Category Archives: Hormone Replacement Therapy

Hypothyroidism patients are more likely to develop sleep apnea, according to new research.

To understand the potential link between hypothyroidism and sleep apnea, a team from Texas Tech University Health Sciences Center (TTUHSC) embarked upon new research using data mined from the National Health and Nutrition Examination Survey (NHANES). Their study, Hypothyroidism and its Association with Sleep Apnea Among Adults in the United States: NHANES 2007-2008, was published in July by theJournal of Clinical Endocrinology & Metabolism.

The NHANES is a biennial survey conducted by the Centers of Disease Control and Prevention to generally evaluate the health of children and adults in the US. In addition to providing a significantly larger sample size, the NHANES provides a cross-sectional sample of the non-institutionalized US adult population. It includes a detailed demographic and behavioral questionnaire, a physical examination, laboratory testing and a list of all prescription medications used by the respondent.

Study coauthors internal medicine resident Subhanudh Thavaraputta, MD; Jeff Dennis, PhD, an assistant professor for TTUHSCs Department of Public Health,looked a the2007-2008 NHANES because it tested respondents for thyroid stimulating hormone (TSH) levels and included a detailed sleep questionnaire.

We had to use those two years to get the exact data points that we wanted, Dennis says in a statement. I always use the most current data when we can, but we were somewhat constrained here, and this is the one NHANES where we could see both TSH levels and sleep disorder information in the same place. We dont have any reason to think that would have changed drastically between the 2007-2008 NHANES and now. What we found should be reasonably consistent over time.

Thavaraputta, the studys lead author, says responses from 5,515 of the 10,000 respondents who participated in the 2007-2008 NHANES were ultimately included in the TTUHSC research. After analyzing those results, he and Dennis estimate that the prevalence for hypothyroidism among US adults is 9.47%, which represents approximately 19.6 million people.

The results also indicate that individuals diagnosed with hypothyroidism are 1.88 times more likely to develop sleep apnea. Hypothyroid patients who were undergoing hormone replacement therapy at the time of the NHANES evaluation were estimated to be 2.51 times more likely to have a sleep apnea diagnosis, regardless of their TSH level.

We hope that our findings will raise awareness and concern among physicians regarding this association, Thavaraputta says. In the future, if this relationship is established, assessing the sleep qualities/problems in hypothyroid patients might be beneficial to improve the patients standard of care, quality of life and treatment outcomes.

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Study: What is the Connection Between Hypothyroidism and Sleep Apnea? - Sleep Review

Talking points

The podcast boom continues apace, with an impressive number of people in the UK listening to an audio show each week according to new figures. Ofcoms latest report shows around 7.1 million of us or one in eight people are tuning into pods, a 24% rise on last year. Its unsurprising given the big investments currently being made in the medium (more on that here).

Meanwhile, its five years this week since Serial restarted the podcast movement, making amateur sleuths of its listeners. While not without its ethical controversies, like much true crime, this early hit remains a truly impressive feat of storytelling.

Dear Joan and JerichaJulia Davis and Vicki Pepperdines judgmental, disgusting and thoroughly convincing agony aunts return for another series of the hilarious podcast. Cringe-inducing wisdom is the core of their business, whether theyre telling women over 35 not to have wrinkly babies or warning them to tend to their husbands physical needs. The chat veers from the absurd to the filthy, all perfectly delivered in the prim way of two know-it-alls who are qualified in psycho-genital counselling and sports journalism. HV

Youre Dead to Me

This amusing new podcast follows TV outings such as Drunk History and Horrible Histories in making the past that bit more exciting. Historian Greg Jenner, who helped to make the latter show, hosts alongside experts including Dr Helen Castor, a medieval historian who helps to explain the remarkable story of Joan of Arc. Of course, there are comedians, too among them Suzi Ruffell, who considers her own identity as a gay woman as they assess the continuing arc of LGBT history. HJD

As part of the Guardians ongoing campaign on menopause awareness, last weeks Science Weekly podcast revealed the exciting new insights scientists have uncovered when it comes to hot flushes insights that could one day give women a much-needed alternative to hormone replacement therapy. As Hannah Devlin finds out, the menopause has historically been a mystery for scientists but could this all be about to change? Max Sanderson

Chosen by David Waters

Calling someone a master of radio, you can be accused of hyperbole. But in the case of superproducer Cathy FitzGerald the self-described caretaker of the Strange & Charmed school for audio storytellers, which is churning out a new generation of fellow superproducers that is literally the case.

