but it’s then also more
likely to cause side effects, such as sleep
disturbances and a dry mouth (worse with
higher doses of clonidine). Since clonidine
has been prescribed in the past to lower
high blood pressure (hypertension), it also
reduces blood pressure and has been found
to reduce blood pressure steeply in women
who start off with normal blood pressure. If
clonidine doesn’t work, women have to
then come off the medicine very gradually
to avoid what’s called ‘rebound
hypertension’. Fifty percent of users also
have significant sleep disturbance when
they take clonidine.
Anti-depressants Anti-depressants are often offered to
menopausal women, sometimes because
their doctors aren’t confident about
prescribing HRT. You must always ask
your doctor why they’re suggesting an
antidepressant for menopausal symptoms
rather than hormonal treatment. If,
however, you know you should avoid
taking hormonal medicines, then instead
you may be able to take an anti-
depressant from the family of Selective
Serotonin Reuptake Inhibitors (SSRIs).
Paroxetine is the SSRI that works
best for flushes and sweats. This works at
10mg, half the dose usually used to treat
depression. An increase to 20mg will
have no extra benefit on flushes and
sweats. The side effects increase as the
dose of paroxetine is increased.
Fluo xet ine, c it a lo pram and
escitalopram may also be used for flushes
and sweats. Sertraline is the least
effective of the SSRIs for flushes and
sweats, but is probably the best for
patients with anxiety. Venlafaxine is a
mix of SSRI and Noradrenaline Reuptake
Inhibitor (SNRI).
All of the antidepressants work as
mood enhancers. Their side effects
include nausea, tummy upset, dizziness,
short-term aggravation of baseline
anxiety and a significant effect on libido.
No single SSRI is any better than any
other, in terms of whether they’re less
likely to cause side effects and everyone
varies in how they respond to treatment,
but paroxetine is probably the best
tolerated. Fluoxetine and paroxetine must
be avoided in patients who are taking
tamoxifen, as these SSRIs interact with
an enzyme that then makes tamoxifen
ineffective. For this reason, doctors tend
to choose venlafaxine for breast cancer
survivors taking tamoxifen; the side
effects may be more prominent at the
beginning of treatment, but if the patient
can persevere, then venlafaxine may also
bring an improved quality of life and
have an antidepressant effect.
Gabapentin and pregabalin Other medicines sometimes used for the
menopause are gabapentin and pregabalin.
Both of these are usually used to treat
epilepsy, neuropathic pain and migraine.
Gabapentin reduces hot flushes at a
dose of 900mg per day in about 50% of
patients and pregabalin would be used at a
dose of between 50mg and 300mg with the
same benefit. In addition to suppressing
flushes and sweats, gabapentin causes
drowsiness and, if taken at night, can have
a positive impact on sleep and may also
help to reduce any pain. Pregabalin
doesn’t have this effect on sleep, but it
works as a useful antidepressant.
The possible side effects of these drugs
are dry mouth, weight gain, dizziness and
of course drowsiness, which is worse with
the higher doses. The major problem now
recognised is that gabapentin and
pregabalin are addictive, and, in the United
States, these medicines are linked to an
epidemic of dependence. In the UK, since
1st April 2019, these medicines have
become subject to special rules requiring a
‘words and figures’ prescription in a set
format, in which only one month of
medicine can be prescribed at a time.
Most GPs are wary of using controlled
drugs and will probably wish to avoid
prescribing them.
Future treatments New non-hormonal medicines on the
horizon are neurokinin-3 receptor agonists,
which seem to have an excellent effect on
flushes and sweats in small trials and there
are ongoing larger studies underway. So
‘watch this space’.
Summary There are a number of medicines that can
be prescribed by a menopause specialist
for women who can’t take HRT. These
may help with flushes and sweats, but
most can cause significant side effects.
4
By Dr Jane Woyka
About the author Dr Jane Woyka is a nationally accredited
Menopause Specialist, is an Associate
Specialist at the Northwick Park Menopause and Clinical Research Unit in Harrow and
has a private menopause practice based at the
Clementine Churchill Hospital within the
Harrow Health Care Centre.
for menopausal sweats and flushes
The Menopause Exchange
Bleeding patterns and the menopause
T he perimenopause is the time
between when a woman starts to
experience the first signs of the menopause
and when she has had 12 months without a
period. Although some women will have
an early menopause, finishing their periods
before their mid-40s, half the women in
the UK go through the menopause by the
age of 51/52. Eighty percent of women
will have stopped having periods by 55.
