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Healthwest Menopause VEE Nov 2025 Presentation
Slide 1
Welcome to your Menopause Virtual Engagement Event
Slide 2
Welcome to your Menopause Virtual Engagement Event Your Facilitatorthis evening is Siobhan Buck Social Prescriber, HealthWest Your Clinicians are Dr Ayo Olomolaiye and Dr Nicola McGuinness GPs, The Family Practice
Slide 3
Flow of this session:
Introductions and Set Up
Virtual Group Consultations
Presentation
Your Questions
Next Steps
Slide 4
What can you do this evening?
Camera: on/off
Mic: mute
Chat box
Respect confidentiality
Leave the session
Be curious
Slide 5
Group Consultations
This evening’s event provides general information and answers general questions.
Group Consultations offer more personalised support – like a normal consultation, but:
• 1½ hours in a group of about 10
• Each person has their consultation with the doctor, and listens to others’ consultations
• Learning about how others manage menopause symptoms
• Sharing of personal information in the group
You can register for a Group Consultation on:
THE FAMILY PRACTICE
• DATE : 17thDECEMBER 2025
• Registration link in email after this evening’s event.
Slide 6
But first … Can you tell us on a scale of 1-10 how confident you are right now in managing your Menopause /Perimenopause?
Slide 7
What do you want to know about the Menopause?
Slide 8
Welcome Dr Ayo Olomolaiye
Transcript onwards by: Dr Ayo Olomolaiya
So thanks so much for joining us for this educational evening. I'm doctor Ayo Olomolaiye, and I'm one of the associate GPS at the Family Practice.
Menopause is so complex and such a confusing subject to many, so I'm really going to try to explain things in an easy to understand and accessible way.
Slide 9
What is the Menopause? INCLUDES IMAGE
Transcript:
First of all, what is the menopause? Like I said, it's a huge subject and I think making it simple should be helpful. So, looking at this diagram, if you think of things in stages we have pre menopause, perimenopause, menopause and post menopause.
So pre menopause is the time in your life following when period starts during which most women will have a regular period. Perimenopause is when those cycles start changing so becoming longer and less regular and then the menopause is defined by the time when your periods have stopped for 12 months or more.
And the whole reason why this is happening is due to overall reducing oestrogen levels. So essentially when you're born, we're each born with a finite number of eggs. These eggs are producing oestrogen and we're supposed to ovulate these eggs each month.
So that's what's happening during the pre-menopausal time in the menopause we get to a point where essentially we've run out of the ability to ovulate and as a consequence our hormones are going a little bit all over the place and overall that oestrogen is gradually going down.
The reduction in oestrogen is actually not completely linear. So during the perimenopausal period hormone levels are fluctuating up and down constantly. And that's not just week by week, but can even be vary throughout a day. Now oestrogen is a hormone that's got lots of places or receptors that it works throughout our whole body.
The symptoms of menopause are extremely broad and can affect us all in so many different ways. As you can see on the slide, common symptoms include irregular periods, hot flashes, night sweats, mood changes, irritability, joint aches, brain fog, poor sleep, reduced sex drive, skin or hair nails.
Now changes vaginal discomfort, urinary symptoms and many, many more. Now I realise that doesn't sound at all appealing, but don't panic because there's nothing to say if you're going to get all of these symptoms and you might not actually have any of them at all. If you've spoken to anyone who has or is going through the perimenopause, you will find.
But one person's symptoms vary completely to the next. The types of symptoms, the severity, the duration, and most importantly, the impact of these symptoms are completely individual. And that's because oestrogen isn't the only thing at play during perimenopause.
There's lots of different factors. So diets, lifestyle and also stress and life circumstances being some of the key things to mention and symptoms can vary day-to-day. Because of these factors. And that's also why different approaches work differently for each woman.
Slide 10
How do we diagnose the menopause?
Transcript
So how do we diagnose the menopause? So as mentioned on the last slide, menopause is defined by 12 months after your last period. So actually, we can only accurately diagnose the menopause retrospectively. Lots of women come to us asking for blood tests. Maybe when they start experiencing symptoms.
That might be due to the menopause or to see where they are in the process of things, or maybe to see if those symptoms actually are due to the menopause. But the problem is because during the perimenopausal period, with the hormones constantly fluctuating.
