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 105 (Summer 2025) of The Menopause Exchange newsletter.

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Please can you tell me about HRT that gives a withdrawal bleed every three months.
Three-monthly bleed HRT was originally proposed about thirty years ago as an option for women who didn’t tolerate the progestogen component of HRT but had a uterus. It involved taking oestrogen-only HRT for 10 weeks followed by a combination with a higher than typical dose of progestogen for two weeks. This would enable any uterine lining that had thickened as a result to be neutralised and then shed. Women may have felt dreadful for the two combination weeks, but the remaining 10 weeks would be fine. Bleeding was usually heavy. There was a ready-made brand, but this has now been discontinued. Subsequent research has shown this strategy doesn’t provide the protection that two weeks of progestogen every month will provide, and it isn’t generally recommended. There may be occasional exceptions for low-risk women after very careful discussion where the trade-offs are explicit and agreed.

I have mild haemorrhoids, which flare up occasionally, causing itching and pain. What’s the most effective product I can buy from a pharmacy? Or should I see my GP?
You can buy numerous brands of medicines to relieve haemorrhoids over the counter from your local pharmacy. Anusol produce a range of suitable products: cream, suppositories and soothing wipes. Preparation H has a choice of ointment and gel, whereas Germoloid is available as a cream and ointment. There are cheaper generic products too. For pain relief, paracetamol is the best option. Avoid codeine as it causes constipation. If your piles are bleeding, don’t take ibuprofen. Dietary changes, such as increasing your fibre and fluid intake, is vital to avoid constipation. Your local pharmacist can speak to you in their consulting room if you wish to have a private discussion. Consult your GP if there’s no relief from the pharmacy medicines, if the pain worsens, or if there’s any bleeding or changes to your bowel habits.

Should I take creatine supplements?
Creatine is a naturally occurring compound (found in the diet and made in the liver and kidneys) that plays a role in energy production in muscle and the brain. Creatine supplements may help athletes to boost high-intensity short-burst sports such as jumping or sprinting, but there’s no effect on overall aerobic fitness. Creatine supplementation has also been proposed to help combat menopause-related decreases in muscle mass. But creatine alone will have little effect unless taking the supplements is being combined with resistance training. Unless you’re prepared to work hard with the resistance training, there’s little benefit. If you have a history of liver or kidney disease, you should seek advice before taking creatine supplements. Athletes typically take 5 g creatine monohydrate four times a day for five days to saturate muscles, and then a maintenance dose of 3 g to 5 g/day (again split, e.g. 1 g three times daily), or a routine daily dose would be 5 g/day.

I had a hysterectomy recently at the age of 37. I still have my ovaries. At what age should I expect to go through the menopause?
Based on current research evidence, if you’ve had a hysterectomy while keeping your ovaries, you might experience the menopause earlier than the typical age. Research indicates that the menopause could occur within about five years after the surgery. Even though your ovaries continue to produce hormones, the onset of your perimenopausal symptoms, such as hot flushes (vasomotor symptoms) and psychological changes, will follow a pattern similar to women with an intact uterus, except without the menstrual cycle changes. In many cases, treatment involves oestrogen -only therapy, which can help to manage these symptoms. However, it’s important to have a consultation with your healthcare provider to determine the best approach for your specific situation.

I’ve been experiencing a very dry mouth. Could this be related to the menopause? Is there anything I can do to help this?
Your dry mouth could well be related to the menopause. Xerostomia, the medical term for the sensation of a dry mouth, is more common in menopausal women and seems to be linked to lower levels of oestrogen, as well as diseases that are more common in middle age, such as Sjogren’s syndrome and diabetes (mellitus), and taking medicines that can dry the mouth, such as diuretics (water tablets) or amitriptyline (an antidepressant and painkiller). Avoiding taking these medicines at night, using saliva substitutes and making lifestyle changes, such as not smoking, drinking lots of water and avoiding spicy and dry food, can all help. HRT doesn’t seem to make much difference to the condition. Speaking to your doctor and dentist about your symptoms is a good idea.

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