The length of time between the first
signs of the menopause (bleeding between
periods or missing a period) and finally
being menopausal is very variable, and
some women in the early stages have
spells of having all the symptoms of the
menopause and then everything reverting
to normal for weeks or months. The
occasional bleed between periods or
missing a period is common at any age but
if an irregularity persists for longer than
two or three months, or if bleeding occurs
after sex, it’s recommended that women
seek advice from a doctor or nurse.
Period changes Usually, the perimenopause lasts for two
to three years. Periods occur less often and
usually become lighter and eventually
stop. Hot flushes and night sweats are
commonly a late feature of the
perimenopause, accompanied by fatigue,
insomnia, irritability and headaches.
Sometimes, periods become heavier
during the perimenopause instead, due to
hormonal fluctuations or fibroids, and this
can trigger iron-deficiency anaemia.
Having ruled out any specific causes, such
as polyps or endometrial cancer, heavy
periods can usually be treated with tablets
containing tranexamic acid or non-
steroidal anti-inflammatory drugs, such as
mefenamic acid (Ponstan). Current NICE
guidelines suggest that a progestogen coil,
such as a Mirena, can be fitted if there are
no reasons why a woman can’t have one.
The combined contraceptive pill or
progestogen-only pill can also be used,
especially if contraception is still needed.
If a woman has fibroids larger than
3cm or more in diameter, ulipristal
(Esmya) is a possible treatment, but this is
normally only prescribed by a hospital
consultant and within certain guidelines, as
there’s risk of rare but serious liver injury.
Uterine artery embolisation is yet another
option and is increasingly becoming more
available on the NHS. Endometrial
ablation of the latest type can also be
used. Surgery to remove fibroids (called a
myomectomy) or hysterectomy (removal
of the uterus with or without both ovaries
and/or the cervix) is considered to be a
final resort for fibroids these days, in
comparison to 20 to 30 years ago, when
total hysterectomy was the most common
treatment for heavy periods.
Looking at all these various options
and choosing the right one can be
difficult. I would advise that women with
heavy or unusual bleeding patterns ask for
a referral to a specialist menopause clinic,
if possible, or a gynaecologist with a
special interest in the menopause, so that
all of the latest advice and guidelines can
be considered, depending on what’s
available locally.
HRT and bleeding patterns With regard to bleeding patterns when
taking HRT, it depends on whether a
woman has been prescribed cyclical or
continuous combined HRT. With cyclical
HRT, the HRT consists of oestrogen in
the first two weeks of the pack, which
thickens the uterine lining (endometrium),
and then progestogen for two weeks,
which makes the lining stay in place. The
change between the two hormones
mimics the body’s natural cycle, so most
women on cyclical HRT will have a
‘withdrawal bleed’ at the end of each
pack, like a light period.
Around the age of 54, a woman can
try changing to a continuous combined
type of HRT, where the two hormones
(oestrogen and progestogen) are mixed
together and the lining of the uterus is
held in a thin layer that shouldn’t come
away, so the woman is then bleed-free.
If the bleeding is very irregular or
heavy on cyclical HRT, then increasing
the amount of progestogen, to keep the
endometrium in place, will usually help.
If this doesn’t settle the problem, or
bleeding becomes heavier, then
investigations should take place to look at
any underlying cause, such as fibroids or
adenomyosis, using vaginal ultrasound/
hysteroscopy. Bleeding persisting after
stopping HRT, when the woman
previously had no periods, should also be
checked out.
Occasionally, doctors prescribe a type
of cyclical HRT that has nearly three
months of oestrogen followed by a short
course of progestogen to cause a
withdrawal bleed. This is a short-term
measure to help with irregular heavy
periods in the perimenopause. It’s not
recommended for long-term use due to an
increased risk of endometrial cancer
because the oestrogen isn’t being
counteracted by progestogen for a much
longer time than normal cyclical HRT.
Breakthrough bleeding is common in
the first three months of taking continuous
combined or long-cycle cyclical HRT, but
should be reported to a doctor or nurse if it
continues for longer than this.