It's not really helpful to check these levels for diagnosis because it doesn't really give us an accurate picture of what's going on. The British Menopause Society state that blood tests shouldn't be used to diagnose people that are aged 45 and over, and we know the average age of menopause in the UK is 51.
So we therefore give any woman that's aged 45 or over a diagnosis based purely on their symptoms. There are some people we do consider blood testing. So for example, in women who have something called premature ovarian insufficiency.
So that's when they start getting symptoms at an age younger than 40, and in some women aged between 40 and 44, we could consider a blood test. For example, if your periods were becoming less frequent. But like I said, because of the fluctuating hormone levels, we would want to have two blood tests for information and these would need to be six weeks apart. In both of these scenarios, we're checking a hormone, something called FSH, or follicle stimulating hormone. This hormone works by stimulating the ovaries to release an egg.
So as your reproduction function is declining, your FSH is trying to kick it into action by raising the FSH. However, the blood test doesn't tell you really where you are in the perimenopause. There's no correlation to FSH and how severe your symptoms are and neither does it predict how long they'll last or whether you need any treatment, and in some cases it might actually delay getting the appropriate treatment; if the results muddy the water. So, we don't recommend them very often.
Slide 11
Ways to manage the Menopause
Transcript
How do we manage the menopause then? As I've mentioned already briefly, there's lots of factors that might influence how you do or don't experience the menopause and it's really hard to treat symptoms with just medicine alone because actually there's so many factors at play. For lots of women, the perimenopausal period is coming at a stage of life where maybe your juggling your career with being a mother or a partner, or caring for an elderly relative. There’s lots of things we have to consider aside from medicine, and there's lots of things that you can do to help during this time.
Slide 12
Exercise INCLUDES IMAGE
Transcript
Exercise is one of them. It's super important for all aspects of our health and during the perimenopausal period can be really great for both mental and physical health. Reducing oestrogen levels do correlate with a significant increase in the risk of heart disease and reduced bone density. Regular exercise helps to counter this, keeping you a healthy weight reduces the risk of heart disease and strength training in particular is really good at reducing the risk of bone thinning and osteoporosis. Now I'm very, very aware that most of us don't look anything like these gym bunnies, in this slide, but aiming for moderate strength or resistance training, maybe one or two intense gym sessions a week using weights. Doing exercises like squats and lunges, press ups and bicep curls are really ideal.
I'll just use this section about strength training to talk about osteoporosis briefly. So osteoporosis is a condition where your bones are weaker and thinner and more likely to break. And the strength of your bones before menopause is one of the factors that will influence how likely you are to develop osteoporosis. We actually achieve our peak bone mass in our 20s, which might be a little bit depressing, but you can still make moves to impact your bone mass now through strength training and actually having a diet adequate in calcium and vitamin D. As well as strength training exercises, you should do exercises to improve your balance; yoga or pilates. These will help to stop you from falling over in the 1st place and will help to reduce fractures in that sense. If you're not someone that's going to go anywhere near a gym, then walking, cycling, swimming. Something to get your heart racing is a really good alternative and actually exercise has been shown to help reduce hot flashes.
Slide 13
Diet INCLUDES IMAGE
Transcript
In terms of diet, what we eat and drink can have a huge impact on menopausal symptoms. Often, we're rushing about snacking, skipping meals, or maybe eating the quickest thing. And all this during the menopause with fluctuating oestrogen levels can really impact how we metabolise food and affect which type of foods might suit us best. Weight gain is one of the most common side effects of perimenopause, and it affects about 50% of women. And being overweight has been shown to worsen hot flashes and increases the risk of heart disease and diabetes.
As a result, women always ask, which diet is best? What should I be doing? What should I be eating? I guess in terms of trying to lose weight, there haven't yet been any high quality studies on perimenopausal or menopausal women to assess the effectiveness of popular diets. Maybe such as the ketogenic diet or intermittent fasting, so we don't really have the data to support how effective they are in this group, but there is lots of data about the use of calorie reducing diets in conjunction with exercise as the route to achieving sustainable weight management.
It's not all about weight loss. I think in general keeping things simple is the best approach, so breaking things down into macro nutrients, which are the main food groups. Protein is really important to keep bones, muscles, skin, hair, nails, healthy. Aiming to have, I'd say about 1/4 of your plate of protein. Sorry 1/4 of your meal plate should be protein and having protein with every snack. It will help you keep full for longer and it's a really great source of important nutrients like iron and omega-3 fatty acids.