Her latest documentary is an explosion of sound and joy from the very first minute. Were immediately transported to the Brooklyn Superhero Supply Company which, it turns out, is part of an American non-profit company (826 National) that uses various cover stories across the US to capture the imaginations of children. From pirates in San Francisco to ghosts in New Orleans and robots in Detroit, various tropes are deployed by the organisations nationwide chapters. And once under their spell, children can access free tutoring and homework help plus workshops for budding authors. Like FitzGeralds own audio school, 826 National is more than just education: its about confidence, creativity and empowering people to tell stories.

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Everyone's favourite filthy agony aunts are back! Podcasts of the week - The Guardian

This transcript has been edited for clarity.

Thomas Allison, PhD: Greetings! I'm Tom Allison, cardiovascular specialist at Mayo Clinic. During today's roundtable, we'll be discussing lipoprotein(a). I'm joined by my colleague, Dr Steve Kopecky, who specializes in this area. Steve, what is lipoprotein(a) and why do we have it? What role does it play?

Stephen L. Kopecky, MD: Lipoprotein(a) is a combination of a couple of standard molecules that we all know about. One is an LDL cholesterol-type molecule or low-density lipoprotein. The second is an apolipoprotein(a) which is bound to the LDL-like molecule at the ApoB receptor with a disulfide bond. Now, what does that mean? Lp(a) is a cholesterol-type molecule, basically.

Allison: I understand that there are different sizes of these Lp(a)s.

Kopecky: Yes, there are different sizes because the apolipoprotein portion can have different kringles. Some are very big, some are very small. The smaller ones seem to be more atherogenic or cause more problems.

Allison: Like the small dense LDL.

Kopecky: Like the small dense LDL. One question that comes up is, why do we even have this molecule? It seems to promote clotting, which may not be a good thing, although years ago if you had trauma, it may have helped with wound healing or clotting. It may have helped prevent excessive bleeding in childbirth, so there may be a reason why we have it in our bloodstream.

Allison: What evidence do we have that this causes heart disease or contributes to our risk for heart disease? And I presume that we're talking about coronary artery disease, right?

Kopecky: Ischemic stroke also could be involved.

First, what is it about this molecule that may be causing problems? The LDL particle can actually promote atherosclerosis. We also know that the apolipoprotein particle is similar to plasminogen, so it can promote clotting. It inhibits fibrinolysis. And the third factor is that it is an inflammatory molecule.

So it does three things: causes atherosclerosis, causes the plaque rupture with inflammation, and then causes clotting at the site of plaque rupture. Large observational studies, such as the INTERHEART study, which involved many nations, show that individuals with elevated lipoprotein(a) have an increased risk for myocardial infarction (MI).[1]Mendelian randomization studies in large numbers of patients/subjects suggest that if you have an elevated lipoprotein(a), you also have an increased risk for MI and stroke.[2]

Allison: Am I correct that some recent trials have shown that the on-treatment level of Lp(a) in a clinical trial actually correlates with the event risk?

Kopecky: Yes. If you look at LDL cholesterol trials where they gave statins to control LDL, the best predictor at that point of recurrent events was actually the lipoprotein(a) level, not the LDL level.[3,4]

Allison: What is the cut point? At what level do we see the increased risk? I know there's some controversy about what the cut point is.

