Relief from menopausal flushes

The depletion of  estrogen stores in a woman’s 40s marks the end of the production of eggs from the ovaries, and therefore the end of periods or the ability to conceive. This decline in estrogen has a direct effect on the thermostat in the brain, the hypothalamus, which regulates temperature. It receives a wrong message that you are hot, and this brings on the changes to blood vessels that seek to cool you down.

While estrogen is declining and follicle-stimulating hormone (FSH) is fluctuating, you get vasomotor symptoms. Most women experience hot flushes for between 6 months and 2 years, until the FSH stops going up and down and instead starts to decline. Hot flushes should cease after this.

Hormone replacement therapy (HRT) is the only medication known to reliably reduce menopausal flushes (although certain other prescribed medications may have some effect). HRT, which contains estrogen, is only available from a doctor or licensed pharmacist, if you meet the prescription criteria.

The decline in estrogen has a direct effect on the plumpness and hydration levels of the skin, especially around the vagina. Known as vaginal atrophy, this can cause symptoms such as itching, burning, pain during sex, bleeding during or after sex, and urinary symptoms such as increased frequency, urgency, incontinence, infection or discomfort while peeing. This can be further complicated by changes to your libido (sex drive) during menopause.

Estrogen replacement in the form of a vaginal ring, tablet or cream can help redress the balance around this area, but this needs to be prescribed. There are other measures you can take to make the area feel more comfortable.

For hot flushes, a bit of planning in your home or work set-up, your diet and your wardrobe can really help. Here are a few pointers to keep hot flushes at bay:

• wear loose cotton clothing and layer-up so you can peel off as needed
• limit alcohol and smoking – both can exacerbate hot flushes and interrupt sleep – aim to quit smoking altogether for all-round good health
• avoid spicy or very warm foods, as these trigger vasomotor symptoms which will exacerbate hot flushes
• make sure you keep your bedroom cool at night
• keep a fan nearby or window open and a cool drink at the ready while working or relaxing
• lose weight if you are overweight or obese

Regular exercise can help relieve stress and boost your levels of feel-good endorphins.

There is some evidence that cognitive behavioral therapy (CBT) may help some women with hot flushes.

For vaginal atrophy, the following measures may help:

• a lubricant before sexual intercourse
• a vaginal moisturizer to relieve dryness

Blood tests to diagnose menopause are not routinely offered to women aged over 45. A diagnosis of menopause is based on your age, regularity of your periods, and other symptoms you are experiencing, and you may have no reason to see a doctor if you fit this picture. In addition, blood tests can be difficult to interpret as some female hormones are fluctuating, which could give an unreliable test result.

There are other medical conditions that can cause your periods to stop. It is important to see your doctor if your periods stop before you are 45, if you are having symptoms that are not typical menopausal symptoms, or if you have had significant changes to your usual menstrual bleeding. If you are experiencing severe menopausal symptoms you should also see your doctor in order for them to discuss treatment options with you.

If you have started bleeding again after you are post-menopausal (one year of having no periods) you should book an appointment to see your doctor. This is because bleeding after menopause usually needs investigating to ensure the lining of the womb (endometrium) is normal.

Your doctor will ask you about your medical history and your current symptoms, the regularity of your periods and when the last one was. They will take baseline health measurements such as your blood pressure and they may order a blood test. They will then discuss any treatment options with you if you require them.