Carbohydrates are your body's primary source of energy, and I think lots of us think about cutting out carbs, but it could be that maybe if you're really tired that you're not getting enough carbs. So it's about choosing the right carbs. And maybe if you're thinking more about complex carbs go for fruit or vegetables, as these are packed full of fibre and they're really important for a healthy gut. Try to keep to a minimum refined carbs so that's sugary foods, white bread. These things will cause a huge sugar spike, so things like multigrain seeded breads, sweet potatoes are much, much better. And in terms of how much carb, then a fist size proportion is recommended. The last micronutrient is fat, and saturated fat is actually needed to create sex hormones such as oestrogen, so it’s important to make sure we're getting the right amount each day. The guidance recommends 20 grammes a day and all the omegas three and six are essential for good heart, brain, hair and skin, and red meat. Oily fish, nuts, seeds, avocado, olive oil. These are really good sources, essentially try to cook from scratch and include unprocessed food as much as possible, rather than refined or processed foods and for bone health, sticking to calcium rich foods, milk, yoghurt and cheese in a reasonable amount.
Slide 14
Alcohol, smoking and caffeine
Transcript
Alcohol, smoking and caffeine. Women who smoke do actually have an earlier menopause than non-smokers and we know that alcohol smoking and caffeine can increase hot flashes and night sweats. If this is something that you're worried about, it's happening to you, maybe keeping a symptom diary.
Might be helpful. Essentially, I think keeping alcohol less than 14 units a week and avoid it. Avoid saving all those units for one of the days of those week. You don't have to be teetotal, but I think if you find reducing if you reduce these things you might find it helps your symptoms.
Slide 15
Sleep
Transcript
Sleep is one of the things that's affected during perimenopause for lots of women. Maybe if it's impacted by stress or night sweats. Good sleep hygiene is key for this, and maintaining a regular sleep schedule, avoiding excessive caffeine or blue light and ensuring relaxation is essential for this.
Slide 16
Cognitive Based Therapy
Transcript
There's also a role for cognitive based therapy, or CBT, in managing menopausal symptoms. I think lots of us might know already that CBT can be helpful for mood or anxiety, but it has also been shown to reduce the impact of hot flashes and sweats.
Through managing your perception to these things, so we do really encourage menopause specific CBT.
Slide 17
Supplements INCLUDES IMAGE
Transcript
Supplements. There's mixed opinion about whether supplements are or aren't helpful during the menopause, especially because lots of nutrients we should easily get in our diet. Vitamin D is the only one that's really evidence based recommended as a dietary supplement for all women in the perimenopause, menopause and menopausal period. So the dose should be daily 10 micrograms or 400 international units a day. Magnesium is currently very popular and there's a little bit of evidence to say that aiming for about 250 milligrammes of magnesium supplements a day might help to prevent bone loss. And as mentioned already, omega-3 is good for your heart, bone, skin and nails and there's lots of supplements out there and maybe we can answer a few questions about any specific ones shortly. If you do choose to take a nutritional supplement, just do be aware of any interactions with other medications that you're taking and don't continue if they're not helping.Supplements. There's mixed opinion about whether supplements are or aren't helpful during the menopause, especially because lots of nutrients we should easily get in our diet. Vitamin D is the only one that's really evidence based recommended as a dietary supplement for all women in the perimenopause, menopause and menopausal period. So the dose should be daily 10 micrograms or 400 international units a day. Magnesium is currently very popular and there's a little bit of evidence to say that aiming for about 250 milligrammes of magnesium supplements a day might help to prevent bone loss. And as mentioned already, omega-3 is good for your heart, bone, skin and nails and there's lots of supplements out there and maybe we can answer a few questions about any specific ones shortly. If you do choose to take a nutritional supplement, just do be aware of any interactions with other medications that you're taking and don't continue if they're not helping.
Slide 18
Hormone Replacement Therapy (HRT) INLUDES IMAGE
Transcript
HRT or hormone replacement therapy is actually the most effective treatment that we currently have for managing menopausal symptoms. So with HRT, we're literally trying to replace the oestrogen that's declining. It can help with hot flushes, night sweats, brain fog, mood, joint pains, all of these if they are being caught being caused by low oestrogen. And what I mean by that is we know that factors such as work relationships, family life, lifestyle are often also contributing, so HRT might not always be the magic fix for lots of women. However, it can be absolutely life changing, so we do really support women and with a trial of this as well as managing symptoms, it can also benefit long term health consequences of menopause can reduce the risk of osteoporosis and fractures.