Any vaginal bleeding after the
menopause is treated as an urgent problem
by doctors, as this can be due to
endometrial cancer. The NHS treats all
cases of post-menopausal bleeding as ‘fast
track’, meaning an appointment and
assessment should be offered within two
weeks of the GP sending a referral to the
local hospital.
Fortunately, most women with post-
menopausal bleeding have a far less
serious reason for their bleeding, such as
atrophic vaginitis (thinning of the vaginal
tissues) or endometrial polyps, but it’s a
symptom that should never be ignored. If
post-menopausal bleeding occurs more
than six months after an earlier episode, it
will be treated as a new symptom and the
woman re-referred to a clinic or specialist
doctor for further tests.
Summary Bleeding patterns in women during the
perimenopause can commonly be
irregular, but any persistent or unusual
symptoms should always be discussed
with a healthcare professional, especially
if she is on HRT for longer than three
months or after her periods have stopped.
5
By Dr Jeni Worden
About the author Dr Jeni Worden is a GP in Christchurch,
Dorset, with a special interest in women's
health, especially the menopause.
Issue 80, Spring 2019
W e live in a close relationship
with the bacteria that are on us,
and inside us – and while we usually think
of bacteria as harmful, there are in fact
countless different bacteria that help us.
You may feel slightly queasy thinking that
around 100 trillion bacteria are living on
and inside your body right now – in fact,
you’re made up of 10 times more bacterial
cells than human cells! Some live on the
surface of your skin, inside your mouth,
nose and vagina – but the biggest number
are living inside your gut, particularly your
colon. The gut flora – also called the gut
microbiota – refers to the community of
bacteria living inside your digestive tract.
Around 1,000 different bacteria are
known to live in the human gut, but
everyone typically has only around 150 at
any point in time. What’s fascinating is
that we all have a completely unique gut
flora, and as there are so many different
possible combinations of bacteria, it
appears that no single combination can be
the ‘optimal healthy gut flora’ – what’s
perfect for me won’t be perfect for you.
What does the gut flora do? Gut bacteria help with digestion, breaking
down parts of food that your stomach and
small intestine are unable to digest (e.g.
dietary fibre), helping to neutralise
harmful by-products of digestion and
adding bulk to your stools. They use
undigested food waste as an energy source
and ferment this to produce useful by-
products, including vitamins (B2, B12,
folate and vitamin K) which you absorb
and use, and short-chain fatty acids, plus
some less useful by-products such as gas.
Gas production in your digestive tract
is perfectly normal, usually harmless, and
disposed of by passing wind – typically
between five and 15 times each day. The
balance of bacteria in your gut, coupled
with the types of food you eat dictates how
much gas you produce. According to a
research study, people with troublesome
flatulence aren’t necessarily producing
more gas, but have an imbalance of
bacteria that means they have a lower
tolerance of the gas produced. Many
people find that a sudden change in fibre
intake can give them wind, but this is
usually short lived and settles within a
few days. However, those who are more
sensitive should make gradual increases
to their fibre intake, and persevere, as this
will help to achieve a better balance of
bacterial types and reduce the
troublesome gas producers in favour of
more helpful bacterial types.
Your gut bacteria produce short chain
fatty acids – key ones being butyrate,
acetate and propionate, each of which is
used differently. Butyrate is used by the
cells lining your colon and helps to reduce
inflammation and protect against colon
disorders. Acetate is absorbed and used
by your brain, muscle and body tissues,
and propionate is cleared by your liver
and may help to lower your cholesterol
and blood sugar levels.
Gut bacteria also play an important
role in helping to boost your immune
system by helping to kill harmful bacteria;
stimulating infection-fighting cells in your
bloodstream and by reducing the amount
of harmful substances ‘leaking’ into your
bloodstream.
Can my gut flora help to keep
me healthy? The simple answer is yes – look after your
gut bacteria and you’re looking after your
long-term health. Over the past 10 years,
there has been a huge discovery of the
amazing role that we now believe gut
bacteria play in our health and wellbeing,
mainly due to advances in technology that
enable us to identify different bacteria and
what they contribute. The gut flora is now
being called the ‘forgotten organ’, and
appears to influence a wide range of
conditions including: obesity; diabetes;
heart disease; irritable bowel syndrome
and colorectal cancer. Interest is also
growing into how the gut microbiome
interacts with the central nervous system
(called the gut-brain axis), and how this
can affect mood and also conditions such
as Alzheimer’s and depression. We don’t
yet have the answers as to whether shifts
in the gut flora cause disease or if these
occur as a consequence, but research
suggests that a diverse and stable gut flora
can help to alleviate some of the
symptoms and challenges that these
conditions bring.