Kopecky: Yes, because a lot of it's observational, and [approximately] 80% of individuals globally have normal levels of less than 50 mg/dL. In the US, we have an average of about 20 mg/dL. If you look at certain ethnic groups, Asians and Caucasians are very similar; African Americans and Arabs also have higher levels, maybe two or three times higher. The question is, how much of that goes into risk? And that's not quite clear. Is an African American's risk higher because they have a higher Lp(a)? That has not been worked out.

Allison: So 50 mg/dLis that the number?

Kopecky: In general, the average number is 20 mg/dL. Over 50 mg/dL, we start to call it increased risk; that's what most guidelines have said. If you're using nmol/L, 100 or 125 is elevated risk.

Allison: In the prevention clinic at Mayo, do you measure Lp(a) on everybody, or are there specific groups for whom you think it's more important?

Kopecky: People have said that we should measure it in everybody. I don't think we're quite there, mainly because we don't have a treatment yet. But also because the people who may benefit the most are the ones who come in with early atherosclerosis or they have a family history, and they say, "My older brother just had a heart attack at age 48." That may be a good time to check it.

Patients who have recurrent atherosclerotic events in spite of optimal treatmenta case has been made to check those patients. And then there are patients who have FH, familial hypercholesterolemia. About 1 in 5 people (or 1 in 3) with FH have elevated lipoprotein(a). It increases risk, so we check.

The last group is aortic stenosis; bicuspid aortic valve is probably the prototype of that. There's evidence that individuals with elevated lipoprotein(a) and bicuspid aortic valve have more rapid progression of aortic stenosis.

Allison: That's new, right?

Kopecky: That's fairly new. We're starting to think of that when we look at patients with the bicuspid aortic valve.

Allison: So now you have lipoprotein(a) and it's over 50. What do you do?

Kopecky: First off, you make sure that when we're talking about over 50, we're talking about over 50 mg/dL versus like 125 nmol/L. The reason why that's important to differentiate is because the mg/dL is the mass concentration whereas nmol/L is the particle concentration. And as you implied, the particles are different sizes, so we can't convert one to the other like we can with LDL or HDL. It has to be a completely different measurement. There's a push right now to have a single way of measuringthe nmol/L, which would take into account the particle size.

Allison: And that's 125 nmol/L.

Kopecky: It would be like 125 nmol/L. So if it's high, what do we do? Well, lifestyle is always very important, although 80%-90% of your Lp(a) level is genetically determined. It's a codominant inheritance, meaning you can get a gene from each parent, and both will raise it more.

You can give things like niacin or hormone replacement therapy. We know that can lower it, but it doesn't lower events; in fact, it may increase cardiovascular events, so it's not recommended. Statins don't affect it. The PCSK9 (proprotein convertase subtilisin/kexin type 9) inhibitors lower it by maybe 25%, but they're not indicated for high lipoprotein(a).

Lipoprotein apheresis can be helpful in a very small percentage of patients. So we have some treatments, the PCSK9 inhibitor, but it's not yet indicated for lowering it.

Allison: Am I correct that there is a new drug under development that was presented at the American Heart Association scientific sessions, that has shown a significant (ie, 80%) lowering effect, but it's not available? Is that right?

Kopecky: Right. It's an antisense oligonucleotide that actually lowers Lp(a) significantly. It's undergoing clinical studies and we don't know the outcomes yet. It sounds like it's a good idea, but we would need the outcome studies to show that it benefits patients.

Allison: No dietary therapies?

Kopecky: Lifestyle is important, but it doesn't lower your lipoprotein(a). It lowers your risk, but that's separate from the Lp(a).

Allison: Steve, any other points we should make about this?

Kopecky: It's always good to look at the guidelines. The recent ACC/AHA lipid guidelines say you should consider lipoprotein(a) over 50 mg/dL or 125 nmol/L as a risk enhancer ,so be a little more aggressive in treating those patients.[5]

It may be the risk enhancer you use with some patients in primary or secondary prevention, and it's something worth checking, especially if you have patients who have recurrent events or early events, or a family history of early events, because it helps you be more aggressive in treating the patients.

