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Getting the best from our Menopause Service at Blackrock Medical

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How to Prepare for Our Menopause Service Videos to Watch Types of Hormone Replacement Therapy Non-Hormone Therapy Prescription Medication Dietary non-HRT Supplements Blood Tests References

How to Prepare for Our Menopause Service

You will have received a questionnaire from our Menopause Team, asking for detailed information on your health and family history. Hopefully, you have already read our Menopause Journey Guide and have your symptoms journal and medical history to hand. It is important that you complete the questionnaire as it will be used to help devise your treatment plan.

Watch the videos we recommend in this document before you attend – so that you have the information you need to make informed decisions. There are also reference articles at the end of this document for your consideration.

Finally, write down and bring a list of any questions you might have to your consultations.

Videos to Watch

Below are videos on Menopause that explain many questions you might have. Please take a look!

Irish Congress of General Practitioners

Advice to women considering HRT

British Menopause Society videos:

Types of Hormone Replacement Therapy

The main components of HRT are oestrogen and progesterone. Both are naturally produced in the female body but decline during perimenopause and menopause, causing symptoms that can range from mild to severe. The goal of hormone therapy is to replace what your body no longer makes, with the lowest amount of hormone therapy that delivers your needed results. Dependent on whether a woman has her uterus, the type of hormone therapy recommended will vary.

Oestrogen only therapy

Oestrogen only therapy is given to women who do not have a uterus.

Combined Oestrogen and Progesterone Therapy

For women with a uterus, a combination therapy of both oestrogen and progestogens is necessary. During perimenopause and post-menopause, when the endometrial lining no longer sheds during menstruation, oestrogen alone can promote excessive growth of the uterine lining. Progestogens play a crucial role in safeguarding the lining and mitigating the risk of developing uterine cancer.

For women who are perimenopausal the recommended treatment is oestrogen as a patch/gel/spray combined with progestogen in the form of a Mirena intrauterine coil or cyclical progestogen tablets for 14 nights per month.

NOTE: cyclical progestogen will trigger a withdrawal bleed/period each month.

For women who are postmenopausal the recommended treatment is oestrogen as a patch/gel/spray combined with progestogen in the form of a Mirena intrauterine coil or continuous progestogen tablets every night.

NOTE: continuous progestogen SHOULD NOT trigger a withdrawal bleed/period.

Non-Hormone Therapy Prescription Medication

Some non hormone prescription medications, originally intended for other use, have been found to be helpful in easing some menopause symptoms. However, they must be prescribed by your doctor on review of your current health.

Dietary non-HRT Supplements

Certain over the counter dietary supplements are available and have been suggested to help alleviate menopausal symptoms. However, there is limited scientific evidence to support their efficacy and they can also have negative side effects and interact with other medications. If you wish to consider these non-prescription supplements, we advise you first discuss their use with your pharmacist and please also watch this video from the British Menopause Society on Complementary and alternative therapies.

· Black Cohosh: Some studies suggest that black cohosh may help alleviate hot flashes and other menopausal symptoms, although results are mixed.
· Soy Isoflavones: Soy foods and supplements containing soy isoflavones may help reduce hot flashes and improve overall menopausal symptoms in some women.
· Dong Quai: Dong quai, an herb used in traditional Chinese medicine, has been used to relieve menopausal symptoms such as hot flushes and vaginal dryness, although scientific evidence is limited.
· Vitamin E: Some studies suggest that vitamin E supplements may help reduce hot flushes in menopausal women, although results are inconclusive.

Blood Tests

Full Blood Count (FBC), Comprehensive Metabolic Panel (CMP), Diabetes Screen (HbA1c), Lipid Profile, and Thyroid Function Tests.

These tests are regularly included in annual health screens and are important for monitoring overall health.

The FBC assesses various components of your blood, such as red and white blood cells, platelets, haemoglobin, and haematocrit. It is used in diagnosing conditions like anaemia and can be an indicator for certain immune system disorders and other illnesses.

