The following questions were submitted by the webcast audience on the night of September 1.

Additional questions submitted as part of the webcast evaluation have also been added. The answers were provided by Jean Hailes Foundation doctors.

The answers are not intended to replace a consultation with your health professionals. Please consult your medical practitioner if you need further advice or information.

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I have had a hysterectomy; do I still need to have a pap smear? Also, since I have had a hysterectomy, how will I know when I have gone through menopause?

After a hysterectomy you do not need a pap smear except if:

• you have had a previous abnormal pap smear such as CIN or dysplasia due to HPV (human papillomavirus)
• or you had the hysterectomy for cancer

After hysterectomy there is no longer the period to act as a marker of menopause. You may develop menopause symptoms which will tell you the ovaries are winding down but if you don’t have symptoms you will not know.

Are the any symptoms/treatment of perimenopause & menopause different or unique to women who've never had children?

No there is no difference and any symptoms will be managed in the same way as for a women who has had children

I have a past history of not tolerating Progestin creams or minipills with Progesterone; does that make it unlikely I would tolerate HRT? 

It may mean that if you have had difficulty with progesterone or progestins you may have similar side effects with the same type of hormomes.

I have intramural fibroids; does this mean I cannot take Oestrogen therapy alone unless I had a hysterectomy?

No, fibroids are not a contraindication to HRT but the reproductive hormones may increase fibroid size. There is one hormone therapy (tibolone) which is less likely to stimulate fibroid growth

Does endometriosis and adenomyosis result in a different experience of menopause?

Not necessarily as both conditions regress after menopause.

Is constant breast tenderness common in perimenopause or an indicator for the beginning of menopause?

Breast tenderness in the perimenopause may be due to the changing hormones but should also be checked by your doctor.

Are there any alternate/herbal remedies for the peri-menopause/menopausal symptoms?

A women’s health trained naturopath would be able to prescribe therapies that may help perimenopausal symptoms.

Are there any specific treatments for thinning hair on the scalp especially male pattern thinning?

Hair loss should be investigated to exclude other causes including thyroid disease and iron deficiency. If hair loss is caused by androgenetic alopecia (sensitivity to male hormones) there are different medications which my help the condition. See your doctor for advice.

What exercise is best for pelvic floor strengthening?

The Jean Hailes Health for Women website has information about pelvic floor exercises and strengthening specific to incontinence. Please click on this link http://www.healthforwomen.org.au/health-issues/30-incontinence#5

There is also a resource available from the Jean Hailes online shop http://shop.jeanhailes.org.au/index.php  called Incontinence: the hidden epidemic

Is there an increase in incidence of urinary tract infections due to tissue thinning and sex as women age? What can be done about it?

Yes there is an increase in urinary tract infections (UTI) due to the thinning of the urethra and lower part of the bladder. Recurrent UTIs postmenopausally are reduced by the use of vaginal oestrogen therapy.  See your doctor to discuss your options.

Is low libido directly associated with estrogen levels? Would taking estrogen increase libido?

Low libido can occur for many reasons but after menopause taking oestrogen may help.

 If you are using contraception how do you know when you have gone through menopause? And how do you know when its safe to stop using contraception?

This is a very good question because you may not know. Research studies have not shown when is the best time to stop.  If you are fit and well, do not have high blood pressure and have a low risk for cardiovascular disease, stopping the pill in your early 50s may be safe. When you to stop the pill you will still need to use contraception such as condoms until it has been established whether your periods have stopped. Blood tests to check your hormone levels performed over a number of months may indicate postmenopause

Could a total lack of libido be associated with ones tubes being tied or having a hysterectomy?

No total lack of sexual desire is not associated with the surgical procedure of tying of the tubes.

After hysterectomy, sometimes if you are premenopausal the hormones may drop temporarily or permanently which may have an effect on libido.It is important to look for other reasons for lack of libido particularly in relation to your body image, role and purpose in life and relationships.  Some women react negatively to operations involving their reproductive organs as it leads to loss of ability to have children and feel a loss of femininity and sexuality

Is increase in facial hair due to changing hormones? How can it be managed? Is it going to get worse as oestrogen levels decrease further?

Some women may develop hirsutism (an excess of hair on the face and/or body) during or after menopause, particularly in the facial area. This is because of several factors including weight gain over menopause and change in hormone levels.

For more information on management see here

http://www.managingmenopause.org.au/about-menopause/hirsutism-excess-hair

I went through premature menopause in my 30s and have been on HRT ever since (12 years). I have tried going off HRT a couple of times but the symptoms come back thick and fast. What would be the usual length of time someone like me would have to continue on HRT?