Allison: Do you ever bring in a patient's family members and check them? If, for example, you're 40 years old and you have an MI, should your brother and your kids get checked?

Kopecky: The cascade screening. Yes, we actually have a letter that we give patients. Once we check them and it's elevated, we say, "Give this letter to your first-degree relatives. You don't have to talk to them; the letter explains everything." It says the patient had this elevated lipoprotein(a), which can be associated with increased risk for heart disease, and the relative should take this letter to their primary care provider to check [lipoprotein(a)].

Allison: Steve, thanks for this update and for your insights. I want to thank everyone for joining us on the heart.org | Medscape Cardiology.

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Excerpt from:
The Lowdown on Lipoprotein(a) - Medscape

SUPERMARKETS are running out of ibuprofen pills due to a worldwide shortage.

Customers say they are increasingly finding empty shelves when they try to buy the painkiller.

1

Many are buying paracetamol instead causing that drug to be in short supply in some areas. News of the shortages comes in the wake of reports that chemists are running low on some prescription drugs.

Tesco said the problem was due to a global shortage of the active ingredient in ibuprofen medicine. It said both own-brand and some branded products are affected.

The supermarket said it was working with suppliers to manage the shortage and aims to have full availability within the next two weeks.

Sainsburys is also having problems, with a spokesman saying stocks of own-brand ibuprofen and paracetamol were running low.

The store has put up notices informing customers of supply issues.

Customers have reported scouring supermarkets for ibuprofen but finding only more costly brands.

A customer named Michelle tweeted: Over the past couple of weeks I have tried to buy in Boots, Superdrug and Tesco without success.

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The shelves are either empty or filled up with expensive brand alternatives.

The shortages of prescription drugs, including hormone replacement therapy, antidepressants and anti-epilepsy pills, are thought to be caused by production problems and stockpiling ahead of Brexit.

Continued here:
Tesco and Sainsburys among UK supermarkets to be hit by worldwide ibuprofen shortage - The Sun

Hilary Swift for The New York Times Senator Bernie Sanders spoke to voters in Davenport, Iowa, last week before his heart attack.

BURLINGTON, Vt. Senator Bernie Sanders, a week after suffering a heart attack in Las Vegas, said on Tuesday that he planned to slow down his pace on the campaign trail and acknowledged that voters would likely consider his health when deciding whether to vote for him.

Speaking to reporters outside his home in Burlington, following a visit with a local cardiologist, Mr. Sanders gave no indication he was planning to drop out of the race and said he would continue to campaign actively.

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We were doing, you know, in some cases five or six meetings a day, three or four rallies and town meetings and meeting with groups of people, Mr. Sanders said. I dont think Im going to do that.

I think were going to change the nature of the campaign a bit, he added. Make sure that I have the strength to do what I have to do.

Asked to clarify what he meant when he said the campaign would change, he replied: Probably not doing four rallies a day.

Standing next to his wife, Jane, Mr. Sanders, 78, also acknowledged that his heart attack could be a factor for voters considering whether to support him.

Everything that happens everyday weighs on how people feel about you, he said. And my own view is that and I think its the voters view you look at the totality of who a candidate is. You look at what that candidate stands for, the integrity of that candidate, the history of that candidate.

Mr. Sanders returned to Burlington over the weekend after being hospitalized in Las Vegas for three days last week, recovering from a heart attack. His campaign said he felt chest pains during events last Tuesday, and he was taken to the hospital, where two stents were inserted into an artery.

Since then, his campaign has insisted that Mr. Sanders does not intend to drop out of the race. During a telephone call with staff members on Monday, Mr. Sanders said he felt more strongly about the need for a political revolution today than I did when I began this campaign.

On Tuesday, Jane Sanders downplayed the decision to slow the campaigns pace down, saying it was something that the entire campaign, and especially me, have been saying for months not for his health but for the ability to keep up that kind of a pace for everybody else, too.