The CMP provides information on your metabolism, on kidney and liver function, and assesses for type 2 diabetes. It measures[DB1] [AC2] levels of electrolytes like sodium and potassium, and how well the kidneys and liver are working. We also measure calcium, protein levels, liver enzymes and bilirubin which is produced by the liver to aid digestion. This panel measures blood levels of albumin[DB3] , blood urea nitrogen, calcium, chloride, creatinine, glucose, potassium, sodium, total bilirubin and protein, and liver enzymes.

Diabetes Screen HbA1c testing assesses blood sugar levels over the previous few months and is more useful than testing glucose levels. Using this test eliminates the requirement to fast before blood sampling. It can also identify individuals who have glucose intolerance and are more likely to develop type 2 diabetes in future. A higher HbA1C indicates elevated average blood glucose levels, which can be correlated with an increased risk of conditions such as Alzheimer’s disease and some cancers, making it a potential indicator of overall longevity.

The Lipid Profile offers a comprehensive view of heart health by evaluating HDL (High Density Lipoprotein) ("good") cholesterol, LDL (Low Density Lipoprotein) ("bad") cholesterol, and triglycerides. While improving HDL (“good”) cholesterol and triglycerides levels is important, our primary focus is to optimise your LDL (“bad”) cholesterol. LDL cholesterol is known to rise during and after menopause and lower LDL cholesterol levels are strongly associated with a lower risk of cardiovascular disease. Lowering LDL cholesterol can be achieved through lifestyle modifications and, if needed, medications depending on your overall risk of cardiovascular disease.

Thyroid Function Tests are essential for identifying thyroid disorders, which are more prevalent among women and may otherwise go undetected. Symptoms of thyroid disorder can mimic perimenopause and menopause symptoms such as unexplained weight changes, chronic fatigue, cold intolerance, hair loss, forgetfulness, constipation, and depression. We screen principally by measuring Thyroxine and Thyroid Stimulating Hormone (TSH) and thyroid antibodies (anti-TPO and anti-thyroglobulin). [DB4] [AC5] A comprehensive panel enables early detection of thyroid issues, allowing for timely intervention and lifestyle modifications. However, if these tests are abnormal then we will advise further screening.

Nutritional Deficiencies: Vitamin D, Zinc, and Magnesium

VITAMIN D: Approximately 43% [DB6] [AC7] of individuals over 50 years have insufficient levels of Vitamin D, with prevalence increasing with age and during menopause. Vitamin D is produced by the skin from light exposure AND absorbed by the gut from certain foods. Deficiency may stem from factors such as limited sun exposure, reduced absorption in darker skin, genetic predisposition, absorption issues, or kidney disease. Vitamin D serves multiple roles in the body, acting as a hormone precursor crucial for immune function, bone health fatigue and mood regulation. Deficiencies in Vitamin D may also be due to other illnesses including coeliac disease and inflammatory bowel disease.

ZINC: Zinc is essential for cell production and immune function. Deficiency in zinc impairs the body's ability to generate healthy cells, leading to symptoms like unexplained weight loss, delayed wound healing, diminished alertness, and reduced sense of smell and taste.

MAGNESIUM: Inadequate magnesium levels are linked to various health issues including poor sleep, nerve dysfunction, mood disorders, fatigue, muscle cramps, headaches, and brittle hair and nails. Magnesium also plays a crucial role in heart health, blood pressure regulation, and thyroid function.

ANAEMIA SCREEN (iron, ferritin, folate, and vitamin B12): Anaemia, characterized by chronic fatigue, can be the result of deficiencies in iron, vitamin B12, or folate.

Chronic Inflammation Testing: C-Reactive Protein (CRP)

These tests screen for inflammation in the body, serving as useful markers to monitor progress following nutrition and lifestyle adjustments. While they are non-specific tests, abnormal levels are an indicator of inflammation and can be of benefit in uncovering and tracking inflammation, which may be improved with nutritional and lifestyle adjustments.

These tests enhance your healthcare outcomes, offering crucial insights and facilitating informed nutritional and lifestyle choices for your long-term health.