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If you have a question about a women’s health issue, chances are so do other people! Submit a comment below and I’ll aim to answer it and add a post to the library – then hopefully others will benefit from the answer too!

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  • Christine

    Is it ever too late to start HRT? I am 67 and have had burning mouth syndrome for eight and a half years (not a menopause symptom but caused by a dental treatment). I understand that HRT can sometimes help this symptom – nothing else has helped. Also, I had a dexa scan about 20 years ago that showed a problem, and the hospital advised HRT but the GP was against it. I have a family history of osteoporosis (mother and sister), and because of the mouth pain my BMI has been very low for a long time. Sorry, that was two questions!

    • admin

      I would say it is never too late to consider starting HRT. However, the risks do start to increase the longer it has been since menopause occurred. It then becomes a balance of risk versus benefit, which will be very individual. But, if it is felt the benefits outweigh the risks, then HRT can be started at any age

  • Susan

    I have a question about menopause. I am 55 and have been menopausal – based on symptoms – for about three years. I am on combined HRT and have just had my (last-ever!) IUS removed. Thanks to the IUS, I have not had a period for 25 years, so am uncertain how I will know when I no longer need any contraception. In short, how do I know when the menopause is over, if HRT is masking/controlling the symptoms, and I have no periods anyway? Many thanks for your help.

    • admin

      Many thanks for your question!
      It is true that the IUS can make it difficult to know when you have truly gone through menopause. This then impacts on the advice we give about contraception. Generally, in women over 50, contraception can be stopped 12 months after menopause – but as you have been using the IUS, we don’t know when that might have been! Therefore, advice from the FSRH (Faculty of Sexual and Reproductive Health) states that contraception in all women can be stopped at age 55, regardless of menopausal status. You do not need to know when actual menopause took place, and the HRT you are using will continue to provide the hormones you need.

  • Lou H

    Hi! i have been advised by a mental health/wellbeing service to request a blood test from my GP to check for perimenapause as i am experiencing very low mood. changes in mood and really struggling the week before my period. What i dont want though is to waste any time or resources on this if it isnt neccesary or will help. is it worth requesting it do you think?

    • admin

      Hello and thank you for your query.
      Generally blood testing in peri-menopause is challenging, and often unhelpful. Blood hormone levels fluctuate significantly, so unless you have tests taken every day over a period of weeks, the result you get is just a vague ‘snapshot’ of what is happening on that particular day, which is not of any help.

      If you are over 45, and having symptoms you think may be related to perimenopause, my advice would be to speak to your doctor and also consider a trial of HRT to see if the symptoms improve – there is no need to do any blood tests. If you are under 45, blood tests may be helpful, but really only if your periods have stopped. Blood tests to exlcude other causes of symptoms may be worthwhile (eg looking for anaemia or thyroid problems).

      I have previously posted about blood testing which may be helpful:

  • Elaine H


    I’m 51 and since the menopause process began I’ve been putting on a lot of weight. I eat healthily and go for walks regularly. I’ve also been trying intermitent fasting for two months, but haven’t lost any weight at all. Is there a special diet for women in menopause? I have all other symptons of menopause, but it’s the weight gain that really upsets me. Can you help me please?

    • admin

      Thank you for your message. Weight changes are very common in perimenopause and beyond. Metabolic processes are affected by the changing hormone levels which can mean significantly more effort is required in terms of eating habits and exercise, just to keep your weight stable (making losing weight even more difficult).

      I am part of an excellent support service called The Perimenopause Hub ( On this website you will be able to link up with experts who can advise on nutrition and exercise to help you manage things during this challenging time.