Does the menopause affect your
gut flora? Probably, but gut flora and the menopause
is an area that hasn’t yet had a great deal
of research. It may be more appropriate to
ask whether the gut flora alters oestrogen
levels, both before and during the
menopause, as gut bacteria play a role in
converting oestrogen to its active form,
and lower levels of bacterial diversity have
been linked to a fall in circulating
oestrogens. More research is needed, but
the gut flora could also play a role in the
higher levels of abdominal fat and
increased risk of cardiovascular disease
that typically accompany the menopause.
How do I look after my gut flora? Changes to your diet can result in rapid
changes to your gut flora, so the good
news is that you can quickly make a
difference. Probiotic drinks and yoghurts
provide a boost to the specific strain of
bacteria that they contain, but only while
you continue to take them. The route to
developing a diverse gut flora, full of the
more helpful types of bacteria appears to
be eating a variety of foods that are rich in
fibre every day and, ideally, topping up the
food supply to your bacteria several times
during a day. Fibre comes in all different
types with some more easily fermented
(e.g. soluble fibre in oats) and others more
challenging (e.g. bran fibre from wheat).
But there are bacteria specially adapted to
use all types of fibre. The more types of
fibre you regularly consume, the more
diverse and stable your gut flora will be –
a key to great health. What’s clear is that
most of us eat far too few fibre-rich foods,
with intakes of fibre hovering below 20g
per day, way below the 30g a day
recommended for good health. I recently
read an article which concluded with the
line: ‘We never really eat for just one –
our trillions of little friends get fed with
every bite’. So by choosing a balanced and
nutritious diet with a good dose of fibre
you’re helping to keep everyone happy!
The Menopause Exchange Issue 80, Spring 2019 6
Your gut bacteria balance By registered dietitian Angie Jefferson
About the author Angie Jefferson (www.angiejefferson.co.uk)
is a registered dietitian with a special interest
in women’s health. She believes in helping women make small positive diet and lifestyle
changes to deliver bigger health benefits.
I’m thinking of going on HRT. Will it affect my eyes and contact lenses? Dr Nuttan Tanna, pharmacist consultant (women’s health & older people), replies: No research shows that HRT can affect
contact lenses. But changes in contact lens
comfort are related to your menstrual cycle
and may be affected by the menopause.
Both high and low oestrogen affect your
eyes differently during different stages of
the menstrual cycle. Many women going
through the menopause struggle with dry
eyes, and HRT may not help. Treatments
for dry eyes include eye drops and dietary
supplements. Warm compresses can help
if you have dry eyes at the end of the day
due to strained eyes after spending a lot of
time reading or at the computer. If you
wear contact lenses, it’s also important to
follow good lens hygiene advice.
I’m 62 and still have hot flushes. These affect my life just as much as they did when I was in my 50s. What advice can you give me? I don’t want to take HRT. I don’t have any medical conditions and I’m not taking any medicines. Dr Sarah Gray, GP, replies: Every woman experiences the menopause
and post-menopause differently, both in
how bad their symptoms are and how long
these last. Not all women have flushes but
for the majority that do, these typically last
for at least five years and then gradually
get better. But I often see women who tell
me that their flushes aren’t any better.
Sometimes, these even seem to get worse
at around the ten-year point. This may be
linked to reduced testosterone production.
There are limited options to ease flushes,
but the most useful self-help ones are to
exercise vigorously and avoid alcohol.
Does IVF have an impact on the menopause and does it bring on the menopause earlier? Kathy Abernethy, senior nurse specialist, replies:
The Menopause Exchange
Ask the Experts
Issue 80, Spring 2019
The IVF process doesn’t affect the onset
of the menopause, even though you may
be worried about stimulating your ovaries
during this time. Sometimes the women
who need IVF because of poor ovarian
reserves are the same women who go on
to have an earlier menopause. This isn’t
because they’ve had IVF but it’s because
of the underlying problem with their
ovaries. Not all women who need IVF
have poor ovarian function and many
factors contribute to getting pregnant, so
IVF isn’t a predictor of early menopause.
