In a surprising revelation that challenges common perceptions of menopause, an exclusive survey has exposed the profound impact menopause can have on relationships, careers, and overall well-being.
The survey, conducted by the Menopause Research and Education Fund (MREF), asked 200 menopausal women to share their experiences and symptoms candidly. This was followed by an extended study by Pause Live, which is still ongoing, exploring how these symptoms are treated and how women can access the help they need.
Asian Voice spoke to Dr Shirin Lakhani, a GP and aesthetic practitioner, specialising in intimate health, sexual dysfunction and menopause.
- What are some of the most commonly overlooked symptoms of menopause that women should be more aware of?
There are many symptoms of menopause, but these are some of the key signs.
These include hot flashes and night sweats, difficulty concentrating, nausea, joint aches, memory loss, palpitations, reduced libido, a change in the normal pattern of periods, difficulty sleeping, and reduced muscle mass.
There are also some lesser-known symptoms that many overlook when it comes to menopause, such as hair loss, mental health issues, recurrent urinary tract infections, and an increase in allergies. Women may also experience joint pains, dry or itchy skin and ringing in the ears.
- In your experience, how does the lack of understanding and awareness about menopause among healthcare providers impact the treatment options available to women?
Many healthcare providers in the UK just aren’t equipped with the right information to help their patients when it comes to menopause, which can be really damaging for women trying to seek help for their symptoms.
Women are often told to accept their symptoms and just “get on with it” as menopause is an inevitable part of ageing. They are often led to believe that the risks of HRT outweigh the benefits, which in the majority is not true.
I advise taking HRT if a woman is suitable for it and chooses to take it. Women often suffer from symptoms for years but do nothing about it. The stigma surrounding HRT is often exacerbated in women from ethnic minorities.
Often GPs just aren’t aware of the benefits of HRT to women. The attitude of GPs, and the health service as a whole, really does need to change
Even with all the information now out there, some GPs still see prescribing HRT as inconvenient and that its use should be avoided.
Often women are prescribed antidepressants instead. GPs don’t focus on the benefits, which are plentiful from preventing heart disease, osteoporosis and dementia, which are all linked to low oestrogen.
While low-dose antidepressants such as SSRIs and SNRIs have been shown to improve the vasomotor symptoms of menopause and may be useful in women who are unable or unwilling to take HRT, in my experience treating with antidepressants like this can instead result in side effects that are similar to those associated with the menopause. This includes problems with concentration, problems with sleep and a decreased libido.
We are forgetting that it is often these symptoms of menopause that can result in patients suffering from depression and anxiety in the first instance.
If your GP is not being responsive to HRT, I would advise seeking out a specialist menopause clinic. These are mainly private but there are some NHS menopause clinics.
- Can you elaborate on the role of testosterone in managing menopausal symptoms, and why it is only available "off-label" for women?
I have always considered testosterone to be essential in hormone replacement in women.
I was fortunate to have trained under an excellent gynaecologist, who taught me the importance of HRT despite the fears surrounding it at the time.
Unfortunately, the NHS do not recognise this and as a result there currently isn’t a licensed testosterone formulation for women in the UK. Therefore, on the NHS women are prescribed the male version “off-label”.
Testosterone is essential for sex drive, metabolism, muscle strength and bone density in women.
Symptoms of low testosterone include decreased sex drive or decreased sexual satisfaction, impaired cognition, fatigue and low energy.
As a result of the lack of a licensed formulation, women have to either use formulations designed for men (at much higher doses) or obtain compounded testosterone (Bioidentical HRT). Often there is a postcode lottery as to whether GPs will prescribe the off-label formulations on the NHS.
I am seeing more women for HRT in general and this includes women who have managed to get NHS prescriptions for oestrogen and progesterone but are unable to get testosterone. It is essential that women have access to a licensed female testosterone product and that access to it is standardised across the UK.
- What advancements or emerging treatments in intimate health and menopause management are you most excited about, and how might they change the current landscape of care?
I think the opening up of dialogue around menopause has been incredibly beneficial for women, with many celebrities openly speaking out about their experiences and increasing awareness around menopause. We still have a long way to go as the message is not reaching everyone, particularly ethnic minorities and women in areas of socioeconomic deprivation.
There have been some fantastic developments in both intimate health and menopause management but these are not widely available unless you seek them out privately.
For example, I offer a range of intimate health treatments for conditions such as vaginal laxity, urinary incontinence, menopausal atrophy, sexual dysfunction and dermatological conditions such as lichen sclerosis which are non-invasive and drug-free.
