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 issues 95 (Winter 2022-23) and 96 (Spring 2023) of The Menopause Exchange newsletter. If you would like to read the questions and answers in the latest issue of The Menopause Exchange newsletter sign up for FREE emailed newsletters:

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.

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.

As a menopause champion, I found your article on ‘The menopause at work’ in Issue 92 to be helpful. I’ve suggested to colleagues that they sign up for your newsletters. But I’m finding it difficult to get managers interested in the menopause. How can I motivate them?
I suggest you produce a menopause policy if you don’t already have one and then promote it, and make impartial, practical menopause information available on your intranet. Managers should be aware of the effects of the menopause on work, and the effects of the workplace on the menopause. They should be open and comfortable about having conversations, including about any possible changes in the workplace. You could set up some menopause presentations geared towards educating managers.

How can I navigate the menopause positively, to increase my self-esteem and confidence?
The menopause has moved from being practically taboo to being much discussed, including positively, on the internet and social media. It’s helpful to become aware of your own beliefs around the menopause and where they originate and challenge them. How we think about things influences our experience so if we see them as negative, this leads to a different experience than if we take a more pro-active, constructive view. We should value our life experience, learn new things to keep our minds active, make positive lifestyle choices (sleeping, eating healthily, doing things we enjoy and physical activity where possible), share our experiences and have good humour. The latter potentially increases our self-esteem and confidence.

How do you know if you’re through the menopause if you’re on HRT?
If you’re settled on HRT with good symptom control, you won’t be able to tell when you’re through the menopause. A healthcare professional would use age criteria to decide on your menopause status. The age for a natural menopause is 50 to 51, but the menopause can happen any time between 45 and 55. Around 80% of women have stopped having periods by the age of 54. So, after a year of stopping your monthly periods naturally, by the age of 55, you can be classified as ‘postmenopausal’.

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Tags: endometrial polyps, fibroids, HRT, libido, menopause, menopause champion, pelvic ultrasound X-ray, perimenopause, periods, postmenopausal, progesterone, self-esteem, testosterone