Mood swings, hot flashes, memory loss and the menopause

At a time when there is a lot being said on the television about the menopause and how it affects womens’ mental health, I thought it appropriate to add my thoughts on the subject. The main advice I can give from experience is to always seek advice, ideally from a women's health specialist in the NHS if available, or possibly a family planning well-woman doctor, as you may also require contraceptive protection during the menopause or peri-menopause. Complementary therapies may help too, but always look for something that suits you best.

Coping with the menopause

When it comes to HRT (hormone replacement therapy), without a doubt the biggest scare is about breast cancer, and there have been a number of studies on this. The womens’ health initiative study on long-term life expectancy shows that HRT does not change a thing with life expectancy. Remember, HRT is not a long-term solution anyway. HRT can help you get over debilitating problems and should not be discounted.

The first breast scare study was a ‘Nurses Study’ conducted in the USA, and any relation to breast cancer was eventually not proven. Other studies blame the use of progestogen as a pre-cursor to breast cancer in women. It is a complex issue, and the benefits overall of HRT seem to outweigh the risks. HRT is contraindicated in anybody with existing breast cancer or with a family history of breast cancer.

Sometimes I hear women say ‘I want to look for a natural remedy’; well, HRT can be natural too in the context that all packaged supplements may not be truly natural anyway, and the source of oestrogen given in HRT is natural. HRT is not generally understood.

Hormones are naturally occurring chemicals in the body which help regulate or control activity in certain cells in the body. For example, thyroxine is produced in our thyroid gland and helps regulate our metabolism, and there are other hormones.

Oestrogen is produced by ovaries in the female body, and they help to regulate the growth of the egg and release from the ovary and lining of the womb ready for implantation of a fertile egg. There are other hormones involved as well. After the fertilised egg has implanted into the lining of the uterus, progesterone is produced to help regulate the lining of the uterus. This helps to keep it healthy, to nurture the egg as it develops into a foetus or baby.

In the case of no fertilised egg, the progesterone levels and then the oestrogen levels fall and the lining is shed, usually monthly, creating menstruation or a ‘period’.

There are different types of oestrogen, estradiol, estriol and replacement oestrogens, but do not worry about the different types.

At the turn of the century, a woman’s life expectancy was around 31 years of age. The menopause, the time that our ovaries stop producing oestrogen, is around the age of between 45 years and 55 years, with the average being about 51 years.

It could be said that we are living ‘un-naturally’ longer due to modern-day scientific interventions, and current life expectancy is around 81 years of age, going beyond the time of our natural menopause.

Giving oestrogen replacement is quite acceptable, especially if the symptoms of the menopause are debilitating. The type of oestrogen replacement could be considered natural too, as the source is natural, either from pregnant mares urine or from Soya extract.

If a woman has suffered premature menopause, caused by a hysterectomy (an operation to remove the uterus/womb), then only oestrogen replacement therapy is required. Usually, combined therapy is given with another hormone progestogen (man-made progesterone) which is required to stop the lining of the womb becoming too ‘thick’, which it would do with oestrogen only. So, modern-day HRT has been tried and tested over many years in long term studies and is relatively safe to use, otherwise, it would not be widely available on prescription.

Well-known side effects of lowered oestrogen levels, or the menopause, are:

• hot flushes (flashing in medical terms)
• excessive perspiration or ‘night sweats’
• mood swings
• memory loss
• vaginal dryness
• chills
• irregular periods
• heavy periods
• tiredness
• lowered metabolism
• problems with libido
• sleep disorders
• hair loss
• urinary tract infections
• long term problems such as osteoporosis (lowered bone density).

Also, according to published studies including the American Heart Association, long-term reduced oestrogen levels can result in heart disease.

One of the natural therapies recommended for the menopause is, in fact, supplements of calcium and vitamin D, because lowered oestrogen levels reduce absorption and lower bone density.

Further studies suggest that it is the hormone progestogen which is more likely to be associated with breast cancer (except in cancers reliant on oestrogen). It is a complex subject.

There are ways of giving low-dose localised progestogen, as in the case of a coil inserted into the womb. One is called Mirena with a hormone called Levonogestrel. This is a very effective means of protecting the womb, keeping the lining thin for very effective contraception, but this does not suit all women. It is sometimes useful to regulate heavy periods during the menopause, and give the added safety net of no unwanted pregnancy during the menopause, which can happen, especially if a woman in her late forties for example has not had a period for a long time; she may think she is safe and cannot get pregnant. But, in fact, the ovaries are not totally inactive during the peri-menopausal period, and although the chances of pregnancy are reduced, it is not impossible.