The usual recommendation for women who have had a premature menopause is to continue the use of HRT until about the age of 50. See you doctor to discuss the most suitable approach.

I have early menopause due to having chemo last year (I had breast cancer). I have terrible hot flushes & night sweats. Is there anything I can take or do to minimise this? I am not allowed to take HRT.

Yes there are non-hormonal medications that we prescribe for women such as yourself. The 3 medications we may use which have been shown to reduce flushing and sweating are: Efexor, an antidepressant, Clonidine, a medicine for blood pressure and Gabapentin, an anti epileptic and chronic pain medicine. We say these medicines are being used 'off label'. Talk to your oncologist to refer you to a doctor or clinic with menopause expertise.

How can I heal fragile split skin around the vulva?

Vulval conditions with splitting can occur for many reasons, See our fact sheet – Irritation of the vulva. You should see your doctor to have an examination or see a gynaecologist.

How safe is hrt for early menopause?

The treatment for early menopause is HRT, and it is recommended that women remain on HRT till about 50.

It is considered safe in that the risk of major illness would be less than being on the Pill. If HRT is not given there is a risk of early onset of osteoporosis and heart disease.

Is HRT safe?

There have been many studies now, looking at hormone therapy use over a long period of time. The controversy is around breast cancer, and hormone use for a long period of time. It will depend at what age it is started and how long it is taken for. Hormone therapy helps prevent osteoporosis and has been shown to decrease bowel cancer in women who used it. There are also risks with increased blood clotting, and this may depend on the form it is given. For more information, I suggest that you look at our website (www.managingmenopause.org.au) which has the latest information available about the safety of HRT.

I get terribly moody at ovulation, rather than right before my period - is this just a hormone fluctuation?

There is a very rapid rise in oestrogen and a rapid fall at the time of ovulation which may contribute to mood swings at that time. 

My GP suggested I take B group vitamins to help my mood swings. Do these help?

For many years we have recommended certain B group Vitamins as a treatment for PMS. These are B6 or pyridoxine at a dose of 50-100 mg taken for 2 weeks before a period. These vitamins are involved in some of the hormone production that affects the cycle. However we have no scientific evidence that these do make a difference to mood across a large group of women. There are many other factors that may contribute to mood changes and these often need to also be explored. Multi B vitamins have been used for stress reduction over the years, but again we have no scientific evidence to support this.

I do not have periods on HRT. How will I know when I have "gone" through menopause?

If your periods had stopped before you went on HRT then you have had your menopause, however if you started on HRT before your periods stopped then you will not know that you have had your final menstrual period until you stop taking HRT.

What changes should a woman who is approaching her mid-forties – who has had a hysterectomy and left ovary removal in her early forties – expect to go through?

Are there differences to a woman approaching menopause 'normally'? The forties will progress similarly for everyone, except you do not have periods and the perimenopausal changes may be the same.

I am a fit and healthy 52 year old on HT who had early menopause. How long can I stay on HT?

When women who have had an early menopause reach about the age of 50, it is recommended to reduce the dose to determine whether menopausal symptoms are still occurring. If they are, and it is interfering with your quality of life then HRT (also known as HT) needs to be continued with annual reassessment. If the symptoms do not occur then HRT can be stopped.

Is it ok to read in bed rather then watching tv?

It is fine to do whatever activity will relax and prepare you for sleep.

Will I reach the menopause at the same age as my mother?

We cannot predict at what time a woman will reach menopause at present. Sometimes this is the same time as your mother, but not always. If your mother had very early menopause it may increase your risk for an earlier one, but many women may still be cycling at 56. Average age of menopause is 51.

You didn't talk about ovarian cancer in the webcast is this common in the 40s?

Ovarian cancer is more common after menopause, but can still occur in the 40s. It is more common in women who have not had children also. If you have a family history of this it is important that you talk to you GP about regular screening.

Symptoms can be quite vague, so if you are concerned mention this to your GP for further testing. We do not screen everyone for this like we do breast and cervical cancer.

What is the best way to prevent bladder and pelvic floor problems?

There are several things to do to assist this – keep weight down to normal levels – increased weight can worsen incontinence. Drink plenty of water and decrease caffeine, avoid constipation. Go to the toilet regularly rather than holding on Exercise such as Pilates is often useful to strengthen your pelvic floor. A visit to a Pelvic floor physiotherapist to teach exercises to strengthen you pelvic floor specifically is very useful.