And for heart health, if it started within 10 years of the menopause under the age of 60, it can be beneficial too. HRT is suitable for almost all women, but the exceptions might be those with certain cancers. So maybe breast cancer or womb cancer, or maybe if they've had previous blood clots and sometimes we do need to take things into consideration. For example, if you have conditions like epilepsy or if you're using medicines like Mounjaro.
One thing to be aware of is that HRT isn't a form of contraception, so if you do consider HRT, we'd recommend you also have a form of contraception too.
So how do we give HRT so as you can see on the slides, there's two hormones that we give oestrogen and progesterone. The purpose of the oestrogen is to replace that which we're losing in the perimenopausal period and in any woman who still has a womb present. We'd also give progesterone.
The purpose of the progesterone is to protect the womb because if we give oestrogen by itself, it can over stimulate the lining of the womb, causing it to grow thicker and thicker, and that can lead to problems with bleeding or maybe in some cases abnormalities such as womb cancer.
So we give progesterone to mitigate this risk.
Oestrogen could be given as an oral tablet or through the skin. I think most women that we consult with these days tend to have oestrogen through the skin. It is considered safer for women with certain medical conditions, for example high blood pressure, increased risk of blood clots or heart disease or if they're overweight.
In terms of the transdermal or through the skin preparations, we can give it as a patch a gel or a spray, basically whichever one you prefer and nothing you choose is set in stone. If you choose one and don't like it, we can always change. Progesterone can be given in patch with oestrogen, which is really nice for convenience, but it can also be given as a oral tablet or as the Mirena coil, or off label as a vaginal tablet too. I guess one of the nice things to point out is that because the Mirena coil can be used for both HRT and contraception, it's a really neat way of killing two birds with one stone.
Slide 19
Vaginal symptoms
Transcript
Lots of women experience vaginal symptoms during the perimenopausal period, and I've just handed over to my colleague Dr McGuinness to briefly explain this.
Transcript onwards by: Dr Nicola McGuinness
Thanks Ayo, I'm doctor McGuinness GP with Ayo at the family practise and one of the symptoms we see quite a lot of presenting around the perimenopause and menopause. Is women experiencing genital urinary symptoms. By that I mean.
Symptoms in the vulva and the vagina, and often this is because the oestrogen in our body that I was describing affects lots of different things. There are receptors all over the vulva and the vagina and the bladder.
As those levels diminish, women may experience symptoms in that area or may not. But we tend to find women aren't always telling us about this and don't talk to their friends about it. So, I suppose we're just using this opportunity to say; speak to us about it. The kind of things people might experience are sort of soreness in the vulva and vagina with itching, soreness, or burning. They may get urine infections, and they may even get recurrent urine infections, and that's related to those oestrogen receptors on the bladder.
They may also feel like they have a urine infection, but they don't. When we check their urine and that may be a symptom of the menopausal changes, they may have intimacy issues, so dryness and an increased need to use lubrication and in difficulty enjoying sex, so different to the loss of libido it just may not feel the same. As I say it's not often talked about, and we as GPs talk about it an awful lot, and we want to really reassure you because it can be really well managed. Aside from the HRT that Ayo has already spoken about, we use a localised oestrogen into the vagina, which can be very helpful and reverse an awful lot of those symptoms I've just described, and it can be used really long term without additional risks associated with it. So they talk about if you use it for a whole year, it's the equivalent of taking one HRT tablet orally. So actually the risks are very low and it's got a long term licence to be used for women. There are actually very few women who can't use it, but there are other approaches and it might be helpful just to touch on that for women who haven't yet reached perimenopause. There are also vaginal moisturisers and lubricants that women can use if they choose not to use vaginal oestrogen, and actually having a good approach to vulval health in the in the 40s, mid 40s and 50s around using emollients to wash with rather than shower gels and not letting shampoos and shower gels run through the vulval area.
For lots of women who are doing exercise, making sure you're not in your gym kit for too long and not in damp clothing and making sure that the clothing is breathable. Trying to keep nice and cool and trying to prevent any itch / scratch cycles.
And sometimes, if things are more difficult, avoiding using towels and shower products, sponges and things to irritate the area.