Known for keeping a grueling schedule on the campaign trail, Mr. Sanders will often criss-cross a state with multiple stops for big rallies and smaller town hall-style events and gatherings.

In a Democratic primary where the three leading candidates are in their 70s, Mr. Sanderss health issue has intensified the scrutiny on age as a factor in running for president. Many Democratic voters have said they worried about nominating a septuagenarian candidate.

Mr. Sanders, who finished second to Hillary Clinton in the 2016 primary, has been among the top three Democratic contenders since he entered the race in February. But in recent weeks has been passed by Elizabeth Warren in national polls and polls of early nominating states like Iowa and New Hampshire.

Still, he remains a formidable challenger; just last week he announced a third-quarter fund-raising total of $25.3 million, the largest in the Democratic field.

In the 2016 presidential campaign, Mr. Sanderss doctor said that the senator was in overall very good health. His ailments included gout; a mild elevation of cholesterol; an inflammation of out-pouches in the bowel known as diverticulitis; and hormone replacement therapy for an underactive thyroid gland. He had no reported history of heart disease.

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Sanders Says He Will 'Change the Nature' of His Campaign After Heart Attack - msnNOW

A trans woman who served 11 years in the US military before transitioning has had surgery to get giant 42JJ breasts.

Maxine Montoya, 38, said she wanted to express her femininity in a way thats right up front".

And she said she is considering getting even larger implants.

Maxine, from San Diego, California, said: I could talk about my boobs all day, I couldnt be happier with the results I got from my breast augmentation.

Why this big? I see this as something empowering. That exaggeration of femininity and what it represents. I sometimes wonder if I want to get bigger.

Before transitioning, Maxine was married and had a daughter, Mia, who still calls her Dad and came out at the age of nine.

She said: I see no reason why a trans woman cant be a father - Im still her father, Im just a woman and a dad."

Her daughter added: There was never any need for me to change what I call my dad because my dad always said I fathered you, so you can continue to call me by that name.

Mia came out as bisexual at a young age and said that having a transgender parent really helped understand her true self.

She said: Being bisexual and having a trans parent around helped immensely.

If my dad hadnt transitioned, I probably wouldnt have come out as soon as I did without the other LGBTQ figure in my life who I knew was going to love me no matter what.

Maxine thinks she would have also transitioned earlier if she had been surrounded by the same positive influences as her daughter.

She said: I was raised in a very sheltered, conservative household.

With all the information thats available now on the internet, if I had that I probably would have done this a lot sooner.

Recalling her time in the armed forces, Maxine said: My mother wanted me to join the military, I honestly dont have very fond memories of my experiences there.

I was in a culture that did not accept me.

Although she left the military before transitioning, Maxine was still in service when she started cross dressing.

I didnt come out as transgender in the military, however that doesnt mean that I didnt experience dysphoria, she said.

I was wearing a skirt and some makeup, and I was walking around, word of that got back to someone in my chain of command and I ended up receiving what were flat out threats against my career.

I asked myself this question: Do I ever want to be perceived as male? And the answer was an immediate no.

Maxine has now been on Hormone Replacement Therapy for over a year and a half and has never been happier.

She said: It just changed everything in a way that I could never have anticipated, it has made a world of difference in the way I feel.

However, in order to reduce the dosage of testosterone blockers or even come off them completely, Maxine is currently planning to get bottom surgery too.

I am getting whats called an orchiectomy - you have the testicles removed, and I have zero attachment to those girls so they can go.

My doctors told me that if I get those removed, she can probably lower my dosage of testosterone blockers or take me off it completely.

Maxine speaks with frustration about the misconceptions that other people have of her,

She said: People assumed that I am attracted to men because Im female, but Im gay - people dont understand that, they cant separate gender from sexuality.

Maxine is in a committed relationship with her partner Melissa, who has muscular dystrophy. Maxine is her full-time carer.

Maxine added: Im a caregiver for my partner and that brings me a lot of joy.