I’ve heard that having phytoestrogens (plant oestrogens) in food and drink is helpful at the menopause. Which menopausal symptoms do they help and which foods contain them? Gaynor Bussell, dietitian, replies: When your body goes through the
menopause, your level of oestrogen falls,
causing menopausal symptoms. Having
extra phytoestrogens in your diet can help
to boost your oestrogen levels but only
mildly. This won’t be as much as if you
were taking HRT, but may be enough to
offset hot flushes and other symptoms. As
an added bonus, phytoestrogens can also
help to lower cholesterol levels. Research
shows that to reduce hot flushes, you need
around 40 to 80 mg of phytoestrogens
daily. Soya products are one of the richest
sources of phytoestrogens: a 250 ml glass
of soya milk contains around 20 mg and a
portion of tofu contains around 30 mg.
Other foods containing phytoestrogens
include oats, linseeds and lentils.
Is bio-identical HRT available on the NHS? Dr Nuttan Tanna, pharmacist consultant (women’s health & older people), replies: ‘Bio-identical hormone’ products contain
exact copies of hormones made by the
ovaries and adrenal and thyroid glands.
The hormones in these products will
include oestradiol, oestriol, oestrone,
p r o g e s t e r o n e , t e s t o s t e r o n e ,
dehydroepiandrosterone and levothyroxine.
Some doctors in private practice will
prescribe what they call ‘bio-identical
hormones’ after a woman has a series of
expensive serum and saliva tests, a
practice that’s not backed up by strong
research as being good medical practice.
These private prescriptions may be
dispensed by specialist compounding
pharmacies, but it’s important to note that
the production of these isn’t regulated.
These medicines are not available on the
NHS. There are regulated HRT products
that are ‘body identical’ on the NHS.
These can be prescribed after a good
medical history has been taken alongside a
risk-benefit discussion with the patient.
What are the different stages of the menopause, at what age can I expect them and how long do they last? Kathy Abernethy, senior nurse specialist, replies: The term ‘pre-menopause’ refers to the
years leading up to changes in your
periods and other menopausal symptoms.
For most women, this lasts until around
their early 40s. Women then enter the
‘perimenopause’ phase, which is when
symptoms commonly occur and periods
may start to change in pattern or
regularity. It’s only during this time that
you will have your last actual period,
although you won’t know that at the time,
only in hindsight. If you’re around your
late 40s or early 50s, then once you
haven’t seen a natural period for one year,
you’re ‘postmenopausal’. Unfortunately
for some, even this doesn’t mean the end
of symptoms as they may last well into the
post-menopause. If you’re under 40, the
term ‘premature ovarian insufficiency’ is
used when your periods stop. In young
women, it’s not so clear which of the
phases you’re in until well after your
periods stop.
7
If you have questions on the menopause or related topics, send them to The Menopause Exchange, PO Box 205, Bushey, Herts WD23 1ZS, e-mail [email protected] or call 020 8420 7245. Your name will not be printed. These questions have been answered by:
Kathy Abernethy, senior nurse specialist, The Northwick Park Menopause Clinical & Research Unit, London North West University Healthcare
NHS Trust, Harrow, Middlesex.
Gaynor Bussell, dietitian and public health nutritionist with over 20 years experience in the women's health field. Dr Sarah Gray is a Cornwall GP who specialises in the menopause and runs private clinics.
Dr Nuttan Tanna, pharmacist consultant, The Northwick Park Menopause Clinical & Research Unit, London North West University Healthcare
NHS Trust, Harrow, Middlesex.
We are e-mailing The Menopause Exchange newsletter for FREE!
The Menopause Exchange newsletter is ideal for anyone with an interest in the menopause, midlife and
post-menopausal health. We provide impartial, practical information on various topics, including
menopausal symptoms, osteoporosis, self-help and lifestyle tips, HRT, prescribed medicine alternatives to
HRT, complementary therapies and medicines, nutrition, exercise and topics such as smoking and alcohol
at the menopause, hair loss and hair thinning, blood pressure and a man’s guide to the menopause.
The Menopause Exchange was established in 1999 and is completely independent. It isn’t sponsored by
any companies or organisations.
If any of your friends, family or colleagues would like to receive FREE quarterly e-mailed
newsletters, they should visit The Menopause Exchange website at www.menopause-exchange.co.uk
for information on how to receive them.
