Your questions on the menopause and HRT - answered by our expert

Maisie Hill - Rebecca Douglas Photography
Every woman will go through it. Why do we know so little about menopause? In fact, many of the symptoms we most closely associate with it - like hot flashes - can also occur during perimenopause, the transition that happens to the female body before the end of periods, typically around the age of 51.
Author Maisie Hill is dedicated to helping women learn about their own bodies. In her new book, Perimenopause Power, she describes the symptoms and strategies for managing them, from hormone therapy (HRT) to the importance of managing your diet and exercise. As she told Stella magazine, "We are socialized to accept that menstrual and perimenopausal symptoms are only part of a female reproductive system - we have to overcome that." We need to share more and need more and have better access to care. "
Here she answers your questions about dealing with symptoms - and gets the help you need.
Will I be on HRT for the rest of my life?
Q: Anonymous, 53: I've been through this since I was 38 years old. I tried natural remedies, followed by HRT, then back to natural, and then back to HRT about 10 years ago. Can I expect to be on HRT for the rest of my life?
A: The good news is that there is no evidence that HRT should be stopped after a certain number of years or at a certain age. So if you are taking it and it is working well for you with no problems, there is no need to stop. HRT offers so many benefits that they will remain in the postmenopausal years.
I'm still getting periods at 54. Do I have to take something?
Q: Natalia, 54: My periods are as regular and heavy, painful and long (8 days) as always. Only missed her twice in the past two years. Sometimes sweating at night (neck and chest area). No mood swings, other than being sentimental two days before my period. My doctor doesn't think it's time to start supportive therapy. Do I have to take anything in advance? Should I get a second opinion?
A: Progesterone can actually be prescribed to treat heavy periods as it can relieve them, and it can also reduce vasomotor symptoms such as night sweats. Therefore, you may want to bring this up with your GP as if your cycle is not yet complete. You might still benefit from HRT in some form on a regular basis.
Does HRT just delay menopausal symptoms?
Q: Anne, 56: I ended my period four years ago and I definitely have postmenopausal symptoms, hot flashes and night sweats. Also, general stiffness and extra belly fat despite good exercise and a healthy diet. My question is, will these symptoms stop and if so, when can I expect this? If HRT is taken, which many of my friends do, will it only delay what I am now experiencing?
A: It sounds like you are taking very good care of yourself Anne, and you could get relief without taking HRT, but without the presence of hormones they are likely to stay to some extent. Taking HRT will not delay your experience with these symptoms because, while many of us have been told to stop after 5 years, we will not do so at all. When you combine HRT with lifestyle measures like exercise and a healthy diet, you will see an even greater effect than either one or the other.
Could my hot feet be a symptom of perimenopause?
Q: Claire, 47: I'm almost 48 and I have the Mirena coil. For the past few months I've had trouble sleeping from hot feet or toes to be precise. I fall asleep well, but after a few hours I wake up with hot feet every evening and can't sleep for a few hours. In the morning, my feet feel swollen and tender for the first five minutes. Is this related to the perimenopause? I am otherwise fit and healthy, 5'6, 10 stone (weight gained one stone in the last year).
A: Yes, this could be related to the hormonal shifts of menopause. I would recommend researching Chinese medicine use, although I would recommend speaking with your GP as well to rule out other possible causes to discuss treatment-appropriate strategies. The British Acupuncture Council maintains a list of qualified and insured acupuncturists.
Is detection normal during perimenopause?
Q: Joan, 47: Are occasional blood stains a normal symptom of perimenopause?
A: Dysfunctional uterine bleeding - bleeding that occurs outside of the usual bleeding pattern - is very common during perimenopause and is often due to a shift in hormone levels. Apart from that, bleeding can occur for other reasons as well. This is why it is always a good idea to talk to your GP about changes to your bleeding. So many women don't do this and it's a habit we need to get out of regardless of what age we are.
Would birth control mask the signs of perimenopause?
Q: Helen, 40: Where does hormonal birth control fit with perimenopause and HRT? When I was 37, I got a terrible PMT and used the Evra patch to manage it. Will it mask the signs of perimenopause? What is the difference between hormonal contraceptives and HRT and how do I know when to switch from one to the other?
A: Hormonal birth control can mask perimenopause as the Evra patch works mainly by suppressing ovulation. This means that you will not experience a menstrual cycle while taking it, just a withdrawal bleeding during the week that you skip with a patch. I love that you asked that question, and there is a whole chapter in my book on sex that covers contraception and HRT.
Could I still get pregnant at 55?
Q: Louisa, 54: I've been on HRT for several years and kept taking the mini pill. One of the GPs said he hadn't prescribed the post-55 pill. I'll be 55 in a few weeks and stopped taking the pill 5 days ago. This is my first period in a few months. Can I still get pregnant?
A: According to NHS guidelines, contraception is unlikely to be required after age 55 as the median age at menopause is 51 and it is recommended that you use contraception for 2 years after your last menstrual period. The bleeding episode you have described may mean that your body has got used to stopping the minipill. However, you should speak to your GP about whether or not ovulation is likely at this stage and see what they recommend.
Can I do something about my adult acne?
Q: Claire, 47: Historically, I have had acne and in recent years it has come back, usually the week before my period. Is this likely a symptom and could I ask my doctor for help? My periods are more irregular now and seem to be more frequent with longer periods of very light flow.
A: A nickname for perimenopause is second puberty and acne is partly the cause. It can be frustrating and disappointing to occur at this stage of life, and it can be due to hormonal changes. Your GP may suggest HRT, and for anything skin-related, nutritional therapists can be very helpful.
Perimenopause Power: Navigating Your Hormones Your Way to Menopause by Maisie Hill (Bloomsbury, £ 14.99) is out tomorrow. Pre-order now.
Now it's your turn. Do share your experience of perimenopause in the comments section below.
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