But bottom line, we talked to a lot of women about this, and we'd encourage you not to suffer in silence with it.
Slide 20
What about testosterone?
Transcript onwards by: Dr Ayo Olomolaiya
Great. Thanks, Nicola. So what about testosterone? The ovary also contributes to the production of the male hormone testosterone. Currently, we only use testosterone replacement for those with persistent low libido. After all other contributing factors have been addressed. We all know that sexual desire in women is complex to say the least, and factors such as low energy, anxiety, low mood, maybe vaginal dryness or discomfort as part of the menopausal symptoms, along with maybe relationship issues and life stresses do need to be considered. Testosterone replacement might not be the magic cure.
If other factors have been considered, and it's been decided to have a trial of testosterone. The evidence says the best effect is likely to only be moderate, with one extra satisfying sexual episode per month.
So if there's no benefit after a trial of six months, then it should be stopped.
In terms of how we'd give testosterone. There is a tablet form that has a combination of oestrogen, progesterone and testosterone that's given to those that are post-menopausal. It comes as a gel, but in the UK is currently only licenced for use in men, but we can use it at a smaller dose for women under specialist advice there's a cream which is licenced for women in the UK, but this is currently only available on private prescription. At the moment, testosterone is only offered to those who are already using systemic oestrogen treatment. So that would be with the patch or the tablet, for example. And we'd want to ensure that you're on the maximum or optimum amount of oestrogen before offering a trial of testosterone because that alone actually in many cases might do the trick, and I guess what I will say is that one size doesn't fit all, so there's no way of knowing exactly what type of HRT may or may not suit you. I guess what suits your friend might not suit you either, and we just have to take an individualised approach, taking everything about you into consideration.
I guess the other thing to say is that you don't have to take HRT. Some women don't have symptoms that impacts them very much. That requires any treatment. So don't feel pressured that you have to go one way or the other.
Slide 21
Are there any risks of HRT?
Slide 22
Breast Cancer Risk INCLUDES IMAGE
Transcript
In terms of HRT risks, I think the thing most people might ask questions about is breast cancer. This slide here is a good infographic that I found which kind of details the breast cancer risk, so essentially on the top line, if you have a look. If you were to take about 1000 women aged between 50 to 59 over a period of about 7 1/2 years, 23 of them would be diagnosed with breast cancer. If they all took HRT for the same length of time, you'd be looking at an extra 4 women affected by breast cancer, so I guess you could say that that's considered a small risk. The risk is related mainly to combined HRT. So that's when we give oestrogen and progesterone with less risk associated with oestrogen only HRT, but we can only give that to women who've had a hysterectomy. Remember, we need the progesterone to protect the womb. The risk is dependent on how long you take HRT with there being an increased risk if you take HRT for more than five years or if you start HRT at an older age when there's an increased risk of breast cancer naturally anyway. And the risk gradually falls over the years after stopping HRT.
Interestingly, as you can see, there's a much higher risk of developing breast cancer with other factors such as being overweight or obese, and with alcohol use too. And the bottom line, I found quite interesting is that you'll notice that exercise actually reduces the risk of breast cancer.
So doing 2 1/2 hours of exercise per week can actually significantly reduce your risk of breast cancer. Other risks we often have to weigh up are the risk of developing blood clots. Though oestrogen can make the blood sticky, so if you're somebody that has an increase of risk of blood clots anyway, we might suggest maybe having oestrogen given through the skin as this would be safer than having oestrogen through a tablet. Generally, the safest time to take HRT is within the first ten years of having menopausal symptoms as the risk goes up with age.
Slide 23
Your Turn...
Transcript
So that was a whistle stop tour of all things perimenopause, menopause and how you can manage this stage of life. We are now going to open up the floor for your questions. So please, can you keep your mics off and write your questions in the chat? And I'm just going to stop sharing my screen.
Transcript onwards discussion by Siobhan Buck, Dr Nicola McGuinness and Dr Ayo Olomolaiya
BUCK, Siobhan
Hey, so thank you loads and loads of questions actually have come up in the chat through that. I think some of them are sort of answered and then or asked. And then I answered it a bit of a later date but some of the nig themes that are coming out is in terms of how to know if perimenopause is starting for people who maybe are on the pill or have a coil, don't have periods for whatever other reasons. How might they identify that they're sort of coming into perimenopause?
OLOMOLAIYE, Ayo
Nicola, can I let you start with that one? Thank you.
