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 97 (Summer 2023) of The Menopause Exchange newsletter.

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Can HRT act as a contraceptive?
HRT regimens are licensed for menopause symptom control, and generally don’t offer contraception cover. The exception is where a woman is prescribed oestrogen with the Mirena intra-uterine system (a coil with progestogen embedded within the coil). Mirena is licensed for the control of heavy bleeds (menorrhagia), for contraception and for use as the progestogen component in an HRT regimen.

Can the menopause affect protein levels? If so, what’s the best way to deal with any changes?
Protein plays a key role in maintaining your muscle mass. Muscle maintenance is a dynamic process, with damaged or aged muscle broken down every day and replaced with new muscle. From around the age of 40, the protein balance in both men and women shifts to more breakdown and less building, and a loss of oestrogen makes this worse. Fighting muscle loss during the menopause is vital. This involves including good-quality proteins every day (lean meat, fish, milk, eggs, nuts, soya, tofu, beans etc). You don’t need fancy protein powders: protein-rich food should be enough. Avoid eating all of this protein in one meal; split it across at least two or ideally three meals each day, as this helps your body make best use of the protein for muscle building. Don’t forget to do some strength exercises on at least two days each week too.

I get really vivid dreams and wake up feeling exhausted. Could this be related to the perimenopause? I’m still getting periods, don’t have any other health problems and I’m not on HRT?
So many symptoms can be linked to the changes associated with the menopause and are part of a bigger picture of your health. I would advise you to look at your mental health and stress levels, as in my GP experience those issues are more likely to be the cause than the perimenopause. We know that dreams are part of the brain’s process of filing life experiences during our sleep, and therefore anything that makes our brains busier can make our sleep less rested.

I find that I struggle seeing clearly when driving in the dark. I now avoid driving when it gets dark as it strains my eyes. I don’t have this problem during the day. I only wear glasses for close-up work. What should I do?
It’s important that you have an up-to-date eye examination. You may not need to wear glasses legally for driving, but you may have a very small glasses prescription that doesn’t significantly affect your vision but, due to night-driving conditions, can lead to eye strain. Being post-menopausal causes your eyes’ lenses to start to become slightly hazy. This leads to glare with oncoming headlamps when you’re driving, which increases eye strain. Night driving requires increased concentration; the more you concentrate, the less you blink. Your eyes then dry out, causing an uneven eye film. One in nine post-menopausal women suffers from dry eyes. Keep your eyes well- lubricated, wear glasses to drive if you need them, and keep your glasses and car windscreen as clean as possible, both inside and out.

I have varicose veins. Can I take HRT?
Varicose veins affect up to one in three people and are more common in women than in men. People with varicose veins often have a family history of them, but the risk can also be increased by pregnancy, occupations involving standing for long periods, and being overweight. Systemic HRT (such as tablets or patches) and vaginal oestrogen preparations (local HRT) can be prescribed to women with varicose veins. In women who have pain in their surface leg veins due to inflammation in the blood vessel (called superficial thrombophlebitis), I normally suggest a transdermal oestrogen product, such as a patch, gel or spray, as there’s a small increased risk of a blood clot in the leg (venous thromboembolism) if they take oral HRT.

How can I curb my sweet tooth?
It’s possible to wean yourself off sweet foods by trying to resist them and eating mostly savoury foods. However, it’s also true that some people inherently have a sweeter tooth than other people. Some experts believe you should allow yourself maybe one sweet treat a day to avoid serious cravings (and eat it slowly and really enjoy it!). If you severely cut down on food, you can develop such severe cravings that you completely lose your resolve and, as a result, end up bingeing on, most commonly, sweet foods. Finally, some experts believe that dips in blood sugars can trigger a sweet craving, so eating mostly foods that don’t spike blood sugar may be helpful, such as pasta, brown rice and granary bread, and also trying to avoid sugary drinks.

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Tags: contraceptive, eye examination, HRT, menopause, Mirena intra-uterine system, night driving, oestrogen, perimenopause, protein levels, sweet tooth, varicose veins, vivid dreams