Dear Elizabeth, is it common to experience 2 periods in some cycles during the perimenopausal years – eg a cloudy, brownish lighter flow period followed by a 'normal' period 2 weeks later, followed by a month break and a normal period? Thank you for this evening's webcast – excellent!

Thank you for watching. We enjoyed talking together to bring you the evening. It can happen that you can have more than one period in a month, but if there is less than 3 weeks from the start of one period to the next, and this keeps happening, you should see your doctor.

My doctor says I have osteopenia what is this?

Osteopenia is a mild thinning of the bones- usuall represented by your Bone Density scan test – looking at hips and spine levels. Your levels are slightly below what would be normal for a similar person of your age, but are not yet low enough to be called osteoporosis, with a marked increased risk of fracture. It is important that you have adequate calcium inyour diet, check Vitamin D levels and do regular weight bearing exercise. Your bones should be checked again in 2 years or at menopause to make sure the density is not decreasing.

I am 48 and have had a hysterectomy. How will I know when I have gone thorugh the menopause?

Because you are no longer cycling, sometimes it is difficult to tell. If you develop menopausal symptoms such as hot flushes, sweats or vaginal dryness, this may be a signal. The best way for you is to have a blood test to check your FSH and oestrogen levels. This is a good indicator if your FSH levels are at menopausal levels. When women have had a hysterectomy, this is one situation when we do order hormone levels in the perimenopause.

Is weight gain inevitable?

No, weight gain is not inevitable. Unfortunately it is a balance of energy consumed and energy used. Our body shapes may change and waists thickened up. We need less calories as we age (smaller plate is useful) and increase our incidental activity.

Does the Jean Hailes Foundation have counsellors that women can access?

Please contact the Jean Hailes Foundation Medical Clinic in Clayton on 03 9562 7555 to check on the availability of counselling appointments or check our webcast resources page for links to other services.

Do women need to take a multivitamin supplement?

Most women don't need to take a multivitamin, provided their diet is adequate in fruit, vegetables, iron and calcium. If these are poor then a multivitamin supplement is useful. Some doctors believe that adults over 50 should take a multivitamin, however there is little scientific evidence for this . It is also important to have adequate sun exposure for Vitamin D levels.

How often should blood tests be done when on HRT?

Blood tests are not normally performed for hormones when on HRT as it is symptom relief that is the way of telling the doses taken are appropriate, not the blood level. Blood tests are never performed for oral therapy but may occasionally be used with patches and gels if there seems to be a problem of the woman absorbing her oestrogen.

Assuming you have many of the symptoms of perimenopause, what tests, if any, are used to diagnose perimenopause. Thanks.

Perimenopause is a time in a woman's life in which the diagnosis is not made on blood tests. If a women is in her forties, especially late forties, then she is probably in what is known as 'perimenopause'. Changing periods are often the first sign. The average legth of time of the perimenopause is 4-6 years.

I've been having terrible headaches since the birth of my children. I'm 46, they are 6 and 4. My GP says its just stress.

Headaches can be caused by a variety of causes – neck problems, eyes problems and stress. If they are related to your menstrual cycle, as determined by making a diary, then sometimes these can be helped by using a variety of medications . Perhaps you may need to ask your GP for a referral to a neurologist to further assess your headaches .

I keep putting on weight even though I eat the same way and do exercise - how can I stop this?

As we age our metabolic rate slows down. So our bodies don't need the same amount of food. We need to eat smaller portions, otherwise it will keep being stored as fat. Exercise also needs to be increased slightly to accelerate the slowing metabolic rate. Watch alcohol as a hidden source of calories too.

Will this webcast be available to watch later? I'd really like my husband to watch it but he was putting the children to bed.

If he wants to watch it in the next 24 hours he can do that and it should be available to watch in the future, keep your eye on the Jean Hailes website.

What treatment is the best for a prolapse?

There are many different types of vaginal prolapse, the front (cystocele) or back (rectocele) vaginal walls may prolapse or there may be a uterine prolapse. However many women have prolapses that never worry them, but if there are symptoms see your local doctor. Sometimes just doing pelvic floor exercises may be enough to hold up the prolapse and relieve symptoms. Otherwise there are pessaries or rings which are inserted into the vagina to hold a prolapse up. If neither of these treatments are helping then surgery may be needed. However, a careful assessment of a prolapse by your doctor and a referral to a gynaecologist may be necessary to decide on the correct operation.

Is it normal to feel cold before a period?