MCGUINNESS, Nicola
I can certainly start, so this is there's a few questions I think buried within that and probably any woman who is in her 40s who begins to feel things are different and that doesn't need to be that the cycle is actually changing. But some of those other symptoms may be happening, so cycles can still be regular and you can be experiencing changes in mood, sleep, brain fog, hot flushes. I think at that point you know focusing on good lifestyle and making sure you're doing what you can to optimise that.
But then thinking about coming to speak to us as GPs, because what we would probably do in that situation is take a very individual approach to try and work out. Is there other stuff in your life that might be explaining it, but if not to be thinking about a trial of HRT, as Ayo mentioned. We would do that probably for about 3 months to see how you respond and which of your symptoms are resolved, often not every symptom is and actually that can happen. I think I saw some questions about when do you start HRT, you don't have to wait for your last period. So, this can happen in you while you're still having regular cycles but experiencing other symptoms.
To ease your way through your last periods. So we would do a trial of treatment and that is usually our best approach and we often say to women very openly if it doesn't help, leave it off after three months and then we try again in future if it's needed.
Does that answer that? I think if you've, if you've got a Mirena coil in you can't use your periods to guide you. But those other symptoms can guide you if you're on the pill. Often you are a little bit protected by the pill from the perimenopause because the oestrogen in the pill may also be protecting you from some of the menopausal symptoms. Not always.
And especially getting closer to the actual menopause, you may need actual HRT as well. So again, it would be about consulting, but you're often protected when you're on the combined pill.
BUCK, Siobhan
Great. Thank you. And actually that has been again one of the questions that's come up quite a lot is if you are on the pill taking oestrogen separately, what are the benefits of taking HRT and is it necessary?
MCGUINNESS, Nicola
Can I finish that one and then I'll hand you for the next one. You probably wouldn't use the combined pill and HRT. I mean that would be a slightly unusual combination, but often if women are having an early menopause, we might recommend the pill as an approach because it gives them contraception as well.
But if they were having symptoms that were breaking through, that or didn't need contraception, then we would probably move them and suggest that they recommend they take HRT and a different form of contraception. If that was still needed, would you agree? Is that what you would do?
OLOMOLAIYE, Ayo
Yeah, yeah, definitely.
BUCK, Siobhan
Great. Thank you. A few people have asked how would you identify if symptoms are menopause or if they're the impact of other things. So sort of stress PTSD.
OLOMOLAIYE, Ayo
Really good question. I think it's so tricky. I think in most cases we can never say for sure. You know this one symptom is definitely due to the menopause or this is definitely due to something else. I guess often when I'm speaking to patients I'm thinking about, OK, how much is this symptom impacting you and what can we potentially try to see if it helps? So I think maybe we can't always be definite, but if we can find a way to manage the symptoms and to have you happier and not having those symptoms impacting you, whatever they're caused by, whether it is life stress.
And if we need to try, you know, recommending counselling, or if it is, or even if we don't go down that route, we could say, OK, let's try some HRT for three months, six months and see how you feel after that. We like to try things in turn. So we know which one works, but it's not always that neat, I'm afraid, I guess.
Yes, it's yeah, we can't always be completely certain is what I'd say.
BUCK, Siobhan
OK. Thank you.
OLOMOLAIYE, Ayo
I hope that answers that question.
BUCK, Siobhan
There's also been some questions about the HRT and if there are, if it is the only way to manage. As in, can you manage menopause completely naturally? Is that something that's possible?
MCGUINNESS, Nicola
Yes, I mean in fact, two in 10 women really don't get an awful lot of symptoms from their menopause. I sometimes wonder if that's been written by a man, but anyway, some women really will not experience a lot of symptoms, but they would still be encouraged around the lifestyle side of things.
Some women can't take HRT, and there are other treatments available to manage some of the symptoms of the menopause, so we often will use other drugs that were developed for other reasons for women who can't take HRT and they're in very specific situations. And of course, some women will do some CBT, manage their lifestyle, and just tolerate their symptoms. They don't want HRT. It's an active choice. Women are not obliged to use HRT and we certainly see women who that's very much a positive choice for them.
BUCK, Siobhan
Great. Thank you. Some questions around what happens when HRT stops, So what would kind of how would that process look like?