Unfortunately, the couple have to face a lot of judgement and prejudice directed at their inter-abled love.

Maxine said: Nobody wants to assume we are a couple; I can kiss her in public and people are looking at us just trying to understand what this means and how does this happen.

But the two go back over 20 years, when they met through a common friend in high school.

Melissa said: In high school she was always very feminine and thats one of the qualities I loved about her, she was my best friend.

When they are out in public, they often receive looks and stares.

A lot of people look at it negatively, theres nothing to say to those people, said Maxine.

Maxine even seems to somewhat enjoy the negative looks.

The attention, I love it all, theres nothing I dont appreciate, both positive and negative - Im not dressing this way to blend, I dress to stand out so if I get negative glares, its just kind of validating, she said.

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Trans army veteran gets 42JJ breast enhancement to 'express her femininity' - Mirror Online

DEAR DEIDRE: IM having erection problems because I fear my wife is not attracted to me sexually.

Weve attempted sex only three times in the past five years successfully just once.

Weve been married very happily for 40 years but my wifes healthy sexual appetite has disappeared.

Im 65 and she is 62. She had hormone replacement therapy when she went through the menopause.

I love her but feel my erection problems suit her just fine.

DEIDRE SAYS: Sexual responsiveness can suffer from the menopause but the HRT should have helped.

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I doubt this crisis is wholly about that. Ask what changes you could make in your relationship as a whole, or in how you make love that would make her happier.

Then she may be more responsive to your needs.

My e-leaflet Love And The Mature Woman can help you both with this.

Get in touch with Deidre today

Got a problem?

Send an email to problems@deardeidre.org. Every problem gets a personal reply, usually within 24 hours weekdays.

You can also send a private message on the DearDeidreOfficial Facebook page.

Follow me on Twitter @deardeidre.

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The menopause made my wifes sex drive disappear but she uses my erection problems as an excuse - The Sun

The hormone replacement therapy market is foreseen to expand at a significant pace withsales of hormone replacement therapy products crossing US$ 12,000 Mn by 2019 end. Rising incidences of osteoporosis fractures coupled with growing menopause rates among women have remained instrumental in driving the demand for hormone replacement therapy. Fact.MR envisages that thedemand for hormone replacement therapy is projected to expand at a CAGR of 6.0% in terms of valuethroughout the period of forecast, 2018-2028.

Disorders associated with hormonal imbalance continue to influence the use of hormone replacement therapy worldwide. Hormone replacement therapy demand is further pushed with macroeconomic aspects such as growing geriatric population and significant increase in healthcare expenditure worldwide. Growing age directly impacts secretion of hormones such as progesterone and estrogen in women, which is expected to trigger the use of estrogen hormone replacement therapy.

Expanding range of menopausal window (45-55 years) coupled with growing number of postmenopausal patients are few of the key factors influencing the growth of thehormone replacement therapy market. According to the report, thedemand for estrogen hormone replacement therapy is expected to grow on the back of growing menopausal rate worldwide. The sales of estrogen hormone replacement therapy are likely to surpass US$ 18,000 Mn by 2028, higher than those of other hormone replacement therapy products including thyroid and growth hormone related hormone replacement therapy products, says the report.

Request forSample Report with Statistical Info @https://www.factmr.com/connectus/sample?flag=S&rep_id=2224

Sales of hormone replacement therapy products through hospital pharmacies and retail pharmacies are likely to be on an upswing with developers of hormone replacement therapy products relying on these channels than online selling. Retail pharmacies are expected to remain an attractive distribution channel for hormone replacement therapy products, with sales accounting for a larger revenue share of the overall hormone replacement therapy market. The sales of hormone replacement therapy through clinics are projected to grow at a steady during the 2018-2028 timeline.

The hormone replacement therapy market is expected to remain influenced by increasing government support apropos to womens health. Governments and non-profit organizations of various countries are spreading awareness regarding hormone replacement therapy along with providing free treatments to lower and middle class people. Regulatory authorities such as FDA are also contributing to the cause of supporting womens health by launching initiatives such as Take Time To Care (TTTC) programs. This aspect is likely to support the growth of the hormone replacement therapy market in the coming years.