The Menopause Exchange Founder & Director: Norma Goldman BPharm. MRPharmS. MSc.
Newsletter Editor: Victoria Goldman BSc. MSc.
Contact details:
PO Box 205, Bushey, Herts WD23 1ZS, England Telephone: 020 8420 7245
E-mail: [email protected]
Website: www.menopause-exchange.co.uk
Copyright © The Menopause Exchange 2019
No part of this publication may be reproduced without
the permission of the editor or publisher. While every
care is taken, The Menopause Exchange accepts no
responsibility for damage or illness that results from
advice or information given in this newsletter. If you
have a medical problem, always consult a healthcare
professional for advice. The articles reflect the opinions
of the authors and not necessarily The Menopause
Exchange. All names and addresses were correct at the
time of going to press.
The Menopause Exchange Issue 80, Spring 2019 8
Understanding the Menopause
W ant to know more about the
menopause? Norma Goldman
(B.Pharm MRPharmS. MSc.), founder and
director of The Menopause Exchange,
gives talks on the menopause to women,
healthcare professionals and anyone with
an interest in midlife issues. Norma also
presents workshops to line managers,
health and safety officers and anyone else
who is responsible in the workplace for
the wellbeing of employees.
About Norma Goldman Norma has a pharmacy degree and is a
qualified health promotion specialist. Her
in-depth knowledge has helped thousands
of women enjoy a more comfortable
menopause. For over 20 years, Norma has
given talks and workshops about the
menopause to employees in the workplace
(including hospitals), groups of women,
healthcare professionals, GP practices,
charities, companies and organisations.
The Menopause Exchange is an
independent organisation, not sponsored by
any companies, and provides impartial, up-
to-date and practical information.
The programme Norma’s presentations are designed to suit
each audience’s specific requirements. The
programme, tailored for each talk, includes
information on:
the menopause and its symptoms
self-help tips for symptom relief
HRT options, types and forms
prescribed medicine alternatives to HRT
complementary therapies and medicines
health promotion advice, including
nutrition and exercise
the menopause at work.
Norma also talks about issues surrounding
midlife and post-menopausal health. For
workplaces, she discusses preparing work-
based menopause guidelines and policies, if
required. You can ask questions and take a
fact sheet home.
Reap the benefits Healthcare professionals increase their
knowledge on a range of menopause-
related topics.
Women come away with:
the ability to make informed decisions
about coping with the menopause
the latest information on the pros and
cons of going on HRT
more knowledge about their own health
and well-being and about which over-
the counter products may help their
menopausal symptoms
relief at being able to hear other women
discuss their experiences and to be able
to share their own experiences if they
choose to do so.
Don’t let the menopause get you all hot
and bothered – make sure you book a
presentation now!
For more information and testimonials,
call Norma on 020 8420 7245 or email
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ISSUE 70/AUTUMN 2016
Going on HRT
Flushes/sweats relief without HRT
Insomnia at the menopause
All about ovarian cancer
ISSUE 72/SPRING 2017
Health & lifestyle tips
HRT questions you forgot to ask your GP
Cystitis and thrush at the menopause
All about your oral health
ISSUE 73/SUMMER 2017
HRT & medical conditions
Chocolate or sex? Healthy relationships
Vegetarian and vegan diets
NHS screening for women over 40
ISSUE 74/AUTUMN 2017
All about the perimenopause
Continuous combined HRT
Exercise at the menopause
Digestive problems
ISSUE 75/WINTER 2017/2018
Non-hormonal help for flushes and sweats
Oestrogen-only and monthly-bleed HRT
Menopause, skin & memory
10 tips on foot health
ISSUE 76/SPRING 2018
Menopause anxiety
Side effects of HRT
Weight management at the menopause
All about osteoarthritis
ISSUE 77/SUMMER 2018
HRT: making a decision
Headaches & migraine at the menopause
Contraception for the over-40s
Pilates & yoga for beginners
ISSUE 78/ AUTUMN 2018
A man’s guide to the menopause
HRT myths
Minerals at the menopause
Hair loss and hair thinning
ISSUE 79/WINTER 2018/19
Prescribing of HRT
Fatigue and the menopause
Smoking and alcohol at the menopause
Blood pressure-the silent killer
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