OLOMOLAIYE, Ayo
Good question. So I guess there's no set duration on how long a woman should stay on HRT if she chooses to go on it. We know that the average duration of menopause or perimenopause or symptoms, sorry, is about seven years.
So most women might stay on it for that long and trial coming off, we generally start to think that after the age of 60 that some of those risks, I kind of briefly touched on might start to outweigh the benefits.
So usually around people's 60th birthday, we start thinking about whether having conversations about trialling coming off treatment, but often much before that people might trial coming off treatment, and I guess without knowing there's no way to know exactly what's going to happen when you stop it. And I think there's possibly always that fear as well, that OK, are my symptoms going to come back really quickly, necessarily? And I guess it's just understanding that we can do things as gradually and slowly as you need to as long as you're aware about the medicine and the potential implications of it in terms of the risk benefit ratio?
There's not. We definitely wouldn't say, oh, we have to come off it. It's just an ongoing conversation, is what I'd say.
BUCK, Siobhan
Great. Thank you. Someone mentioned that some GP practises are doing sort of across the board blood tests at 45 for their patients to test for symptoms of perimenopause. Is that something?
That is on offer at the moment. Is that something that we're doing?
MCGUINNESS, Nicola
So I think that's referring. Can you hear me? Sorry, I think that's referring to the NHS health checks that's offered at 45 and that at the moment doesn't test. There are no hormonal tests in there and I don't think that's proposed to be on offer, but there is a cholesterol test as part of that.
BUCK, Siobhan
Yeah.
OK.
MCGUINNESS, Nicola
And an assessment of cardiovascular risk based on blood pressure and smoking status and other factors. And for some individuals also are checked for diabetes and for kidney disease and in the last couple of weeks it's announced they are proposing to include questions about the perimenopause for women and an opportunity to ask questions at that point. I think all three of our practises do offer that. It's something that has to be staggered or else we are doing nothing but health checks, but there will be invitations, I'm sure coming from the practices around that, but it doesn't check for hormonal levels and it and that's very clear.
BUCK, Siobhan
Thank you. There are some questions coming through and there's a few around quite specific circumstances, which is great to kind of have the questions I'll ask a couple of them. Just to see if we can sort of answer. So there's one around migraines.
And whether HRT has an impact on that, if someone's used to having migraines.
OLOMOLAIYE, Ayo
So in terms of migraines, I guess it's a whole huge topic in itself. Some women find that their migraines actually get better in the perimenopausal and menopausal status, and some women find that it gets worse.
In terms of HRT, migraines are something that we do take into consideration.
And just in maybe which preparation of HRT that we'd give you. So I think if you were somebody that was having migraines, I might suggest having the oestrogen given through the skin just because sometimes migraines can be associated with other cardiovascular risk factors. So we might suggest that route instead.
Does that answer that question?
MCGUINNESS, Nicola
And we might consider the coil, mightn't we in terms of progesterone?
OLOMOLAIYE, Ayo
Yeah.
BUCK, Siobhan
Great. Thank you. Another interesting question was can you predict the symptoms of your menopause based on maybe family history and kind of how your mum experienced it?
MCGUINNESS, Nicola
That's interesting. I don't think there is evidence for that, but I think there is evidence that you are likely to have a menopause at the similar age to your mum. That is, there is evidence of that. Interestingly, the generation above who had higher rates of hysterectomies because they didn't have Mirena coil. So a lot of their mums don't actually know when they would have had their menopause. But I think there isn't an association with the experience. I might be wrong. Are you? Are you aware that I know there's some other GPs in the call, so they may have a view too, but.
OLOMOLAIYE, Ayo
No, I'm not aware of any kind of predictive markers or anything like that, no.
BUCK, Siobhan
OK, there was a mention of some perimenopause sort of tests that have been seen on social media. I'm not quite sure what that meant that is there any legitimacy to those? Or if you had, do you know of anything that kind of can be used to predict?
OLOMOLAIYE, Ayo
No, not really. And I guess it comes back to what I mentioned in the presentation is because your hormone levels are just fluctuating up and down. So, so constantly throughout the perimenopause even in a day your hormone levels might be slightly different compared to later on that day. So I think it's difficult to know how.