Sales of hormone replacement therapy products are likely to remain concentrated among developed countries of North America and Europe. Tug-of-war between North America and Europe apropos to demand for hormone replacement therapy has been witnessed since the past couple of years, with the latter gaining tempo over the former, says the report.

Stakeholders in the hormone replacement therapy can find attractive opportunities in developed countries in North America, particularly the United States. According to the American Congress of Obstetricians and Gynecologists, around 6,000 women reach menopause every day, reaching a count of over 2 million annually. This has translated into significant adoption of hormone replacement therapy in the country. The demand for hormone replacement therapy in the US is also accompanied by higher GDP per capita, triggering high healthcare expenditure.

Need more Information about Report Methodology @https://www.factmr.com/connectus/sample?flag=RM&rep_id=2224

The report also foresees that the hormone replacement therapy market in Asia Pacific excluding Japan (APEJ) region is poised to expand at a relatively higher pace as compared to other regions. According to the report, the APEJ hormone replacement therapy market is projected to expand at a stellar pace of 7.2% during the assessment period. This growth can be attributed to increasing population coupled with higher life expectancy in emerging economies such as India and China. Against this backdrop, stakeholders in hormone replacement therapy market can expect optimistic growth in the region in the years to follow, leveraging its lucrativeness from an investment standpoint.

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Hormone Replacement Therapy Market to Register a Stout Growth by 2028 - Space Market Research

Education around hormonal health is sadly lacking, with many women thinking they are suffering from depression or dementia when actually they are entering the menopause.

Here, Dr Mary Ryan explores the difference between perimenopause and menopause, the various symptoms involved, treatments available and a new surgery which could actually delay the menopause by up to 20 years.

For some women, the first clue they have been experiencing symptoms of the menopause is after they arrive at the doctors surgery, fearful that something is gravely amiss.

Women often think they are suffering from depression. And I have patients coming to me saying, Doctor, my memory is gone, am I getting dementia? But in fact it is all down to hormonal imbalance as they enter the menopause.

Women of my mothers generation never discussed menopause, they suffered dreadfully and were supposed to put up and shut up. But menopause is something all women should discuss and the stigma needs to go. Too many women struggled in the past, which was wrong and unnecessary.

Perimenopause Vs Menopause

Perimenopause begins several years before menopause, as the ovaries gradually begin to make less oestrogen. Perimenopause usually starts in a womans 40s, but can start as early as your 30s. The transition phase to menopause may last four to eight years and it is very important that during this time of hormone imbalance that women pace themselves and listen to their bodies requirements as this helps with hormone regulation. Menopause officially kicks in when the ovaries produce so little oestrogen that eggs are no longer released, also causing your periods to stop.

Symptoms

The symptoms for perimenopause and menopause are extremely similar. The key difference is in their severity. Typically symptoms include: mood swings, depression, brain fog, hot flushes, sleeplessness, vaginal dryness, reduced energy, bloating, aches and pains and reduced sex drive.

Hormone Health Is Key

The decrease in oestrogen and progesterone that occurs in menopause can result in a reduction in your immune function.

Oestrogen and progesterone are also thought to play a role in autoimmune diseases where the immune system attacks the body, meaning menopausal women may be more susceptible to autoimmune disease. In addition, menopause results in a decrease in T cells, which are a key part of the immune system, and help destroy cancer cells, fight bacteria and orchestrate the immune response throughout the body.

Not only do womens immune systems become compromised during the menopause, but their mental health may suffer too. Oestrogen acts to increase your happy hormone, serotonin, as well as your memory neurotransmitter.

As these levels begin to fluctuate, your hormone levels also fluctuate affecting your mood, memory and your bodys energy levels.

This is wrongly labelled depression when it is actually a hormone imbalance that can often settle with no medication and a good support structure.

