A DECADE ago the menopause was rarely spoken about, certainly not in public.

Despite the fact it affects every woman, “the change” was considered taboo and frequently suffered in silence.

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Now menopause is discussed everywhere; in podcasts, documentaries, and social media, and targeted with a growing market of products including supplements and herbal remedies to help ease its symptoms.

Increased awareness – fuelled by The Sun’s Fabulous Menopause Matters campaign – has been a life-saver. But with more information available than ever, it can be difficult to know where to find accurate advice.

If you want to know the symptoms of perimenopause – the lead-up to your final period – or whether you should be avoiding certain foods or using hormone therapy, Sun Health is here to help cut through the noise.

Dr Philippa Kaye – GP and author of the new book The Science Of Menopause – answers the most common questions on the subject and BBC presenter Gabby Logan shares her own experience of it.

Gabby Logan says HRT reignited her libido after becoming so disinterested in sex with her husband she worried it would “become a duty’.

The Welsh presenter, 51, first realised she was perimenopausal at the age of 47, but didn’t recognise it as such.

Rather, Gabby says she just felt like a “lesser version of herself”.

I couldn’t think that it had anything to do with the menopause. I was only in my mid-40s

And while the mum of two credits HRT with bringing her back, she has also taken up cold swimming among other lifestyle hacks to feel good again.

Gabby, who is married to ex-Scottish international rugby Kenny Logan, tells Sun Health: “I was feeling like a lesser version of my usual self. I didn’t know what was wrong with me.

“I’ve always been into health and fitness, and I started being extra careful about what I ate and I was training more — things that normally made me feel really good — but were now having no effect.

Out of control

“I couldn’t think that it had anything to do with the menopause. I was only in my mid-40s.”

But it was only when Gabby invited broadcaster Mariella Frostrup on her podcast, The Mid Point, in 2020 that everything clicked at last.

Gabby, who has 19-year-old twins Lois and Reuben with Kenny, says: “She was talking about her menopause, describing the symptoms — anxiety, im­patience, shouting at family and friends, losing your temper over silly things, feeling a bit out of control and not on top of stuff, feeling tired a lot of the time with low energy levels and having brain fog.

“I thought, ‘Hello? This sounds very familiar’.

“My libido was definitely affected by the menopause and perimenopause. I found I didn’t want to have sex with my husband as much, and it felt like something I was going to have to do even if I didn’t really want to.

“It was almost like, ‘Is this going to become a duty?’ So many women say this and I didn’t want to become one of them.

“I wanted to keep enjoying having sex. When I understood that I could get my former sex drive back, it was an enormous relief.” Gabby saw a doctor who prescribed HRT after tests revealed her hormones were “on the floor” and she likely only had a couple of periods left.

“I was surprised to hear this but not particularly emotional about it. I just wanted to feel like me again,” Gabby says.

My libido came back within about a week and our sex life was back on track — even to the extent of having daytime sex. Our kids will kill me if I say any more!

“I’d had a very healthy relationship with Kenny. I loved him and fancied him, and hadn’t been able to understand why I no longer wanted to have sex as much as I had before.

“My libido came back within about a week and our sex life was back on track — even to the extent of having daytime sex. Our kids will kill me if I say any more!”

The couple faced more challenges when Kenny was diagnosed with prostate cancer in 2022, requiring surgery.

And while Gabby admits she has felt “bereft” transitioning to an “empty nest”, she focuses on hobbies to fill the void.

She says: “I regularly go cold-water swimming.

“It’s something I kind of fell into by accident.”

It’s one of several habits that relieve her menopause symptoms.

She says: “The menopause affects our physical and mental wellbeing, things like heart health and the threat of osteoporosis. Exercise can help guard against both, particularly weight training for osteoporosis.

“Simple walking and cycling are great things to do.

“What helps me is being as holistic as I can.

“I make sure I take all the right vitamins and minerals for a woman of my age.

“It’s also a good idea to read up on the menopause before it actually happens so that it doesn’t overwhelm you.

“There’s nothing like prepping before midlife actually hits.”

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IT is about time the menopause was in the spotlight – and long may it continue to be.

Its symptoms can, for some women, span decades of their mid to late life.

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You may think “hot flushes” when you hear menopause, an image of a woman getting hot and bothered and fanning herself.

But there are 34 recognised symptoms, most of which are invisible to others, including joint aches and pains, headaches, and dry, itchy skin.

The genitals and urinary tract can be affected, leading to sore, itchy, painful vulva and vagina, pain during sex and recurrent urinary tract infections.

Even less obvious are the psychological symptoms women can experience.

Low mood and depression, anxiety, “brain fog”, insomnia, fatigue and loss of libido are all symptoms commonly raised by women in menopause.

The effects can be so severe that one in ten women report having thoughts about suicide.

So you can see why it is important to keep the conversation with menopause going. Here I tackle some of the main questions:

What is menopause and why does it happen?

