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 issues 106 (Autumn 2025) and 107 (Winter 2025/26) of The Menopause Exchange newsletter.
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Is there an age limit for HRT?
There’s no fixed upper age limit for continuing HRT. Once a woman starts on HRT, she can continue HRT for as long as it’s beneficial and safe for her. Research has mainly focused on starting HRT near the age of natural menopause. Women are advised to use the lowest effective dose for the shortest time that meets their treatment goals, and they should have annual HRT risk-benefit checks. NICE guidance notes that oestrogen only HRT, which is usually prescribed for women who have had a hysterectomy, carries little or no increased risk of breast cancer. Combined oestrogen-progestogen HRT may slightly increase the breast cancer risk if it’s taken for more than 5 years after age 50. This is around 4 extra cases of breast cancer per 1,000 women over 5 years. NICE guidance notes that the risk of blood clots increases with age, especially with oral oestrogen. Transdermal options (oestrogen taken through the skin – such as via patches or gels) are safer for older women. The longer use of HRT helps to maintain bone density and may help with osteoarthritis. If menopause symptoms such as hot flushes, mood swings or vaginal dryness persist, continuing HRT can be life enhancing. It’s important that decisions about using HRT are made jointly with your healthcare provider, taking into account your menopause symptom severity, personal and family medical history and preferences around risk tolerance and quality of life. Lifestyle interventions should be part of a holistic management plan, as these can help to reduce some of the risks associated with HRT.
Which foods can make hot flushes and night sweats worse?
Hot flushes and night sweats are the most common symptoms of the menopause, but looking after yourself by eating healthily, keeping active and avoiding weight gain can help to reduce hot flushes and night sweats along with other menopause symptoms. For hot flushes specifically, top foods that seem to make it worse include spicy foods, caffeine and alcohol. It has been shown that the type of diet that triggers menopause symptoms, including hot flushes, includes processed sugars, refined carbohydrates and high-fat/salty foods. This is because these foods can increase body temperature, trigger blood vessel dilation or disrupt blood sugar, leading to more intense flushing and sweating. In addition, these foods can contribute to inflammation, weight gain and discomfort. Reducing these triggers and focusing on whole foods, water and eating more plant-based options can help to manage menopausal symptoms.
I am 61 and experiencing hip pain that travels down my leg to my knee on both sides of my body. What could this pain be due to?
Hip pain on both sides of your body, on the outside or front of your leg, between the bony part of your hip joint to your knee joint, is most likely to be due to muscle or ligament strain or underlying wear and tear in your hip joint due to age. The latter is often referred to ‘degenerative change’ on an X-ray. Osteoarthritis is another cause of hip pain – the hip joint pain is usually felt in the groin and is worse at night, especially when lying on the affected joint. With any joint or limb pain, speaking to a physiotherapist is a good idea. Many GP surgeries now have direct access to specialist physiotherapy, so arrange a consultation if your symptoms continue.
What are the most common mental health problems at the perimenopause and menopause?
Changes in shifting hormone levels affect mental wellbeing, but their impact is often misunderstood or overlooked. These changes can be real and serious but don’t apply to everyone. There’s little evidence of a physiological cause, but the changes generally seem to be more pronounced in women who have experienced mental health problems in the past. The most common mental health problems at the menopause are: anxiety and panic attacks; mood swings; poor memory and concentration (brain fog); feelings of overwhelm, low energy or crushing fatigue; and reduced confidence and self-esteem. Depression ranges from feelings of sadness and hopelessness to active suicidality, and a sense of lack of value or purpose. These struggles need to be taken seriously and supported with appropriate medicines and psychological support. It’s important to realise that mental health difficulties can be wrongly attributed to the menopause. This time of life can also be empowering if women can grow their own potential.
What is the difference between vaginal lubricants and vaginal moisturisers? Can you give me some examples?
Vaginal lubricants and vaginal moisturisers help vaginal dryness. Vaginal lubricants provide immediate, short-term relief so these are particularly useful when applied just before sex. They aren’t absorbed via the skin or vagina. They can be water-based, silicone-based or oil-based. Products with similar acidity to the vagina and similar concentration to cervical mucus cause the least irritation. Vaginal lubricants include Sylk and Yes aqueous or oil-based products. Vaginal moisturisers offer longer-lasting hydration to help chronic vaginal dryness and improve overall vaginal health. These moisturisers are applied one to three times a week using an applicator or pessary. They stick to the vaginal wall, promoting hydration and lubrication. Vaginal moisturisers are made up of water, hyaluronic acid or polycarbophil and provide similar improvements in vaginal dryness and (acidity) as local vaginal oestrogen products. Good examples of vaginal moisturisers are Replens, Regelle and Yes vaginal moisturisers.
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