Has My Period Gone For Good?

Periods become irregular during the perimenopause. However, not having a period for six months doesnt mean it wont return. I always tell women to carry pads with them even when their periods are irregular because they could suddenly have a deluge. Perimenopause can start when youre about 47, and your cycle could remain irregular until you are 53 or 55, so it may be a long time before youre through it.

Am I Going Through The Menopause?

The only way to accurately confirm you are perimenopausal is to visit your GP. Women can have their hormones tested by their doctor and get the full basic tests of bloods including the hormones that control periods FSH and LH and the thyroid hormone to rule out any underlying conditions and confirm the menopause.

Treatment

Early intervention is key. Perimenopause is just the start and women who look after themselves at this stage will have a much easier menopause. Depending on the severity of your symptoms, a combination of diet, supplements and medication may be helpful. In my experience, 50 per cent of women do well after making some lifestyle changes, through healthy eating and natural supplements. In addition to the above, 30 per cent need medication for peripheral nerve pain and autonomic symptoms, and the remainder may need HRT. Everyone is different.

Diet And Supplements

Soya products are great sources of oestrogen. Both Omega 3 and B vitamins are also of benefit at this time. Vitamin B6 contributes to the regulation of hormonal activity and along with vitamins B1 and B12, it also contributes to normal psychological function. Vitamin D3 is important for bone health as we age, as osteoporosis can become an issue for women as their oestrogen decreases. I like supplements like Cleanmarine which contain everything you need.

Hormone Replacement Therapy (HRT)

For patients with chronic symptoms, HRT can be a life changer. I reserve HRT for the women who come in profusely sweating which, thankfully, is only about 20 per cent. My preference is to prescribe the patch: you are getting the minimal amount and it is not as highly concentrated, which works very well for almost all of the women who try it. When prescribing HRT, I will always do a mammogram even if there is no history of breast cancer to ensure there is nothing there. I always inform women on the slight risk of breast cancer new research indicates it increases your risk by four per cent. However, this doesnt give any indication of whether there are other factors such as obesity. Some eight per cent of breast cancer is caused by excessive weight, and eight per cent is caused by excessive alcohol. Both of these figures pose a far more significant threat than HRT.

At the end of the day it has to be about the womans quality of life and she has to be trusted to make an informed decision.

A lot of women are now asking about bioidenticals a natural form of oestrogen but for me there isnt enough research yet.

Postponing The Menopause

A first-of-its-kind surgery is now being piloted which could delay the menopause by up to 20 years. The procedure involves removing a portion of a womans ovaries and then cryogenically freezing it. If this is safe then it will be wonderful and will offer working women a choice while taking some of the pressure off their shoulders. It would also allow women to hold onto their collagen production for much longer, however we dont have enough evidence to assure us of its safety just yet.

Stress And Self Love

Women need to listen to their bodies and rest more to allow the hormone control centre to cope better. Those who go into menopause pacing themselves and eating healthily fare much, much better. Your body is wonderful at adapting to change once we allow it to rest and be healthy.

Women need to realise that once they lose the protective effect of oestrogen in menopause they are at risk of heart disease so it is important that they keep their weight and blood pressure normal during this time and also look after their bone health.

I advise all my patients to listen to their bodies: when they are tired, they must rest. We plug in our mobile phones when they are in the red, but we must also do the same with ourselves.

We need to empower women to put themselves first and look after their wellbeing. After all, menopause is only the next chapter in their lives. It is part of a normal evolution and women can look forward to the next 40 years with vigour provided they take care of their health.

Dr Mary Ryan, consultant endocrinologist, will be a guest speaker at The M Word, Irelands first major conference on the menopause, on October 11 in Dublin.

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Am I going through the menopause? Dr Mary Ryan shares the symptoms to look out for - RSVP Live

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Hormone Replacement Therapy Market Global Industry to Gain High Market Share During the Forecast Period 2019-2025 - Space Market Research