MENOPAUSE simply means the last period; and after you have not had a period for 12 months you have been through menopause.

Perimenopause is the time leading up to menopause, when periods become more irregular until they stop when there are no eggs left.

The hormones oestrogen and progesterone are on a downward trend but fluctuate during perimenopause until they flatline at menopause.

The average age of menopause is 51, according to research on white women, but African American and Hispanic women have menopause on average 8.5 months earlier.

Globally, the average age appears to be even younger.

You don’t need blood tests for diagnosis of menopause, but if you are under the age of 45, they are offered to rule out other causes of symptoms.

Approximately one in 20 women will have an early menopause, before the age of 45.

For some women symptoms will start up to a decade before the final period – and we can’t predict how long they will last or when their intensity will peak.

A quarter of women will have no symptoms at all, or at least, very few.

What treatments are there?

WE tell women to see their GP when their symptoms bother them and are affecting their lives. You can have treatment in perimen-opause as well as postmenopause.

GPs will offer medication to ease symptoms as appropriate, but may also discuss lifestyle changes (more on that later).

The most famous treatment is hormone replacement therapy, which does exactly what it says on the tin – it replaces the hormones that have decreased.

If you are prescribed HRT you will certainly be given oestrogen. You’ll also be given progesterone to prevent the womb lining from becoming thickened, but if your womb has been removed by hysterectomy, it is not generally needed.

Testosterone may be offered to help treat low libido.

Many women have feared HRT due to studies earlier this decade that seemed to show it increased the risk of heart attacks, breast cancer and stroke.

With the help of your doctor, you will weigh up the generally small risks

Dr Philippa Kaye

However, the women in these studies used an older version of oral HRT that we don’t use now, and they started HRT aged 63 years, on average.

This is more than a decade after the average age of menopause.

Research since then has shown that starting HRT within the first ten years doesn’t seem to have the same risks.

So let’s be clear: For the majority of women who can take HRT, starting within the first decade after menopause, is safe.

The change in risk of a stroke or heart attack depends on how and when you start taking HRT.

There is a small increased risk of breast cancer with HRT, but this is approximately the same rise as that related to smoking and drinking alcohol, and you can decrease your risk by trying to maintain a healthy weight and exercising regularly.

What’s more, other benefits of HRT should not be underestimated!

These include a decreased chance of osteoporosis, muscle loss, bowel cancer and more.

With the help of your doctor, you will weigh up the generally small risks and compare them to benefits on a case-by-case basis.

There are also non-hormonal prescribable treatment options such as cognitive behavioural therapy (CBT), which can predominantly help mental health-related symptoms.

What lifestyle changes can relieve symptoms?

AS a doctor, it is never a question of either when it comes to medication or lifestyle changes.

A healthy diet may help your symptoms. For example, cutting out caffeine and spicy food can reduce hot flushes and sweats.

Decreasing alcohol can help improve your sleep, fatigue, mood and hot flushes.

Calcium and vitamin D are vital in the diet to help protect your bones.

And foods rich in phytoestrogens (plant-based oestrogens), such as tofu and soybeans, may be helpful.

Exercise is vital at any age, but during this time it can help protect your bones, decrease symptoms such as fatigue and hot flushes, boost your mood, improve your sleep, and reduce your risk of various cancers.

Remember, it’s about looking after your mental health, too.

When it comes to menopause products, there is a huge amount on offer

Dr Philippa Kaye

Make sure you attend cancer-screening programmes for women your age, such as mammograms or smears, and do your self-checks for lumps, bumps and changes.

When it comes to menopause products, there is a huge amount on offer – everything from “speciality” chocolate to pyjamas, face creams and supplements.

When we don’t feel at our best we are vulnerable. After all, wouldn’t it be nice if a set of sheets might be the answer to our symptoms?

While these products may help some people, there is no evidence for effectiveness of many of them.

An expensive face cream or shampoo labelled “for menopause” may well contain similar ingredients to a cheaper one.

The way through is to get empowered and informed so that you can make evidence-based decisions about your health, which is why I wrote the book!

• The Science Of Menopause by Dr Philippa Kaye, out now (published by DK, £16.99).

EIGHT in ten women in the UK aren’t checking their breasts regularly and a third admit they never check themselves for signs of breast cancer, research by Estée Lauder found in 2022.

This is shocking as two-thirds of cases are detected in this way.

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I’m in my third year as an ambassador for its breast cancer campaign and we have been focusing on the groups that are least likely to check – including South Asian women, women under 40 and Black women.

Attending mammograms, women are invited between the ages of 50 and 71, is another way to spot breast cancer early. You can ask for mammograms after 71.

Aside from a lump in the breast, chest, collarbone or armpit, other signs to look and feel for are: changes to the skin or nipple, a rash, crusting or discharge around the nipple, or changes in size, shape or colour of the breasts.

See your GP for any changes so they can rule out cancer, or detect it as soon as possible.