      I hope that you find it helpful

  • Emma

    Hi, I was recently prescribed vagifem vaginal oestrogen tablets, to treat vaginal dryness and discomfort. I very quickly developed a migraine which continued for 2 days, and only went away when I stopped taking the vagifem. My doctor says it’s not possible to take oestrogen if you get migraines (a different GP prescribed them and took a personal and family history but did not ask about migraines) but I have also read that it can cause migraines for a couple of weeks and then settle down. I did use to suffer from migraines but rarely get them now that I am in my 50s. Do you agree that it’s not possible to take oestrogen if you get migraines? Thank you

    • admin

      Thank you for your question. Migraines can often be triggered by oestrogen: women going through peri-menopause may find their migraines become worse during this phase of life (as the hormone levels fluctuate a lot). They often improve again post-menopause (when the oestrogen level falls). It is true that you should not use the combined contraceptive pill if you have a history of migraine with aura, as it increases the risk of stroke. However, this is not the case with HRT: it can be used, even with a history of migraine (although a form given through the skin is usually recommended). When it comes to vaginal oestrogen, this is also safe to use. Only very small amounts of oestrogen are absorbed so there is no risk involved. It may trigger migraines if you are very sensitive to even minor changes in levels, but this does usually improve over time

  • Rose

    Hi, do you know where I could get bioidentical progesterone prescribed please? My progesterone is very low and I think it’s (one of) the reasons behind my secondary infertility. I’m 42. Thanks.

    • admin

      Thank you for your message. I do not personally recommend bio-identical hormones as they are not a regulated form of treatment. If you are concerned about fertility issues I suggest speaking to your GP to arrange referral to a fertility specialist service.

    • Jane coe

      I am 55, perimenopausal and have an underactive thyroid gland, have taken thyroxine for decades, no changes in years.
      My fingernails have stopped growing in recent months, any suggestions please?

      • admin

        Thank you for your question. Changes to nails can be related to lots of conditions. I would often suggest some baseline blood investigations to ensure you are not anaemic, and to make sure your thyroid function remains controlled on your current thyroxine dose.
        If all is well, it may well be related to menopause. I would encourage you to speak to your doctor about whether HRT may be an option for you

  • Christina arber

    I have shown signs of being perimenopausal for past 2 years, I have just 41. My GP has taken 2 blood tests which have returned high FSH levels. Due to not having many symptoms at the moment, hot flushes, insomnia, irregular periods, weight gain which I am kind of controlling through over the counter medications I have been told that I do not need to go onto HRT.
    I have started to read up and found that at my age I shouldn’t be without oestrogen due to the long term effects of not producing enough has on my body. Could you advise if this correct so I can speak to my doctor armed with some sound advice please.

    • admin

      Thank you for your message. At the age of 41, your raised FSH levels do suggest you are going through an early menopause. HRT is more important for women experiencing an early or premature menopause as the lower oestrogen level can have longer term health effects – such as heart problems and osteoporosis. Although guidance suggests HRT should only be used to treat menopausal symptoms, this is really for women experiencing menopause at the usual age. Those experiencing menopause earlier than expected should be offered HRT up to the age of 50 to replace the hormones they should naturally still have. I would definitely go back to your GP to discuss this again.

  • Anonymous

    I have had a burning feeling in my vulvar for around 2 months, and have spoken to multiple doctors, had multiple tests and have landed on vulvar dermatitis. I have been prescribed a steroid cream and been using it for a few weeks but not noticed any improvement. I wash once a day with hydromol ointment as recommended by a doctor. Is there anything else that you could suggest that would help? The issue started a couple of weeks after starting university and moving into new accommodation, hence using new toilet roll, laundry capsules, etc. Is it worth buying different toilet roll and laundry products to see if this helps? I’ve also bought some cotton knickers to see if this makes a difference too.

    • admin

      I am sorry to hear you have been having such troubling symptoms.

      Reading what you have described, there are a few things that could potentially be going on. I think the first thing to exclude would be a potential herpes infection. This classically gives you a very sore area, often looks like an ulcer, and then can remain inflamed and sore for quite some time. Testing for that requires a very specific swab which may not have been done by your doctor, and might not have been done as part of an STI screen if you didn’t have the symptoms at the time (the swab needs to be taken from the active ulcer).