I am 47 It is possible to get a variety of symptoms before a period, which are related to several hormone outputs. Each person can have different symptoms. This one may be due to subtle changes in your blood vessels before a period.

What age do you suggest going off the contraceptive pill?

The pill can be continued until at least 50 years, providing there are no risk factors such as smoking, blood pressure, diabetes or high cholesterol or heart problems or clots. There is no actual cut off age that we have, but we know over 50 your clotting and heart disease risk increases on the pill. Some women in their late 40's may decrease to a lower strength pill for the last few years. This is still a reliable contraceptive. In the early 50's it is also important to know if you have already gone through menopause as being on the pill can mask this. This will require back up contraception, as over 50 you need 12 months of no periods to ensure no pregnancy.

I just turned 40 and my facial hair became noticeable. Is it going to get worse in time?

Facial hair may have many causes but as we transit through the 40s to the years after the periods stop, we have more testosterone compared to oestrogen, and so facial hair may increase. However, there are other causes which should be checked by your local doctor.

I keep getting thrush infections, what can I do to prevent this from happening?

When recurrent thrush infections occur it is important to see your local doctor to make sure it is an infection caused by the yeast Candida, and not due to some other cause such as an allergy to soap, condoms, pads or tampons used for the period. Having a vaginal swab is important to detect the cause of the infection so that the correct treatment is prescribed.

I am too embarassed to discuss my sexual problems with my male GP what should I do?

You may be able to discuss this with another female GP in the practice, or access a womens health clinic with female doctors. If you are in the country and have no female GP access, community health nurses are approachable about these subjects

How do I go about getting a 45-49 year old health check?

All doctors' practices will handle these extended assessment consultations differently. For this reason we advise that you make an initial appointment to discuss with your GP the appropriateness of the check for you. If the check is recommended it is likely that another longer consultation will be required for the check to be carried out.

Is replens only available by prescripton?

You do not need a script for Replens. It may be behind the pharmacy shelf.

What about skin changes as we get older - like increased acne?

Skin changes occur with age – usually increased dryness of the skin as hormones can affect oil production. It is more unusual to develop acne with age. This may recur if you have had it previously, and some women do develop adult onset acne. It is important to make sure that it is not another skin condition or that there are no other causes for your acne. It is important to see your GP to discuss this.

I went thru early menopause - 37 yrs old. I am now 46 and am experiencing increasing lack of bladder control. What has caused this and what do I do about it?

When a women goes through early menopause and does not receive any hormone replacement the tissues in the vagina, bladder and pelvic tissues lose oestrogen and can cause weakness in the bladder and vagina. See your GP and a pelvic floor physio may help.

I was diagnosed with premature menopause 7 years ago and since then I have been taking the pill to keep my oestrogen levels up. I am now 45. Would it be better to be taking hormone replacement therapy instead? Would that improve my libido?

If you are fit and healthy, are a non-smoker, have no high blood pressure nor a family history of early onset of heart disease, then continuing the pill is an option till about 50 years. If you have libido problems then you should consult your doctor as you may be better on HRT.

I have been told that my FSH levels are high, what does this mean? Do I need to do anything about this?

As women move through 40s more cycle changes occur and FSH starts to slightly rise indicating the ovarian function is starting to wind down. The FSH rises more dramatically in the late perimenopause but oestrogen levels can swing quite widely, very high and very low, eventually falling to a low level by the FMP. FSH also becomes high for a short time with ovulation. For these reasons Hormone testing is not recommended as it does not give useful information about when menopause will occur but just suggests that changes to hormone levels are occurring.

I think I am entering menopause, should I consult my GP? Can or will they do anything?

A health check up in the 45-49 year age group is appropriate, and your regular pap smears if your experience is without difficulty.

I feel like I am about 5 degrees warmer than any one else, is this normal?

An increase in body heat may be a sign of being in the perimenopause but there also other causes such as thyroid problems particularly if you have other symptoms.

I am 44, is there anything I need to be mindful of when still using the mini-pill for contraception and approaching peri-menopause? Should I be exploring other options?

I assume by the mini-pill you mean a low dose progestin pill. It may be more appropriate to switch to other forms as you may get more irregular bleeding especially if your cycles are not coming monthly. Often women in their 40s have heavy periods so a combined pill or the progestin releasing IUD may be more suitable.

My periods are currently all over the place in terms of timing and length? I know this is part of perimenopause. When or do I need to consult a doctor? Should I just ride it out?

If your periods are occurring less than 3 weekly and you are having bleeding between your periods, or if the periods have become uncomfortably heavier you should see your doctor.