Here is a selection of what readers have asked this week. . .   

SON’S REAR CONDITION

Q) CAN you please tell me anything about desmin myopathy?

My 51-year-old son has this condition but we are not being told anything about it and I am worried. It is awful to see him suffer in this way.

A) Desmin is a protein that helps maintain the structure and strength of muscles.

Think of it as scaffolding that helps hold muscle fibres together, keeping them aligned and all working properly.

Desmin myopathy (also known as myofibrillar myopathy) is a rare genetic condition that causes muscle weakness, typically in the legs first.

It can slowly spread to the body, neck, face, respiratory muscles and sometimes the heart muscle, causing cardiomyopathy.

The severity and progression of symptoms can vary greatly between individuals.

While this can be a genetic disease, it is not always inherited.

Sometimes the genetic mutation is sporadic, meaning it can arise in people without a family history of the disease.

It is very difficult to watch a loved one suffer, especially with a rare condition that isn’t well understood – the first case of desmin myopathy wasn’t identified until the late Nineties.

Does he have someone to attend hospital appointments with, and share the worry with?

Sometimes when we receive a diagnosis we try to shield our loved ones from information that might upset them. Letting your son know that you want to know everything so that you can help support him may help get some honest conversations started.

Think of ways in which you can offer support in the meantime – cooking meals, supporting childcare, shopping or housework if that is relevant.

I strongly recommend asking your son to engage with specialist nurses or therapists who are part of his healthcare team as they can provide more detailed care and support.

Physiotherapy, mobility aids, and respiratory monitoring are often used to manage this condition, and psychological support can be extremely helpful.

Please don’t hesitate to contact patient groups or charities, such as Muscular Dystrophy UK. They can offer valuable information and emotional support.

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Q) I AM a male, 67 years old, and for the past six months I have had pain in my left groin, particularly when walking or standing for a long time.

I have had four knee replacements on my right leg and have just finished radiotherapy for prostate cancer. I was previously very sporty. I am still playing golf regularly.

Many friends have mentioned this as a sign of needing a hip replacement.

Do you think it may be that, or could it be something else?

A) Osteoarthritis in the hip is a common cause of groin pain in men over 60 and could explain your symptoms.

For example, hip pain can sometimes worsen with walking or standing, and can even affect sleep when lying down.

The multiple knee surgeries may have chan-ged how you walk, putting extra strain on your hips, and potentially accelerating any wear and tear on the joint.

Radiotherapy itself is not linked to osteoarthritis, but the overall stress on your body from cancer treatments, such as hormonal therapy, could play a role in how you recover from or manage joint issues.

You mention having been sporty, and a lifetime of sports that involve high speeds, pivoting, kicking or high impact such as football, rugby, and running can increase the risk of hip osteoarthritis. Having said that, it is important to know that remaining active can help maintain the health of the joint now.

Furthermore, keeping the muscles strong can alleviate the pain.

In particular, lower-impact activities such as cycling, swimming and walking can be beneficial.

Being physically active has many other health benefits, so please do keep it up.

That said, the pain may not actually be coming from the hip joint at all.

Other causes should be considered, such as referred pain from the spine or pelvic region, or even lingering effects from radiotherapy.

An assessment by your GP or an orthopaedic specialist can help determine if this is a hip issue, or something else.

If surgery is a concern, non-surgical options like physiotherapy and pain management can help, and some lifestyle adjustments such as weight loss may also provide relief.

STOPPING MEDS WRECKED MY HAIR

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Q) I USED to be on vitamin D and alendronic acid for osteoporosis but after about six years, my doctor advised me to stop them.

Within a few months, most of my hair (body and head) fell out and now my fingernails are so brittle. If I mention any of my worries to my doctors they make me feel like a hypochondriac.

I’m not accepting “old age” and my once thick, healthy, shiny hair and lovely nails are gone.

A) I’d be interested to know why you were told to stop taking your treatment.

Most likely it’s the alendronic acid that’s been stopped, due to side effects including heartburn, swallowing difficulty or other issues with the gullet. It may also be stopped if your kidney function goes below a certain threshold.

I would guess that the vitamin D is fine to continue and you should check if it’s OK to restart this. Vitamin D is something we should all be supplementing with from October to March anyway, and for someone with osteoporosis, I would advise supplementing all year round.

Vitamin D deficiency can affect both hair and nail health. Iron, B12, folate, zinc and magnesium deficiency should be ruled out too. If you wanted to have this assessed further and have the funds to do so, you could see a hair and scalp specialist (trichologist).

They will use a special camera to look at the hair follicles and give you bespoke advice about supplements, hair products and lifestyle to optimise your hair health.

I can understand you may feel fobbed off by your GP. It can be very difficult to give patients additional time when we are so limited if the issue is raised at the end of an appointment.

Our hair and nails do change as we age, but it should not be assumed to be all age-related, especially if there was a rapid change when you stopped taking the medication.