MENOPAUSE ‘ASK THE EXPERTS’ QUESTIONS & ANSWERS

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 101 (Summer 2024) of The Menopause Exchange newsletter.

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Can topical oestrogen be used in women who have had breast cancer? If so, which products are suitable?
Yes, topical oestrogen can be used in women who have had breast cancer, even with an oestrogen-positive receptor tumour. Topical forms of oestrogen, whether applied externally to the vulva or internally to the vagina, are available in the form of rings, creams and pessaries. The vaginal ring, S ring, delivers a marginally higher dose of oestrogen than pessaries or creams. The amount of oestrogen from creams and pessaries if used for one year is less than 1mg of oral oestradiol per year, so systemic absorption is therefore negligible. In a few women, where neither the cream or pessaries are suitable, the S ring can be prescribed, but the amount of oestrogen delivered is marginally higher. Therefore, it’s advisable to discuss this with your healthcare professional and possible oncologist before starting treatment.

I’m 57 and haven’t had any signs of the menopause. Is this unusual?
Yes, but unlike periods that are late to start, being late to stop isn’t a cause for concern. The typical age for the last period is around 52, but 1 in 4 women will still have periods at 54 and the proportions decrease over time. While having periods may be a nuisance, an alternative approach may be to reflect that the hormones driving your periods are still present and will be keeping your bones, skin and heart healthy. At some point, they will stop, but there’s usually some irregularity before they do, and at that point you may, or may not, experience associated symptoms.

I’m 48 and have hearing loss. As far as I’m aware, this isn’t inherited. Is it possible my hearing loss will get much worse, and is there anything I can do to restore my hearing?
Hearing is a very complex issue and is best dealt with by a specialist in the area. Speak to your GP to request an ENT (ear, nose and throat) consultant or hospital service. Hearing loss isn’t normally affected by the hormonal changes of the menopause.

I’m 65. Is it too late to start HRT?
Some women in their 60s may still have problematic flushes and sweats, although many find their symptoms improve as they get older. HRT can still be prescribed, but the potential risks such as breast cancer may start to outweigh the benefits of HRT (such as helping to prevent osteoporosis). If HRT is prescribed, your healthcare professional may suggest a low-dose oestrogen patch, gel or spray. If you still have a uterus (womb), you’ll need progestogen with the oestrogen to protect the endometrium (lining of your womb). This should be taken daily to provide a continuous combined regimen; your periods shouldn’t return, but you may have a small amount of bleeding initially. Micronised progesterone (100mg a day) would be a good choice as this progestogen seems to have less of an effect on the risk of breast cancer compared to the older progestogens, for example norethisterone.

Do you recommend taking collagen supplements during the menopause?
Collagen is a protein that forms the body’s scaffolding, helping to keep skin supple and bones and joint cartilage strong. Collagen production falls as we age, and for women the loss is increased by the menopause. Collagen supplements generally pose little risk, apart from their cost. But whether they work is hard to answer as there’s been little good research. Taking collagen daily for 12 months might give a small increase in bone density, but resistance exercise programmes (for free) also give positive effects. A review of research studies suggests that there may be some positive effects on skin health, but these are likely to be dwarfed by other factors such as sun exposure, smoking, loss of lean muscle mass, dehydration and facial expressions. Do I recommend collagen supplements? No, as you’ll likely get the same benefits from diet and exercise. But if you want to try them, go ahead as they’re unlikely to harm you.

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Tags: breast cancer, collagen supplements, hearing loss, HRT, menopause, topical oestrogen, vaginal oestrogen