ONE friend swears by yoga and green smoothies, another by their miracle HRT.
So how should you address your menopause symptoms when there's an abundance of options being thrown at you?
The menopause can be a confusing time as it is, and working out how to keep on top of it, even more so.
Typically methods fall into the either the lifestyle or medication category.
Dr Philippa Kaye, a GP and author of The M Word, told The Sun: “There are people who will be very pro one or the other.
"But it should always be a combination of both.
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“If I gave you a blood pressure medicine, in an ideal world, I still want you to exercise and look at your diet to help yourself.
"The same goes for the menopause.”
Dr Philippa has met hundreds of women seeking to ease their symptoms.
She says: “The commonest question I'm asked is: 'When should I ask for help?' The answer is: when you need it.
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“People think they need to wait for some magic age or moment, but they don’t.
“When you say, ‘I'm not managing, it's affecting my relationship with my partner, with my kids, my work, I'm unhappy, I’m not not coping’ – that's when you ask for help.”
“It’s not a ladder, either. You don’t have to try all the lifestyle hacks before you get to try HRT – but it would help if you thought about them, too.”
For The Sun's Fabulous Menopause Matters campaign, Dr Philippa outlines the various ways women are successfully taking control of their symptoms:
Physical exercise is Dr Philippa’s number one recommendation for menopausal women.
She said: “It’s not for weight loss, but for the benefit of exercise.
"It will help with your hot flushes and mood, as well as bone density strength and heart health – both of which are very important after the menopause.
“But if you are new to exercise, start slowly and work yourself up to reap the benefits later.”
You don’t need to run a marathon – something as simple as a daily walk or carrying your shopping bags home can make a difference.
Dr Philippa says to aim for the NHS recommendation; strength training twice a week, and at least 75 minutes (vigorous), or 150 (moderate) minutes, of exercise a week.
Many menopausal women rave about yoga for its gentle movement, which can be easy on the joints, and the mindfulness element, which can help with mental wellbeing.
2. Quit smoking
Smoking makes hot flushes worse, says Dr Philippa.
Nicotine is also a stimulant, which can drive insomnia – a common menopausal symptom.
Smoking can also worsen the risk of conditions that menopausal women are prone to as they age, including osteoporosis and cardiovascular disease.
And of course, menopause aside, smoking is a killer habit and a leading cause of death globally – taking 78,000 lives a year in the UK.
Dr Philippa says: “Smoking kills people.
"It is linked to so many forms of cancer – not just lung – increases risk of cardiovascular and respiratory disease, it brings on the menopause earlier – it's not good for you!”
3. Cut back on caffeine
If your hot flushes are causing you grief, you may want to cut back on the copious cups of tea and coffee.
“Caffeine causes hot flushes,” Dr Philippa says.
“Caffeine can also make you feel irritable and worsen anxiety, which is another reason to cut down.”
Because it’s a stimulant, caffeine won’t help any sleep related issues either, such as insomnia or night sweats.
Therefore, it's recommended to avoid it for five to six hours before bed, at least.
4. Stick to alcohol limits
Do you really know how many units are in that half-a-bottle of wine each night?
All UK adults are recommended to stick to no more than 14 units a week, which is equivalent to around five large glasses of wine.
As well as being linked to a number of deadly diseases, including cancer and liver failure, alcohol can worsen menopause symptoms like hot flushes and urinary problems.
“It is even associated with an increased risk of developing osteoporosis, as it can affect how calcium is absorbed into your bones,” says Dr Philippa.
Try getting used to recording how many units are in each of your favourite tipples so you can keep track of consumption with ease.
Yoga calms me down
Samantha Woods tried menopause medications but found they did not work for her, and instead poured her time into yoga.
The 52-year-old, from Devon, started having symptoms two years ago, mostly fatigue, back pain, nervousness, anxiety and low mood.
She told The Sun: “I went to the doctor a couple of times, but they were trying to put me off.
“So I went to a specialist who put me on oestrogen and progesterone gel (HRT). But it didn't change anything after six months.
“I felt like it was making me worse in a way.
“Yoga definitely helps calm me down, it resets my nervous system and I just love it. It makes me feel so much better.”
Samantha also took a menopause yoga teaching course – where she discovered the power of exercise and nutrition.
She said: “I've been doing yoga for about 20 years and teaching for 13 years.
“After I did this course it made me realise how nutrition can affect my menopause.
"So I changed my diet. I cut out gluten, dairy, lowered my sugar, and cut down on meat, caffeine and alcohol.
“I think it directly helped my menopause symptoms after around a couple months.
“I noticed a massive difference with alcohol, caffeine and sugar mostly.”
Samantha says she has to “really work” to stick to her routines to keep her relaxed.
She said: “It's really hard actually – and that's another symptom, losing motivation.
"I just know it's good for me because of the way I feel after.”
5. Hormone replacement therapy (HRT)
It’s common for women to worry about taking HRT, even if they could hugely benefit from it.
There are some risks of HRT, like with any medicine, but for most women, HRT is safe and has huge benefits, not only for short-term menopause problems (night sweats, anxiety, painful sex, joint pain and more), but for helping prevent long term disease, like heart disease.