A Mirena coil can be used as a means of administering local progesterone or progestogen, and avoids higher systemic levels, giving contraceptive protection and reduced or no bleeding. At the same time, the woman can be given oestrogen replacement, as the coil is preventing the uterus lining from becoming too thick. However, the Mirena coil does not suit all women.

There are different types of oestrogen too. Not many people are aware that some oestrogen comes from equine urine, or from pregnant mares. There is another form of oestrogen made from soya bean extract or yams called estradiol. There are few studies comparing benefits of these two different eostrogens. Most of the studies can be complicated by the different types of progesterone chemicals, and also how the combination of the two hormones (oestrogen and progesterone) are given and in what form. There is some evidence to show that patches are better than oral form, and sometimes localised oestrogen replacement is better, such as in the case of vaginitis. The oestrogen can be administered by patch, vaginal cream, or tablets.

Some women ‘sail through’ their menopause and hardly notice it; others suffer greatly. If you have symptoms, don’t worry - it is normal for two thirds of women to have symptoms, so do not suffer in silence.

On balance, all drugs have side effects, but if the side effects of an early menopause are unbearable, you should not suffer, but go and see a dedicated menopause specialist in the NHS and discuss all the options. Personally, I preferred the Mirena coil for the low dose localised progestogen (progesterone is the natural hormone, progestogen is the man-made form), and low dose plant extract oestrogen from soya plant, during my menopause, eventually reducing the oestrogen intake to a very low dose over time. My symptoms of memory loss, fatigue and dry skin etc were unbearable at the time, and I was glad to have HRT in the more natural form of plant extract. Although equine oestrogen can be considered natural too, I preferred the soya extract.

What about ‘natural’ herb extracts?

Well, it is a case of understanding the word 'natural'. If we are living un-naturally longer due to medical interventions, but still have a natural menopause at around 40 to 50 years of age, why not take replacement therapy? Extracts from soya bean can be regarded as natural too. Herbs all have to be grown, manufactured and wrapped in a sort of manufactured absorb-able container, which isn’t as natural as picking a plant from the crop.

So I believe that just as modern scientific developments are in themselves natural, and just as we are living longer, it is fine to take HRT, so long as it is tailored to your personal benefit. It is not natural to take anti-depressives or anti anxiolytics, but these medications can feel like a ‘life saver’ at the time.

I hear women say that they want to take natural products for the menopause, but still take anti-depressive drugs or alcohol to help them sleep or to deal with anxiety. Use of alcohol, anti-depressives, anit-anxiolytics, and smoking are not healthy options for managing symptoms. In this modern age, at least we can benefit from treatments that have undergone rigorous long-term trials with proven clinical efficacy, all provided under the safety of our modern NHS and its monitoring systems.

If we want to try complementary therapies, we should seek out therapists ideally registered with the Complimentary Natural Health Council (CNHC).

The Royal Womens Hospital in Victoria, Australia, recommend hypnotherapy for the menopause as one of the natural remedies. An article in the Telegraph (15th May 2019) discussed how hypnotherapy can help, and quoted results of rigorous clinical studies on the topic; a panel of experts commissioned by the North American Menopause Society concluded there was solid evidence that both clinical hypnosis (hypnotherapy) and cognitive behavioural therapy were beneficial.

The advantages of HRT can outweigh risks, such as bone protection, heart, memory, and general well-being; skin and hair look and feel better with hormone replacement. Seek professional advice from the NHS or, as an alternative, seek out tried and tested safe and healthy recommendations, and/or therapists approved and recognised on professional registers such as the CNHC.

If the menopause is making you miserable, do not suffer in silence and be frightened off by scare-mongering. I recommend that you discuss all the options with a dedicated specialist and weigh up all the pros and cons of your symptoms - your medical history versus risk. Discuss your symptoms with your manager at work, and your family, and ask for help. Taking natural hormone replacement is fine.

Alcohol, gambling, anti-depressives, and smoking are all negative coping strategies, and do not create happiness.

Self hypnosis, meditation, yoga, exercise, mindfulness, healthy eating, healthy thinking, and finding true happiness in each and every day are also natural ways to cope with life’s everyday ‘natural’ problems. Do not discount HRT if you are suffering, and if your GP is against it, go and see a specialist in a ‘well-woman’ clinic, or even in a family planning clinic, especially if looking for protection from pregnancy too. Don’t give up, but do use all the other natural healthy remedies available too in addition to therapy.

You're worth it, so take advantage of everything that will help you feel better.