We launched our #MidlifeMoments video series with a Q&A with the brilliant Dr Stephanie Goodwin. The series runs as an Instagram Live on @wearehylda, so that you can ask your midlife health and wellbeing questions direct to a doctor. The videos are then saved on our IGTV channel.
A GP and menopause specialist, Dr Goodwin is one of the Hylda medical team. She is passionate about ensuring women know the facts – not the fictions – about the menopause and the midlife years.
You can watch all of our #MidlifeMoments videos with Dr Goodwin, along with our #DIYMidlife series on topics from how to touch up grey roots, to the best exercises for midlife fitness, over on our IGTV channel.
Here’s what we learnt from our conversation with Dr Goodwin.
The definitions you need to know for midlife
“The menopause just means that you haven’t had a period for a whole year,” says Dr Goodwin. “You often don’t know you’ve had the menopause until a year later. The time leading up to that is the perimenopause. That can last anything from six months to five years. It’s in the perimenopause that women start to become symptomatic.”
The most common midlife health symptoms
“The most common symptoms that I see and talk to women about are hot flushes and hot sweats, night sweats, muscle pain, brain fog and poor concentration,” says Dr Goodwin. “Many women in all sorts of jobs find it really difficult to function.”
She also hears lots of issues with vaginal dryness and soreness, and lack of libido.
Anxiety is a biggie
“I’ve observed that women learn to live in a state that is not how we should be,” says Dr Goodwin. “We accept it as the new norm. Many women will go and chat to their GPs about it, presenting with anxiety and mood changes. One lady told me that her GP just said, ‘that’s just how it is, you have to get on with it’.
Loss of confidence is a common midlife affliction. “It’s a subtle thing,” says Dr Goodwin. “Sometimes it’s from poor concentration and memory and people feeling that they’re not of use. They withdraw a bit. Social isolation can be a problem. I think the psychological changes can be very distressing, they creep up on you.”
Many women are prescribed anti depressants which is not appropriate. “The NICE guidelines say that the first line of treatment for women with anxiety symptoms around the menopause is HRT not anti depressants,” clarifies Dr Goodwin. “The mood is often the first thing that goes.”
The truth about HRT
“Let’s start with benefits because there are so many,” says Dr Goodwin. “There are immediate benefits. You feel better and the symptoms like hot flushes, sweats, brain fog, poor sleep, lack of concentration can go away within a few days. You feel back to normal.”
The good news doesn’t end there. “The long term benefits of HRT are very significant,” says Dr Goodwin. “You will not get osteoporosis, where the bones get very thin and you start having fractures. That’s a very significant cause of death in older women.
“Also, your risk of heart disease is reduced by up to 50%. Remember, you’re seven times more likely to die of heart disease than of breast cancer. It’s one of the most common causes of death in women.
“There’s a 30% reduction in your risk of getting bowel cancer, and a reduction in your risk of getting dementia. So every part of your body is protected. The benefits are very significant.”
Don’t be scared of HRT
“What I say to women is, remember that when you use hormone replacement therapy you’re doing just that. You’re putting back a small amount of what was there before,” says Dr Goodwin. “These are very gentle hormones. They’re the same as the ones that we make in our own body. We’re just topping everything up. The reason we have menopause is only to stop reproduction, because we would be dead by the time we were 50. It’s an evolutionary thing.
Know the risks
“The breast cancer risk with HRT is extremely low,” says Dr Goodwin. “The data that’s often presented is using women from studies a long time ago, where hormones that were used were very synthetic oestrogen and progesterone.
“Things have moved on a lot since then. In the current studies, when you use the hormones which are identical to the ones that we use in our own bodies, the risk is so low. It might go up by 0.1% per year, but it’s a very small number versus the benefits.
“The breast cancer fear, when it’s presented in the press, is always explained out of context. A recent study showed that in women who use HRT, their risk of all forms and causes of death, is lower in women who use HRT than in women who don’t. So that’s what we need to be looking at.”
Your GP may let you down
The NHS is a marvellous institution, but unfortunately some GPs are letting women down when it comes to menopause care.
“I think what’s happened is that lot of doctors are not aware of current data, even though it’s in the NICE guidelines,” says Dr Goodwin. “I think menopause is not a sexy subject. It doesn’t feel very heroic. So the level of knowledge can be rather poor.
“I think doctors are often not particularly well informed, although there’s a lot of work being done to educate them. It’s definitely better than it was. It’s improving.”
When to start HRT
“You can start taking HRT as soon as you become symptomatic,” says Dr Goodwin. “Even if you’re still having periods. I’ve had patients who have been told you have to wait a year of not having a period before you can take it. That’s not true.
“Ideally, in order to get all the benefits of HRT, you want to start it within six years of your last period. That’s when you get the maximum benefits for your bones, your brain and your heart. Within 10 years would be the limit.”
