The Female Health Doctor MK

Learn About The Menopause - Online Edition!

The menopause is a tricky time for many, but you don't need to suffer needlessly. In this session I breakdown what menopause is and what you can do to help you by using HRT. To download a free guide to help you talk to your GP about menopause support, go here: https://www.thefemalehealthdoctor.com/free-download-menopause-care-qa/

Using testosterone in the perimenopause and beyond

Did you think testosterone was just a male hormone?! Testosterone is an important hormone that is partially made by your ovaries and production of this hormone falls over time (not. as sharply as oestrogen, but it does gradually declined). This fall in testosterone can lead to a lack of energy, brain fog and reduced libido (sex drive). Unfortunately it is not currently licensed to women in the UK, but it is prescribed by many menopause experts and some GPs (like me!), as it has many potential benefits. Many people think of it as a ‘male’ hormone which is true, but women produce testosterone too. In fact, women produce three times as much testosterone than oestrogen before the menopause. https://balance-menopause.com/uploads... Testosterone plays an important role for your muscle and bone health, your cardiovascular health, concentration, mental "sharpness", your overall energy levels and quality of sleep. The hormone also influences your level of interest in sex, and the amount of pleasure you feel from it. When your levels of testosterone reduce, you may find that you desire sex less often and when you do have sex, it’s not as enjoyable as it used to be, (even when you still desire and love your partner). Many women find that taking testosterone as part of their HRT provides further improvements in how they feel. Benefits could include: Improved energy and stamina, Improved muscle mass and strength, improved concentration, improved libido and better quality sleep. Current BMS guidelines only recommend testosterone if you have severely reduced libido or ‘Hypoactive Sexual Desire Disorder’. So not all menopause trained doctors would consider prescribing this if libido isn't a problem for you. Once you're established on HRT, testosterone could then be considered. Testosterone is usually given as a cream or gel which you rub into your skin like a moisturiser, and it then becomes absorbed directly into your bloodstream. AndroFeme® is the only licensed version for women and it needs to be imported from Australia. Testogel sachets and Testim gels are made for men but can be safely used in lower doses for women. It should be rubbed onto clean, dry skin on your upper outer thigh or buttocks, it usually takes about 30 seconds to dry and can sometimes leave a white residue behind - this is harmless and not a cause for concern. You should wash your hands thoroughly after using it. Avoid swimming or showering until around 30 minutes after application. It can sometimes take a few months for the full effects of testosterone to work in your body. You should have a blood test before you start to check your testosterone levels and then again after around 3 months, then 6 months, then annually if it remains stable. Think also about your vaginal and vulval health and make sure you have treatment for this too. Vaginal oestrogen can work really well, as can regular moisturising and using oil/water-based lubricants regularly. If this is something you would like to try, I now offer a testosterone check appointment which you can see here: https://www.thefemalehealthdoctor.com/book-an-appointment/#tve-jump-1906eeaa0f1

That embarrassing topic: What to do about dry vaginas?

Genitourinary Syndrome of Menopause (GSM) is a condition that affects many women, caused by reducing circulating oestrogen in the body. It can also be known as vaginal atrophy or atrophic vaginitis, but it is so much more than just vaginal dryness! It can significantly impact a woman's quality of life, yet it often goes undiagnosed and undertreated in the majority of those with these symptoms. GSM classically occurs in premature ovarian insufficiency, menopause and perimenopause, but vaginal dryness can also occur when breastfeeding due to the hormonal changes after pregnancy and with the depo contraceptive injection. According to The Lowdown, 42% of women say they experience vaginal dryness with the injection. https://thelowdown.com/contraceptives... Postpartum dryness has been shown to affect 43% of breastfeeding women! https://www.ahyes.org/blogs/blog-post... And up to 80% of postmenopausal women experience troubling GSM symptoms and despite this, only 25% of women seek help and less than 10% start any treatment. https://www.ucc-today.com/journals/is... So it's a common problem that sadly isn't talked about enough, let alone treated! Symptoms include: 1. Vaginal dryness: One of the hallmark symptoms of GSM is vaginal dryness, which can result in discomfort, itching, and pain during sexual intercourse. 2. Genital burning or irritation: Women with GSM may experience a sensation of burning or irritation in the genital area, making daily activities uncomfortable. 3. Dyspareunia: Painful sex (aka dyspareunia), is common in women with GSM due to vaginal dryness and thinning of the vaginal tissues. 4. Urinary symptoms: GSM can also affect the urinary tract, leading to symptoms such as urinary urgency, frequency, and recurrent urinary tract infections. 5. Vaginal wall prolapse: The decrease in oestrogen levels can cause the vaginal tissues to become less elastic and resilient. It's a myth that this only happens to women who have given birth vaginally. What medication is used for GSM? HRT - I like to start with HRT if a woman can have it. 10% of women also need vaginal oestrogen, but systemic HRT can help to alleviate many of the symptoms. Vaginal oestrogen - there are many forms of vaginal oestrogen including gels, creams, pessaries, tablets and an oestrogen ring. These can also be used for GSM and dryness associated with breast feeding and contraceptive injection use. It can even be used for those who have had breast cancer in the past. https://www.ucc-today.com/journals/is... Vaginal DHEA - intrarosa is a pessary that is inserted into the vagina and is licensed for symptoms of GSM but not dryness associated with breastfeeding or contraception. The active substance of Intrarosa, prasterone, is converted into oestrogens and androgens when inserted into the vagina. The hormone levels increase in the local area which boosts the cells of the tissues and relieves the symptoms. https://www.ema.europa.eu/en/medicine... Steroid cream - high potency steroid cream can be really helpful for severe itch symptoms while waiting for the oestrogen or DHEA to do it's job! What alternatives can help GSM? Regular pH balanced moisturising - companies like Yes VM are helpful for this. Moisturise "down there" every day (like you would for your face!) Lubrication- oil and water based lubricants together can really help during sex (unless using condoms so should be water based only) Wearing cotton underwear, avoiding synthetic panty liners and not using anything other than water to wash with can help to keep the natural flora of the vagina healthy (be gone femfresh!!) What new/innovative treatments are available for GSM? Lasers can help with vaginal wall prolapse, stress incontinence and vaginal dryness. For example the monalisa touch is a CO2 laser that gently acts on the vaginal walls causing painiless micro-lesions that triggers production of new collagen and therefore improvement in symptoms. https://www.monalisatouch.com/monalis... Ospemifene is a selective oestrogen receptor modulator that has an oestrogen-like effect in the vagina. It is licensed in the UK for use in women who have completed their breast cancer therapy. There is a lack of long-term safety data from clinical trials though, so if this is something you'd liketo try, then a discussion with your breast cancer specialist would be a good idea first. https://bnf.nice.org.uk/drugs/ospemif... https://thebms.org.uk/wp-content/uplo... Don't suffer in silence! If you need help, reach out to me and we can set up a consultation. https://www.thefemalehealthdoctor.com/book-an-appointment/

