5 things doctors want women over 45 to do


Your health is important, and as women enter their mid-40s they need to be proactive about their wellbeing. The menopause brings certain challenges and reasons to reappraise our lifestyles. Here are five health hacks your doctor definitely wants you to consider ...

1. Book a DEXA scan

Women’s risk of osteoporosis increases after the menopause. This condition causes the bones to crumble and become fragile. Unfortunately, it is associated with higher mortality and needs to be taken seriously. Oestrogen levels dramatically decrease after the menopause, and as much as half of a woman’s total bone loss occurs within the first 10 years following her last monthly period. This condition doesn't cause obvious symptoms, until has already caused problems, so it has been dubbed 'the silent killer'. The good news is, osteoporosis and early bone loss can be diagnosed by DEXA scanning, minimising the damage and allowing treatment. Naturally, osteoporosis is best avoided in the first place if at all possible and HRT can help with this. Women with smaller body frames from white or Asian descent are more likely to be at risk from osteoporosis. Consultant Gynaecologist Mr Neale Watson says: ‘Booking in for a DEXA scan will allow you to understand your risk of osteoporosis and potentially serious fractures. Ideally, osteoporosis is best avoided in the first place if at all possible, by taking proactive action. Talk to your doctor about how to do this.



2. Get fitness on track

A gym membership won’t stave off hot flushes and night sweats, but exercising regularly and eating healthily will ensure you feel better and reduce your stress levels. Post-menopause, lots of women put on weight. Working out will lessen that tendency too. ‘Exercise is effective for treatment and prevention of anxiety depression,’ explains consultant gynaecologist Miss Beverly Benster.  ‘All forms are effective for anxiety and depression, including cardio, strength training, and yoga.’ Mix things up to prevent boredom. Cardio refers to the kind of exercise that makes you get out of breath, such as running, brisk walking, bicycling, or dancing along with strength training, such as weight-training or weight-bearing exercises like practising the plank. Muscle wastage can happen as we get older – this helps alleviate it, as well as strengthening bones. Aim for at least 150 minutes of moderate intensity activity a week or 75 minutes of vigorous intensity activity if you are already active, or a combination of both. Miss Benster adds: ‘The effects of physical training will be optimised by ensuring adequate protein intake from either plant or animal sources - active women at the time of the menopause should aim for a daily intake of 1g protein per kilogram body weight.’



3. Do some research

A lot of women are wary of HRT, as they believe it will increase their risk of developing breast cancer. This belief became entrenched after a large study by the Women’s Health Initiative (WHI) detected a link. However, many doctors believe these findings were misunderstood and the analysis flawed. ‘Virtually all of the major side effects from the WHI study have been withdrawn even by the investigators,’ says Professor John Studd, formerly consultant gynaecologist at the Chelsea & Westminster Hospital and professor of gynaecology at Imperial College. ‘The research included women who started the wrong dose of HRT over the age of 60. In women who started below the age of 60 there were fewer heart attacks, fewer deaths, fewer osteoporotic fractures and even less breast cancer. The one residual side effect is that there probably is a very slight – a 1% extra lifetime risk of developing breast cancer but this is no more than the breast cancer risk of being overweight, drinking wine, having no children or even taking statins.’


4. Consider testosterone

When HRT for menopause is mentioned, people usually think about oestrogen and progesterone, which of course are very important. Testosterone may also be required. Despite being so associated with the male sex, testosterone is also a female hormone. Healthy young women produce approximately 100 – 400 mcg per day of testosterone, which is three to four times the amount of oestrogen produced by the ovaries. It naturally declines over the years. According to consultant gynaecologist Mr Neale Watson, women should consider testosterone as part of their HRT, if their hormonal profile indicates it may be a good idea. ‘Testosterone can help in the treatment of postmenopausal symptoms including low moods, lack of libido, headaches and tiredness,’ he says. ‘Not only is this more effective it will also help with other menopausal symptoms, and reduce the risk of osteoporosis and heart disease. The addition of testosterone in women receiving oestrogen replacement can increase muscle mass and some studies have shown that oestrogen and testosterone combination may be better than oestrogen alone in preventing osteoporosis.’



5. Prioritise sleep

We all know how we feel when we don’t sleep – crotchety and bad tempered, often unable to function. As many as 61% of women report sleeping problems during the time of the menopause. Hot flushes may be to blame – but not always. ‘Poor sleep is also a symptom of anxiety and depression which are common in women around the menopause,’ explains consultant gynaecologist Mr Mike Savvas. In the first instance, good sleep hygiene may help – that’s avoiding caffeine, alcohol and rich, spicy foods in the evening and avoiding electronic devices before bed. If that doesn’t help, women should consider other strategies. ‘One option would be Cognitive Behaviour Therapy Insomnia or (CBT-I). This is a structured program that identifies negative behaviours and beliefs around sleep.’ Another way to help with sleep is HRT. ‘It has been shown to be effective in improving sleep, indirectly though the alleviation of such symptoms as mood changes or hot flushes and night sweats but it may also have a direct effect on sleep too.’

If you would like to talk to a specialist about menopause and protecting your future health, please make an appointment. Call us on 020 7486 0497 or email harley@studd.co.uk.

To find our more about menopause and HRT, Professor John Studd, the internationally acknowledged expert in the field of  gynaecological endocrinology and founder of  The London PMS & Menopause Clinic has made a series of podcasts. You can listen here.