      Herpes is an unusual infection in that it can flare up repeatedly, months and even years after your initial infection – you even if you haven’t been sexually active recently, the symptoms can be from a previous infection. Annoyingly, herpes is difficult to treat. Antiviral treatment (eg aciclovir) can be helpful, but it needs to be started as soon as the symptoms appear, so you might find it is not much help now. But it could be worth trying. The other option to treat is to use gels that numb the area to help with the pain (eg Instilagel) whilst it heals by itself. You just have to be careful as you can pass on the infection whilst you have symptoms.

      There is the potential it may also be a skin related problem as you have described. Eczema/dermatitis is a common problem and can affect the vulva. I often recommend using an emollient called dermol 500 to use as a soap substitute and a moisturiser. It is important not to wash the vulval tissues with ‘feminine products’ as there is a delicate balance of bacteria that are important to keep the tissues healthy. Removing these with overwashing can actually make things worse. A steroid cream can also be helpful, but it may take time to settle things.

      One thing I would stress is if you feel things are not getting better, you should go back to your doctor to be examined again. There is often a tendency to put these symptoms down to ‘thrush’ – I can see you have been treated twice for this with no benefit. Therefore, it is unlikely to be due to thrush as the treatment is usually very effective. From what you have described, I think it has reached a point where you should be examined again.

      Further advice on vulval pain can be found here:

      • admin

        Thank you for your question! HRT does not cause high blood pressure. HRT does not need to be stopped if your blood pressure goes up. However, if your blood pressure does increase whilst you are taking HRT it is important to review it with your GP as it may be that you will need treatment to help bring your blood pressure down again. Raised blood pressure puts you at a higher risk of heart attacks and strokes, so it is important to treat it (this is why we check your blood pressure once a year as part of your HRT review – it is a good opportunity to identify women who have raised blood pressure so they can be treated, it is not to decide if we should continue the HRT or not!)

  • Jaz

    I have lots of symptoms that would suggest I am peri menopausal – hair loss, memory issues, breast tenderness, migraines, irritability, anxiety, joint stiffness and pain, crying, low energy, poor sleep… These have gradually developed over the past 3 years and I’m now turning 50 in a few months. I also have a mirena coil and am on my 3rd one.
    I’m starting to feel like I need some help to feel better, yoga and lifestyle changes only seem to go so far and I’m concerned about the impact of how I am feeling on my family and my job.

    I’m building up to contacting my GP, with a view to possibly discussing some kind of hrt. However last time I had my coil replaced, 3 years ago, she made a comment about this being my last coil, then it will be removed to see what stage I’m at with the menopause.

    I don’t really want this and would like to see her as prepared as I can be, however I feel totally overwhelmed at the amount of conflicting advice and treatment options there are and don’t know where to start. I don’t want to be ‘done to’ and wish to go into this informed and with my eyes open, equally I really want to feel better in myself and more in control.

    Can you suggest a starting point and how best to approach my GP?
    Many thanks

    • admin

      Many thanks for your question. I definitely feel the symptoms you describe are related to the peri-menopause, and HRT is likely to significantly improve these!! I would strongly encourage you to speak to your GP to find out more!

      With regards to your Mirena coil – this puts you in a great position. The coil can be used as the progestogen part of your HRT, meaning you would only need to have extra oestrogen. I would recommend using a gel or patch for this.

      There is no need to have it removed to ‘see what stage of menopause’ you are in, and there are no limits to how many coils you have. If you had it fitted after age 45, it would be the last one needed for contraception. But, if you want to use it for HRT, it will need to be replaced after 5 years of use.

      The Mirena is an excellent choice, so don’t get it removed unnecessarily!!

      If you do not get the support you need, I do run a menopause clinic offering online consultations, with no need for referral. You can book directly at this web address:

      Hope that offers some help!

    • Katy

      Hi there,

      I’m almost 45 and have recently had a blood test which showed my FSH was normal.

      I have symptoms which I think could be perimenopause related (lack of focus, depression plus some physical symptoms) and have heard that my GP can prescribe HRT on the basis of these.

      It would seem sensible to test oestrogen levels before starting HRT but this does not seem to be routinely done on the NHS.