Heavy periods, causes and treatments

Heavy periods, known medically as menorrhagia, is common and many women suffer unnecessarily. Here is what causes them and how you can manage them. What is normal blood loss? 80ml of blood (about 5 tablespoons) or less is considered normal, but I don't know anyone who measures their period blood! So if your periods are interfering with your ability to go to school, work or do your normal daily activities of life, it's too much! Causes: - Hormonal Imbalance: Fluctuations in oestrogen and progesterone levels can disrupt the normal menstrual cycle, leading to excessive bleeding - Hypothyroidism - Uterine Fibroids: Noncancerous growths in the uterus can increase menstrual bleeding (image credit: https://www.wrh.ox.ac.uk/research/endometriosis-care-what-are-fibroids) - Polyps: Uterine or cervical polyps can cause heavier periods. - Adenomyosis: This condition occurs when the tissue lining the uterus grows into the muscular wall, leading to heavier bleeding and severe menstrual cramps. - Endometriosis: Tissue similar to the lining of the uterus grows outside the uterus, causing heavy bleeding, pain, and other complications. - Blood Disorders: Conditions like von Willebrand disease or platelet function disorders can lead to excessive bleeding. - Certain Medications: Blood thinners or hormonal medications may increase bleeding. Symptoms: - Excessive Bleeding: Needing to change pads or tampons frequently, passing large blood clots, or bleeding through clothing or bedding. - Prolonged Periods: Menstrual periods lasting longer than a week. - Symptoms of anaemia: fatigue, weakness: feeling faint or dizzy, short of breath, looking pale, hair thinning and falling out, sore corners of the lips, spoon-shaped nails - Pelvic pain and pressure Diagnosis: - Medical History and Physical Examination: Discussing symptoms and health history with a healthcare provider. - Blood Tests: To check for anaemia and hormonal imbalance - Pelvic Ultrasound: To visualise the uterus and ovaries, identifying any structural abnormalities. - If needed, endometrial biopsy: Taking a small sample of the uterine lining to check for abnormalities or signs of cancer. Treatment: 1. Medications - Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Reduce menstrual bleeding and relieve pain. - Hormonal Birth Control: Regulates the menstrual cycle and reduces bleeding. - Tranexamic Acid: Helps reduce blood loss by promoting clotting. 2. Surgical Interventions - Endometrial Ablation: Destroys the uterine lining to reduce bleeding. - Uterine Artery Embolisation: Shrinks fibroids by cutting off their blood supply. - Myomectomy: removing individual fibroids surgically - Hysterectomy: Removal of the uterus, usually considered a last resort. 3. Lifestyle Modifications: Including iron supplementation to manage anaemia, stress reduction techniques, and maintaining a healthy diet and exercise routine. Conclusion: Heavy periods are common, with various underlying causes and treatment options. With the right approach, women can find relief from heavy menstrual bleeding and improve their overall quality of life. In short, don't suffer in silence! If you're needing help with this, book to see me for investigations and a planof action: https://www.thefemalehealthdoctor.com/book-an-appointment/ You can also join my facebook group for support too: https://www.facebook.com/groups/womenshealthsupportuk