The following ‘Ask the Experts’ questions were sent into The Menopause Exchange by our members, the answers were provided by our ‘Ask the Experts’ panel and included in issue 102 (Autumn 2024) of The Menopause Exchange newsletter.
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Should HRT be stopped suddenly or slowly?
The National Institute for Health and Care Excellence (NICE) considered this when working on their menopause guidance and have said that it doesn’t matter if you stop your HRT suddenly or slowly; it’s a personal choice. In my clinic, I advise weaning off slowly over a period of three to six months by halving the dose of HRT, and then stopping. There are some cases in which we would advise stopping immediately: for example, in cases of breast cancer diagnosis, with surgery or a blood clotting event.
My GP has suggested that I see a physiotherapist who specialises in pelvic floor health. I’m very nervous about this. What happens at a pelvic floor physio appointment?
It’s completely normal to feel nervous before your first appointment. Be reassured that it’s a comfortable, professional experience. You’ll start with a thorough conversation about your symptoms, medical history and concerns. This helps the physiotherapist understand your situation. If you’re comfortable, a physical assessment may include checking your posture, breathing and the function of your pelvic floor muscles. Sometimes a gentle internal exam is helpful to assess the strength and coordination of those muscles, but this is always done with your consent and comfort in mind. The physiotherapist will create a tailored treatment plan with you. This may include exercises, lifestyle advice and education about pelvic health. The goal is to help you feel more confident, in control and symptom-free over time.
I’m suffering from painful periods. What can I buy from a pharmacy to ease them?
Period pain may be relieved with painkillers such as paracetamol and ibuprofen. Your pharmacist, or trained pharmacy staff, can discuss the various products with you. You can also buy heat packs. Use these on your stomach and lower back to provide comfort. Gentle exercises may release natural chemicals that relieve pain, and lifestyle changes, such as reducing alcohol intake and quitting smoking, may also help. If this doesn’t reduce your pain, your GP may prescribe anti-inflammatory medicines or refer you for further investigation.
Does smoking accelerate the onset of the menopause?
Scientific evidence suggests that smoking increases the risk of experiencing an early menopause. On average, smokers experience the menopause about one year earlier than non-smokers, and up to two years earlier in heavy smokers. One of the largest studies published recently stated there was no increased risk in former light smokers. But current heavy smokers of more than 20 cigarettes a day who have smoked for more than 14 years are 50% more likely to experience menopause before age 40. Smoking duration is the strongest predictor of premature ovarian insufficiency (early menopause). So far, there hasn’t been any association between vaping and an increased risk of an early menopause.
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