      My question is could I potentially be harming myself by taking HRT if my oestrogen levels are in fact normal and my symptoms are not related to perimenopause?

      Many thanks

      • admin

        Many thanks for your question.
        Blood tests in perimenopause are very difficult to interpret as they fluctuate significantly from one day to the next. This fluctuation is often the cause of many of the symptoms. This is why blood tests are not generally recommended.

        If you are having symptoms of perimenopause, HRT can definitely be prescribed on this basis alone, without the need for blood tests. There is no need to worry if your oestrogen levels are ‘normal’ or not – it is likely they will be at times, but will also be fluctuating – HRT aims to help stabilise these fluctuations, and therefore improve the symptoms. If the symptoms are not related to perimenopause, the HRT is unlikely to help, but will not cause any problems if you want to try it.

        Hope that helps!

  • Anonymous

    Hi, I had signs of menopause from about 37 years old, I am now 50, I was diagnosed with fibromyalgia when I was 40. The ladies in my family have early menopause. Lots of information I could go in to but wont at the moment. I am wondering if the fibro is just another symptom of the menopause. Or is it that the early menopause symptoms were the start of fibro? I am very confused. I would really like more help. My gp started me on hrt about 3 years ago. I am trying various things to help myself, meditation, nutrition (eating well and taking supplements), pacing, and I have very supportive family and friends. Exercise is limited due to exhaustion and pain levels but generally I can manage a 10 minute slow walk with my dogs and I usually spend a lot of time in my garden. I suppose my question is can you help with menopause/fibro or have you experienced this and can you help me? Many thanks

    • admin

      Thank you so much for submitting a question to my website. You describe how you have had symptoms suggestive of menopause from your late 30s, which was further complicated by a diagnosis of fibromyalgia.

      There is a significant overlap of symptoms with menopause and fibromyalgia, particularly the generalised joint pains and levels of lethargy and exhaustion. Sometimes it can be difficult to pick out which symptoms are caused by which problem, and the presence of one can definitely impact on the other.

      It may be that your early symptoms were the start of the fibromyalgia, but if you have a family history of early menopause, it is more likely that you would also experience your menopause earlier.

      If you are using HRT, I would hope that would be improving any of the symptoms that are related to the menopause – however, if things are not improving, it might be that you are not using the most appropriate formulation or dose.

      I am afraid I cannot provide specific individual advice via this website. However, I would be happy to discuss this is in more detail, and review your current HRT and fibromyalgia treatment, to see if there is any potential to tweak this in my Cambridge Women’s Health clinic. If you would like to see me you can book directly online through the following website:

      My clinic is mainly focused on menopause care. However, I have seen many women with fibromyalgia in my years in general practice, and would be happy to discuss both issues with you.

      I am doing all my current consultations via video link at present.

      Hopefully I will meet you soon!

  • Laura

    Hi. I had unprotected sex on cycle day 16. I took the morning after pill on day 18. I then had normal period bleeding on day 31 for 5 days. My cycles are usually regular at 28 days. Now I’m on cycle day 38 and so 10 days late. I’ve done 3 pregnancy tests- all negative. Please can someone give advice on what to do next?

    • admin

      Hi Laura

      Looking at the information you have provided, it seems you had a normal period after taking the emergency contraceptive pill (although slightly delayed). However, your next cycle is now also delayed.

      It is not unusual for women to notice a change in their cycle regularity after taking the emergency contraceptive, but this usually resolves within a few cycles.

      It takes up to 3 weeks after having unprotected sex for a pregnancy test to show positive, so as long as it is still negative after this time has passed, then you did not fall pregnant from that episode of unprotected sex. The only issues that would complicate this is if you had any further episodes of unprotected sex after the original episode, as the emergency contraceptive pill will not protect you for those.

      There are other things that can affect how effective the emergency contraceptive pill works, such as vomiting within 2 hours, having a long time delay between having sex and taking it, and using the normal contraceptive pill straight afterwards (this varies depending on the pill taken). However, the 3 week timescale for a pregnancy test would exclude failure.