Basically, the way we think about tests is, are they going to change what we're going to do and how would we interpret them necessarily? And I think with having an FSH about hormone level that I mentioned being up one day and down the next, it wouldn't really move you very much further in knowing definitely is that symptom due to the menopause or does that mean I need treatment. It doesn't really provide any answers. So I think if it was me, I wouldn't really recommend. I wouldn't personally have any blood tests done for checking for perimenopause because we know for that evidence isn't really there. It's much better to be guided by your symptoms, and I think that is a bit tricky sometimes not having that definite data or yes, and they're also used to having this data about all of our lives. And I think sometimes going back to basics a little bit, maybe keeping a symptom diary. Tracking symptoms that you are noticing over periods of weeks or months might be maybe more helpful than having a blood test.
BUCK, Siobhan
Great. Thank you. I'll do one sort of final question just because I'm conscious about time, are there any menopause specialists at either of the three practises?
MCGUINNESS, Nicola
Absolutely there are, although I'm not sure we'd call ourselves menopause specialists. I think there are so many consultations around the perimenopause and menopause that all GPs in our practice have really good skills in talking about this. That's not just the female GPs and we talk about it an awful lot in our clinical meetings and I know that in the other practices there are some excellent colleagues who have specialist knowledge, but also that this is a really common consultation now. So it should be something you can access very easily.
So I'm going to say yes, I mean the reception team will guide you if you've got particular issues, I'm sure.
Can I just pick up on the testing? Do you mind about Dutch tests? Because I think that someone has brought up these specialist online tests that they're talking about a lot on social media.
And I saw one the other day for the first time and looked at it in real detail, and I thought, I don't think that they're particularly evidence based, or at least not very easy to interpret. So I think that the jury's out. I think maybe that, you know, in the future there may be some interpretation of some particular tests that they do, but they when you look at them, they're incredibly complicated and I don't think I yet with my experience know how to interpret them at the moment and they cost a lot of money. I don't know if anyone, have you seen any of these Dutch tests that people sometimes bring to consultations, so I agree keeping it simple and listening to the story and how people are doing.
BUCK, Siobhan
Great. Thank you. There's been some questions around sending these slides and the information I know we've got some resources that we are going to send out at the end.
And if you got anything else to add at the end here, before we start wrapping up.
OLOMOLAIYE, Ayo
I don't think I do. No, but very happy to share the slides and we'll send out an e-mail with all that information and hopefully we'll be able to collate some of the commonly asked questions from this chat and can come back to you with that too. I think that might be helpful.
BUCK, Siobhan
Yeah, so as if I've been sort of taking notes on the question, so definitely we can go back through and get those common themes. And would everyone in the chat be happy to sort of answer the question I asked at the beginning and say how confident you might feel now in terms of managing your menopause or perimenopause?
Slide 24
And now...
Can you tell us on a scale of 1-10 how confident you feel now in managing your Menopause /Perimenopause?
No Transcript for this slide
Slide 25
Useful Local Resources
• The Bristol Menopause Toolkit A local guide to navigating perimenopause and menopause in Bristol, created by local healthcare professionals
• MPower A local monthly group to discuss all things menopause, usually meeting on the first Thursday of each month at The Greenway Centre in Southmead
• Rock My Menopause Resources and tools to manage perimenopause and menopause, including a symptom tracker.
• Queer Menopause Inclusive menopause resources
Transcript onward by Siobhan Buck
So these are just some local kind of useful resources that could be helpful. And so we will send out an e-mail after this. So the Bristol Menopause Toolkit is really great created by healthcare professionals locally with lots of different resources and there's M power, which is a local group. They meet at the Greenway Centre in Southmead and that's the sort of peer support group with lots of different information. And there's also a website called Rock My Menopause, which does have things like a symptom tracking. Yeah, various tools in sort of identifying symptoms and then also queer menopause, which is a really great website with inclusive menopause resources. If we go to the next slide, I think the final slide.
Slide 26
Next Stepts and Thank You
This evening’s event provided general information
Group Consultations offer more personalised support:
• 1½ hours in a group of about 10
• Each person has consultation with a doctor, and listens to others’ consultations
Register with Eventbrite link in follow-up email for:
Menopause Virtual Group Consultation
The FAMILY PRACTICE
• DATE: 17TH DECEMBER 2025
Tell us what you thought
Transcript
So as we said, this was a sort of general information and session. We will be holding a group consultation with some more personalised support, so there'll be sort of groups of up to 10 where you'll be able to have a one to one consultation and listen to others consultations. And again, we'll send out an e-mail that that is happening I think on the 17th of December. Yeah. Thank you.