The following ‘Ask the Experts’ questions were sent in to The Menopause Exchange by our members, the answers were provided by our ‘Ask the Experts’ panel and included in issue 96 (Spring 2023) of The Menopause Exchange newsletter.

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Is testosterone only useful if I want to get my libido back? Or will it also help to maintain my muscle mass and increase motivation, concentration and general wellbeing?
Testosterone may be game-changing for some women but it won’t help everyone and some may find it makes them angry or overassertive. Testosterone can help libido but only if any physical, psychological and relationship factors are also addressed and oestrogen replacement is adequate. If testosterone insufficiency is the critical factor in the sexual equation, there will usually be other indicators of deficiency, such as aching muscles or low motivation and energy. If testosterone is used appropriately, these may improve but there are no guarantees. Testosterone should only be prescribed for low sexual interest despite oestrogen replacement.

I am 48. Do I have to wait until I reach the menopause, when my periods have stopped, to start HRT?
It’s a myth, sadly even held by some healthcare professionals, that you can’t start HRT until your periods stop. In fact, for some women this is the very time they need HRT the most as their symptoms can start before their periods actually stop. Starting HRT while you still have periods will involve taking a type of HRT designed for someone in the perimenopause, rather than after the menopause. This will mean using a combined oestrogen and progesterone HRT products. These will be likely to keep giving you monthly bleeds for as long as you take it. Once you have been on this type of HRT for a couple of years or so, you should be able to switch to a period-free type of HRT. Depending on your medical history, you could be offered tablets or patches that contain both hormones, or patches, spray or gels with a separate progesterone.

Does urinary incontinence depend on your choice of beverage?
Incontinence can happen for many reasons including urinary tract or vaginal infections, weak pelvic floor muscles or the bladder weakening with age or nerve damage. It can worsen during the menopause too. There are certain things you can do to minimise incontinence, especially maintaining a healthy weight, avoiding or cutting down on alcohol and staying active. It’s particularly important to ensure that your pelvic floor muscles are strong (with exercises). Additionally, certain foods and drinks may irritate your bladder and trigger incontinence or make it worse. These include caffeine-containing drinks fizzy drinks and certain acidic fruits (oranges, grapefruits, lemons and limes and their juices). Always get any level of bladder incontinence checked out by your GP.

My periods are irregular but I get one every three or so months. Between periods, I sometimes have a light brown discharge with no other vaginal symptoms (e.g. itching or pain). Is this normal during the perimenopause?
Intermenstrual bleeding, or bleeding between periods, should always be checked out by a medical professional. Yes, it is common during the perimenopause due to the normal hormonal changes happening at that life BUT it also can be due to polyps of the womb (uterus) or cervix, medicines such as the progesterone only pill or contraceptive injections, or the hormonal coil (IUS). A simple speculum examination, similar to having a smear test, may show up a cervical polyp (growth) or cervical ectropion (red area). A pelvic ultrasound X-ray may show if you have any fibroids or endometrial polyps or thickening of the lining of your uterus (endometrium). You may need to be referred to a hospital gynaecologist for further advice or investigations if your GP can’t find a cause for your irregular bleeding.

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Tags: contraceptive injections, fibroids, hormonal coil, HRT, libido, menopause, perimenopause, periods, progesterone only pill, testosterone, urinary incontinence, vaginal symptoms