This week I am delighted to answer two readers’ queries, both about Women’s Health.

My advice is given in good faith and in line with current guidance and agreed practice.

It cannot be a substitute for consulting with your own doctor.

 

QUESTION - Will HRT help with my low mood?

I am going through the change and I am unsure as to what is for the best. Part of me wants to just grit my teeth and get on with it – Jayne, 47.

ANSWER – It is very brave to admit that you are struggling.

While the menopause is a natural process, it can cause significant disruption to a woman’s life. We now know that the perimenopause may commence as far back as your late thirties.

With the average age of natural menopause being between 51-52, for some there may be many years of unwanted symptoms. Indeed, these may persist past the menopause.

Natural menopause is defined as having occurred when you have not had a period for more than 12 months.

While we typically associate the menopause with hot flushes, these are the tip of the iceberg. There are a multitude of complaints both physical and psychological.

No list could be exhaustive but joint aches and pains, bowel and bladder disturbance, hair thinning, skin changes, reduced libido, brain fog, and anxiety and depression are among symptoms we now recognise are associated with the menopause.

Equally, it is important to recognise when these are part of the menopause, against when they may be a sign of other conditions, including those that may need urgent referral to a specialist.

If your low mood is as a result of the perimenopause, a trial of HRT may be appropriate to see if this improves things. Drenching sweats disrupting your sleep and leaving you unrefreshed and exhausted will affect most people’s mental health over time.

However, if your only symptoms are those associated with anxiety and/or depression, talking therapies, and antidepressants if needed, may be more suitable.

There are antidepressants that have been found to work on both hot sweats, also known as vasomotor symptoms, as well as addressing mood issues.

It may be that these provide relief.

Most importantly, while adopting a stoic approach may work for some, if you are struggling, help is at hand. Most GPs are well versed in dealing with the menopause and many gynaecologists have a specialist interest in the topic.

 

QUESTION - I was diagnosed with Polycystic Ovary Syndrome (PCOS) on a scan because I am having heavy periods.

Now I am worried it means I cannot have children – Hannah, 22,

ANSWER - While any abnormality on a scan may cause distress, it is important to think about why the scan was done in the first place. Ultrasounds of the female pelvis are requested several reasons. These include investigating heavy or unusual menstrual bleeding and as part of fertility investigations in those struggling to conceive. It may also be used if cancer is suspected. We most associate ultrasound with pregnancy, when it provides excellent visualisation of your baby.

Polycystic ovary syndrome is both a clinical diagnosis as well as an ultrasound finding. A scan may be requested if a patient complains of certain features such as excess hair, especially facial, and irregular periods. It is likely that blood tests will be done at the same time to assess your hormonal profile.

Ultrasound of the pelvis may also be part of the tests done in women struggling with overweight or obesity.

PCOS is a risk factor for insulin resistance and the development of diabetes.

A scan of a woman with PCOS will demonstrate multiple cysts on her ovaries.

While PCOS is a risk factor for reduced fertility, it is not an absolute bar. Indeed, some women may be diagnosed with PCOS after they have successfully and uneventfully conceived.

Nor is it a definite that all women with PCOS will be overweight, nor complain of excess unwanted hair.

There is no cure for PCOS, though there are medications to address obesity, irregular, heavy or painful periods, excess unwanted hair, or male pattern hair loss.

Fertility investigations will be offered if you are unable to conceive after a certain duration of regular unprotected intercourse.

However, trying to improve your general health may be all that is needed to achieve a successful pregnancy.

Dr Zak Uddin, General Practitioner