      If you have not had sex since the original episode, and the tests are negative after 3 weeks, you are not pregnant. The delay in your period is likely just a result of having taken the emergency contraception. I would expect it to settle back to your usual cycle in the next few months. If not, you may need further assessment to see why your period has not come. If you have had further episodes of sex, a test 3 weeks after the last episode will confirm whether or not you are pregnant.

      I hope that offers some help!

  • Lisa

    So I’m on the oestrogen gel (daily 3 pumps) and the progesterone tablets (2weeks). I’ve been getting on just fine but am now finding my monthly bleeds are becoming erratic. I.e late or like this month, not at all. The problem is I really NEED to come on. I have all the symptoms of PMT/bloating/retention/grumpy and it’s not passing! Originally I was bleeding monthly during the oestrogen phase with little ‘hormonal build up’ and life was lovely. Now I’m feeling a hormonal mess on a rollercoaster. Is this normal? Any ideas?
    TIA X

    • admin

      Hi Lisa

      This might suggest you are actually reaching a natural menopause, and require higher doses of oestrogen in order to build u enough lining to result in a bleed. I would suggest considering switching your HRT to a continuous form to see if that works better for you. The other option would be to increase the oestrogen due to 4 pumps daily, although this is the maximum dose I would recommend

      Hopefully that is of some help!

  • Sara P

    I had an early menopause in my 20s now 54, no longer on hrt but sffering chronic vaginal tightness and dryness. I am using the vaginal oestrogen pessaries but not really helping

    • admin

      Vaginal symptoms are really common during the menopause. Vaginal estrogen is usually very effective. It might be you are not using quite enough. I usually recommend using it every day for 2 weeks to settle things down, then using it 2-3 times a week. The safety data is based on using 50mcg/week (based on the old product that was 25mcg/vaginal tablet – the new vagifem dose is only 10mcg/tablet). Therefore, I usually say it can be safely used up to 5 times a week if needed. However, if this is not improving your symptoms you should visit your GP for review as there may be other issues causing your symptoms.

      • Anonymous

        Hello, I have a HRT question please.
        My Gp prescribed elleste duet October 2019, due to increased aura migraine due to Lack of availability of sequential patches I then started in April On ustrogestan and estrogel (2 pumps a day) Since I have developed and been diagnosed with
        1. Contact dermatitis on eyelids and dry eyes-which hasn’t cleared and severity varies throughout the month despite using hydrocortisone intermittently since April
        2. Fungal infection under breasts – treatment hasn’t cleared
        3. Eczema on nipples and 3 days ago developed mastitis.

        My GP doesn’t think any of the above are linked to HRT but my symptoms only started since taking this new regime of HRT. I’m 50 and I’ve never had skin problems in my life. I’m desperate for help .my GP can’t do anymore she said she will refer to Me to a dermatologist .. Can HRT be causing my skin issues? There are at present no other HRT options available to me according to my GP so her advice was “it’s up to you either stop or carry on” . I don’t want to stop HRT because it’s helped me control other symptoms. I’m at a loss I really am . Any help or advice Or signposting would be greatly appreciated. Thank you

        • admin

          Thank you for your question about HRT.
          I am sorry to hear that you are struggling with these skin issues. I generally agree with your GP that it is unlikely that the HRT is causing these issues. It is more likely due to the actual peri-menopause itself, as skin problems are actually very common during this phase. However, some people can be very sensitive to the excipients in some medications, so it may be worth trialing alternative options. My suggestion would be to try changing things, but change things one at a time so you know what is potentially causing what. But that doesn’t mean stopping the HRT!

          Yes, there have been some supply issues, but lots of things are still available. You should still stick with transdermal oestrogen due to migraine, but there are other products you could try (other patches and a gel). If that doesn’t help, you could try using the utrogestan vaginally rather than orally.

          I would suggest speaking to your GP about how to make these changes to see if you can find products that work better for you.

          Alternatively, I offer a menopause clinic online where we can discuss this in more detail. Booking is available online:

          Hope that offers some help

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