It comes in several forms, from tablets to skin patches, oestrogen gel and implants.
In a nutshell, if you are still having periods, you can take sequential/cyclical HRT on and off depending on how irregular the bleeds are.
If you are in the menopause, you take continuous combined HRT every day.
These options combine oestrogen and progesterone.
However, if you no longer have a womb, you’ll likely take oestrogen only HRT.
Dr Philippa says: “Talk to your doctor about the specific risks and benefits as they apply to you, with your medical history.
“Get empowered, educated and informed by looking at good sources.
“If you do that and still don’t want HRT, there are other options available.”
6. Vaginal oestrogen
If your vagina becomes dry, painful or itchy as a result of the menopause, an oestrogen treatment put directly into the vagina can help.
A GP can prescribe pessaries, creams or vaginal rings, while over-the-counter moisturisers or lubricants can help in addition.
Dr Philippa says although hormonal treatment, vaginal oestrogen does not have the same risks as HRT.
She said: “We should be much more pro vaginal oestrogen, because so little of it gets absorbed into the bloodstream.”
Vaginal oestrogen can also be taken in combination with HRT, Dr Philippa adds: “The risks of HRT are extremely small, but the therapy can be lifechanging for women, giving them back their sex life but also getting rid of itchiness, recurrent urinary tract infections, burning and soreness.”
“For some women, HRT is not enough and some women need a smidge of testosterone,” Dr Philippa says.
“To help with things like libido, testosterone does give you back your oomph.
"It's also involved in energy and metabolism.”
Testosterone, the male sex hormone, can help restore a woman’s sex drive – but may come with unwanted side effects, like acne and hair growth.
There are currently no female testosterone products licensed in the UK, but some specialist doctors prescribe it off label.
Dr Philippa explains it’s not unlicensed because it is unsafe, but due to commercial reasons.
8. Cognitive behavioural therapy (CBT)
Not all treatments for the menopause involve hormones.
CBT is a type of talking therapy accessible to some for free on the NHS.
It was originally developed for people with anxiety and depression, but is now considered to be helpful for people trying to manage physical health problems as well, such as insomnia and chronic pain.
Although women’s experience of menopausal symptoms is driven by biological factors, how they cope with them can be massively influenced by their own thoughts.
Dr Philippa explains: “It’s about managing what you’ve got, as opposed to trying to change what you've got.
"Even if you think some of your symptoms are solely physical – like flushes and sweats – CBT has been shown to help, even when you finish it.”
CBT could be useful for women who are unable to use HRT.
If your doctor suggests antidepressants as a non hormonal way to treat the menopause, Dr Philippa says not to panic.
“We aren't saying you are depressed, or that your hot flushes are depression," she says.
“In an ideal world you'd take HRT. But if you can’t [for medical reasons] or don’t want to have HRT, your doctor may recommend antidepressants for hot flushes.”
You’ll be offered either selective serotonin reuptake inhibitors (SSRIs) or serotonin-noradrenaline reuptake inhibitors (SNRIs).
The NHS says: “These medicines are not licensed for this use.
"This means they have not undergone clinical trials to test if they help this symptom, but many experts believe they're likely to help and your doctor will discuss the possible benefits and risks with you.”
‘I feel like a 90-year-old without HRT’
Anna Goldsmith, 54, says she couldn’t live without HRT – which took her years to find.
“My perimenopause symptoms started at 45, but could have been earlier as I didn’t realise that was what was happening to me,” she told The Sun.
“My initial symptoms were sleep disturbances and painful hand joints and terrible vaginal dryness, but I didn’t know that was what it was until a year or two later.
“My GP did not discuss with me what my symptoms were or what the symptoms of perimenopause were in general.
"I found out I had many other symptoms only after doing my own research.”
After her own investigations, Anna believed she had depleted oestrogen levels and saw a private menopause specialist due to her inadequate experience with her GP.
She says: “HRT gives me my life back literally. I feel like a 90-year-old without it.
“Without oestrogen, my joints are so painful, I get heart palpitations, sleep deprivation, itchy skin to name a few.
"Without testosterone I lose my mojo, energy and libido.
“I do lots of exercise and eat a healthy diet. I take some supplements such as Vitamin D, magnesium, Omega 3 and collagen alongside HRT.”
Anna, a married nurse from Winchester, set up a menopause support group called “Flushed Friends” in 2019 with a nursing friend after realising how many women needed information and support during this time.
10. Bioidentical ("natural") hormones
Bioidentical hormones are seen as a “natural” version of HRT, made from plant oestrogens that are chemically the same as that found in the human body.
“It is something that is extremely controversial,” Dr Philippa says.
“Most doctors on the NHS, or private in certain areas, will say it is not something that has the safety, or efficacy data on.”
Indeed the NHS says it is “not clear how safe” bioidentical hormones are.
Dr Philippa suggests women who have concerns about medicinal HRT may as well have the same concerns about bioidentical HRT.
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She said: “If it works for you, then aren't the same risks involved?
"There isn't the same data to show bioidenticals are safe, effective and are not regulated in the same way.”
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