When to come off HRT
This question is asked a lot. “There’s no reason to come off it,” says Dr Goodwin. “You can stay on it for as long as you like. There was a figure plucked out of the air that you can only stay on it for five years and then you have to stop. That’s not based on any evidence. You can stay on it for as long as you feel well.
“Many women will stay on it until the day they die – including me. We reduce the dose a bit as we get older, but no reason to stop taking it.”
Sexual problems and lack of libido is a very common problem. Often due to the pain of intercourse from vaginal dryness. But testosterone deficiency can affect libido as well.
You don’t need to pay for bioidentical HRT
We were keen to clarify the difference between bioidentical and body identical HRT.
“Let’s demystify this,” says Dr Goodwin. “Most doctors who are menopause specialists prefer to use hormones that are structurally the same as the hormones that we make in our own bodies. These are body identical hormones. They’re widely available, and any GP can prescribe body identical hormones for their patients.
“The oestrogen comes generally as a gel or a patch. You also take progesterone, because it stops the lining of the womb from thickening too much. The only body identical progesterone available is a capsule called Utrogestan, and it’s widely available on the NHS.
“There are companies and clinics that supply what are called bioidentical hormones. These are hormones that are also structurally the same as we make in our own body, but they are made in special pharmacies where they’re either mixed up in a cream or a lozenge. They’re expensive. Are they necessary? I’ve learned about both bioidentical and body identical and personally I don’t think bioidentical is necessary. They’re all derived from plants.
The options if you can’t take HRT
Some women choose not to take HRT, or may have had an oestrogen-linked breast cancer that makes it not an option for them.
“For those women, there are other treatments you can use for the hot flushes and sweats that aren’t necessarily hormones,” says Dr Goodwin. “That’s when we might use anti depressants. They can work really well for hot flushes.”
Testosterone isn’t just for men
“Women make testosterone, we’re meant to have it,” says Dr Goodwin. “It’s not just good for libido. It gives you joie de vivre and oomph and drive and focus. Like all of these treatments, if you use the right dose, you won’t get the side effects.
“If you use far too much testosterone, yes you might get hairy. But the doses are very small and I always tell my patients to rub it where you don’t have any hair. I normally rub it on my inner arm where I don’t have hair follicles. If you rub it where you have hair you will get more hair in that place, but nowhere else.”
HRT can help thinning hair
“There are lots of reasons why you might get thinning hair, and they can sometimes coincide with the menopause,” says Dr Goodwin. “For example, iron deficiency, which is common in women who might be having heavy periods around the time of the menopause. Or an underactive thyroid, which can cause changes in your hair.
“Certainly, oestrogen deficiency has an effect on your hair and skin. So often when women start taking hormonal treatment, the quality of their hair does improve a lot.”
The best supplements to take
With so many supplements on sale, it’s easy to end up buying lots and never taking any of them. So what exactly should we be buying to help with midlife?
“I think magnesium is a good supplement at any time,” says Dr Goodwin. “Not just for women, men can be magnesium deficient as well. It’s good for relaxation, it can help you sleep and it’s good for energy.
“At the moment, I’m recommending people take magnesium, Vitamin D (because although it’s beautiful weather we can’t go outside very much) and Vitamin C if you can get it, because it’s difficult to get hold of at the moment. Omega 3 is also helpful.
“The other one I think is important right now is some good quality probiotics. There’s a link between gut health, respiratory health and immunity, so I’d add that in at the moment.”
Aching joints are a symptom
“Muscle joint pain is very common at this time,” says Dr Goodwin. “Usually it responds really well to oestrogen treatment, because oestrogen is anti inflammatory. Magnesium can also help.
“It’s important that we keep moving. I always say to people, at this time of life it’s not just about me giving you a prescription for HRT. You’ve got to do the stuff yourself – eat healthily, exercise and so on.”
How to help with vaginal dryness
“A very significant problem that women can get is vagina dryness and soreness, along with urinary symptoms,” says Dr Goodwin. “Oestrogen deficiency affects the vagina and also the bladder and urethra. I’ve seen women who’ve told me they’ve had a smear and it’s been excruciating. They definitely can’t have sex, it’s too painful.
“When you use systemic HRT, that means taking either the gel or the patches. We put it into the blood stream. That can help with vaginal dryness because the whole level of oestrogen is going up. But quite often we need to add in some vaginal oestrogen as well. That can be a tiny pessary or a cream or gel. The dose that you get in a vaginal preparation is very low. If you use vaginal oestrogen for a whole year, it’s the equivalent of taking one HRT tablet, but it’s very effective.”
Midlife is a brilliant time of life
It’s good to be reminded of this. The menopause years bring health challenges, but this is a wonderful time of a woman’s life.
“What we want is for women to know what they might expect, so that they can be prepared,” says Dr Goodwin. “For me, being in my 50s is one of the best times of my life. We should celebrate it.”
You can watch the full Q&A with Dr Goodwin on our IGTV channel, @wearehylda. And you can read lots more articles by her, here and find out more about her own practice here.