Is it me?  I have the worst mood swings

Emotional upsets are not uncommon, but there is no doubt that many women suffer worse during the menopause. Feelings of depression, irritability and anxiety are common during the menopause - you are not going out of your mind.  Counting to 10 helps some women, but not all.  Often speaking to friends and family can make you feel a little better.  You can even warn family and friends in advance, let them know this is a common problem and encourage them to be a little more patient with you. There are also Menopause clinics/mornings at some surgeries, it is a good idea to visit one and discuss how you are feeling. 

I'm always in the loo!

The lining of the bladder during the menopause may become thinner, and some women become more prone to urinary problems, such as frequency, cystitis or incontinence.  Practice pelvic floor exercises to stengthen pelvic muscles and help urinary problems. 

How can I stop a hot flushes as it happens?

Don't be embarrassed.  Breathe deeply and try to relax.  Sit still until it passes.  For some, acupuncture can also help with this particularly side effect.  Soya is rich in natural isoflavones and can help.

I am having trouble sleeping.  Wide awake most of the night and very restless although tired.  The hot sweats are not too bad.  What can I do which will help?

Insomnia and restlessness are very common symptoms of the menopause.
Here are some tips for aiding a restful nights sleep.

• 1) Don't eat too late. Allow at least 3 hours after eating before going to bed and try to eat your lightest meal in the evening keeping you main meal for lunch if possible.
• 2) Don't drink caffeine or alcohol in the evening as these are both stimulants not to mention their diuretic affect which is bound to have you up in the night to pass water!
• 3) Get some exercise every day even if it's just a brisk walk. The early evening is the best time for this as it will help wear you out.
• 4) Try not to nap during the day. If you feel exhausted sit down for 15 minutes with your eyes closed and clear your mind. This should rejuvenate you until bedtime.
• 5) Make sure your bedroom is quiet with black out blinds and dim lighting. The room should be cool. Ban the TV to the living room. It does not lend to restful sleep.
• 6) Take a warm bath late in the evening with lavender essential oils and dim lighting. Use this time to do some deep breathing exercises relaxing you for the night ahead.
• 7) Before getting into bed write a list of things you need to do tomorrow or concerns playing on your mind.
• 8) Wear loose cotton clothing and only sleep in 100% cotton sheets/duvet cover. These will reduce the overheating common during the menopause.
• 9) A diet high in vitamins E, C and B and Phyto-oestrogen like Soya and tofu are said to be helpful. Vitamin E can be taken as a supplement or found in hazelnuts, almonds, sweet potato and avocado. Vitamin B can be found in Brazil nuts, sesame seeds, avocados and some oily fish like salmon and sardines.

Aim for no more than 6-8 hours of sleep. We need less sleep as we get older. Set your alarm for the morning and make sure you get up even if you've had a dreadful night.

What are the dangers/risks of HRT?

Things have been very confusing for women over the last 10 years as far as the reported dangers of HRT go.

What we now know is that breast cancer is more common in certain HRT users than in the general population. We also know is that this risk increases with the duration and type of treatment. For 1000 women aged 50-70, 45 will get breast cancer who never take HRT. An extra 2 cases will be seen in HRT users of 5-10years,an extra 6 in over 10 years use and an extra 12 in over 15years use.

Women with a strong family or personal history of breast cancer should avoid HRT except under specialist supervision.

HRT also increases the chances of having a stroke or thromboembolic episode like a blood clot in the deep veins of the legs or the lung(a Pulmonary Embolus). This risk is small and for most women using HRT can be ignored but if you have a strong family or personal history of blood clots or strokes HRT should be avoided.

Originally it was felt that HRT reduced the risks of heart disease but later studies show a slight increase in the incidence of heart disease and stroke. This seems to be in women 20 years post menopause in whom the presence of early blood vessels disease before starting HRT may have been exacerbated by HRT. Advice therefore is not to use HRT in women with known heart disease.

The general consensus now is that HRT should be used for the shortest period necessary to control moderate to severe symptoms of menopause that cannot be controlled by any other means. It is felt that for up to five years of treatment the benefit of HRT probably outweighs the increased risk for the vast majority of women.