Wednesday, 23 February 2011

#Menopause and bowel function

Previous research, including surveys on Menopause Matters, has shown that many women experience poor bladder control. which often starts or is worsened by the menopause. Despite this causing significant distress, many women do not seek help because of embarrassment, acceptance of the problem, or lack of awareness of treatment options. It is possible that the same mechanisms leading to urinary incontinence, pelvic floor damage during childbirth and then later reduced strength of the pelvic floor muscles due to the estrogen deficiency of the menopause, can also affect bowel control. We have no idea how many women may be affected by lack of bowel control, ie faecal incontinence, and how many are suffering in silence.
To shed some light on this potentially huge problem, please take a few minutes to complete this anonymous questionnaire, whether or not you are affected.

Monday, 21 February 2011

Preventing #menopausal vaginal changes

For many years, the menopause was associated with hot flushes, night sweats and mood swings, with little regard for either the “intermediate” or “long term” consequences of estrogen deficiency. We now have increased awareness of the later effect of estrogen deficiency on bone density with increasing risk of osteoporosis and we are still learning about the significant effects on the cardiovascular system. Although we have unquestionable evidence that estrogen deficiency leads to significant effects on the vagina and bladder, (urogenital atrophy), we are still very poor in both identifying and treating the “intermediate” symptoms.

It is thought that urogenital atrophy causes signs and symptoms in up to 50% of all postmenopausal women, yet why do only about 25% of those with symptoms seek medical help and of those, even less are treated? Both women and healthcare professionals seem to continue to be reluctant or unable to address this serious issue perhaps due to embarrassment, lack of time, acceptance of the symptoms being an inevitable part of ageing, or lack of appreciation of the scale of the problem. It was heartening to see the International Menopause Society focus on Vaginal atrophy with the publication of recommendations, a slide set and patient information leaflets to mark World Menopause Day this year. It is hoped that the surrounding publicity will go some way in enabling women to feel able to report symptoms, and in encouraging healthcare professionals to ask appropriate questions when offering menopause counselling, and opportunistically, for example when women are attending for cervical smears.

Perhaps we need to take even further measures to really tackle the burden of this problem. Some women have such severe atrophy that even the gentlest of examinations to exclude a serious cause of postmenopausal bleeding is impossible without causing significant discomfort. Many such women may not have been able to be sexually active for many years, living with discomfort, distress and sometimes relationship problems and rejection. At this stage, the changes may be irrevocable whereas early treatment can halt the progression of the condition, restoring the physiology of the urogenital tract to normal. Why do we allow the vagina to become so fragile and painful when safe effective treatments are available? Why do still, so many women with postmenopausal bleeding have to go through the frightening experience of fast track investigation with the worry of an underlying cancer when, for so many, vaginal atrophy is the cause? Why do so many women suffer from urinary symptoms and have repeated courses of antibiotics when local estrogen can have such a beneficial effect?

Even if these symptoms and presentations are recognized, vaginal estrogen tends to be tarred with the same brush as systemic HRT with concerns about risks and uncertainty about duration of use. With more evidence appearing to show that systemic absorption of low dose vaginal estrogen is minimal, perhaps it is time to consider the case for preventetive estrogen in women who either choose to stop HRT, or do not require HRT at all. If even very low dose vaginal estrogen is undesired, then a range of lubricants and moisturizers which can ease symptoms are now available.
The answer must lie with grasping the opportunity to discuss urogenital health whenever possible, looking for early signs such as flattening of the vaginal walls, and having the knowledge and experience to offer effective treatment, even if symptoms are not yet apparent or are very mild, and to continue treatment long term, before the changes become untreatable.
See a whole section on vaginal problems at

Tuesday, 8 February 2011

Risks for #breast cancer

There was much interest in the media last week about the current incidence of breast cancer in the UK, with 1 in 8 women now being affected, while this figure was previously 1 in 9. Much discussion took place about the possible cause of this increase, with diet and lifestyle factors featuring. It has been recognised that drinking 2 or more units of alcohol per day, or being overweight after the menopause are associated with significant increased risk of breast cancer yet there is generally a low level of awareness of these important factors. I was delighted that the recent publicity highlighted these issues.
However, much mention was also made of the risk associated with the use of HRT. While it is known that using certain types of HRT for a long time is associated with a small increased risk of breast cancer, there is no evidence that HRT actually causes breast cancer. More likely is that it may stimulate the growth of abnormal cells which are already present in some women. This association must be taken into account when considering the risks and benefits of HRT and when deciding on how long to take HRT, but the risks should be kept in perspective, and there should be more awareness that alcohol intake and being overweight are by far greater risks. See a useful chart demonstrating this at

Thursday, 3 February 2011

Managing the #menopause

We are due to hold a symposium with the leading menopause specialists in the UK and would like to present the public perception of the menopause and its management by the medical profession. Consequently, we would be most grateful if you would complete a short questionnaire. It will be anonymous, but your views will be invaluable for the ongoing management of menopause in the UK. Please help by taking just a few minutes to complete the questionnaire at

Tuesday, 1 February 2011


The perimenopause is the stage when ovarian function is changing, often leading to a change in periods and the early signs of estrogen deficiency. It can be a very confusing time since the ovaries can produce different levels of hormones from month to month. This fluctuating stage can last for a few years before the ovarian hormones are very low, the lining of the womb stops being stimulated and hence periods stop--THE MENOPAUSE. Following the menopause, defined as the last period, estrogen deficiency symptoms may occur but then the situation is less fluctuant and can be easier to treat.
Treatments around the time of the perimenopause have to take into consideration control of bleeding, contraception requirements, and control of early estrogen deficiency symptoms, not to mention all the life stresses which often occur at the same stage, all very challenging at times.
Don't miss the Medical Matters programme, BBC Radio 4, on perimenopause on Wednesday 2nd Feb 2011 at 3.30pm, with an interview with myself. After the programme has aired a link to the prog will be on our Multimedia page .