Dr Zoe Williams is one of our most popular media GP ‘s, frequently appearing on ITV’s This Morning and BBC’s Trust Me I’m A Doctor. She is also a medical ambassador for online menopause platform, Issviva. In a recent study Dr Zoe answered a selection of menopause-themed questions from it’s members and here we look at the most common and Zoe’s expert advice.

Question 1

I’ve suffered with brain fog for a while now and recently, I've just started getting hormonal acne, which I’ve never had before. Should I book an appointment with my GP to discuss whether I’m menopausal and if so, and how can I best prepare myself for that conversation?

Dr Zoe: I think that's such a good question because I know so many people are fearful of going to their GP to establish whether they’re menopausal and they often question whether it is something that's worthy of an appointment. Firstly, I should say that anything if it bothers you, is worthy of a GP appointment. Maybe not an emergency or same day appointment, but I suggest booking a standard routine appointment or even a telephone or video appointment.

I think it’s important to define peri-menopause and menopause, because I think they are terms that can confuse people. The word ‘menopause’ means just a moment in time and it is when you haven't had a period for a year. If you're having symptoms associated with changes in your hormones as you're approaching menopause, that's called ‘peri-menopause’. The word ‘peri’ in the medical world just means the ‘time around’ the menopause. As we know, women can start having symptoms years before their periods completely stop and they can also continue to have symptoms for years afterwards too.

Do book an appointment with your GP as this is worthy of an appointment. I would say the best way to prepare yourself is to gather as much information as you can. The GP is probably going to ask you lots of questions and will want you to provide quite a bit detail. The GP will want to know about your symptoms, how long they've been going on for, how they've changed over time, and if they fluctuate. They might ask when during your cycle do you tend to have symptoms - just before your period or after?

There are lots of different apps now that you can download to help you keep track of your periods and your symptoms, and also there are websites like The Menopause Society website, where you can find a form that you complete to help you track your symptoms. Having that information written down and recorded is important. I think the other thing I would suggest is to do some background reading and research yourself prior to your appointment – being armed with possible solutions is helpful for your discussion with your GP.

When you're booking your appointment, especially if you have a large practice, make sure you ask if there is a doctor or a nurse that specialises in menopause. You tend to find that if there is, then they'll likely to have had some additional training and they're more likely to be up to date in terms of guidelines, treatments etc.

Finally, talk to your friends and talk to your family members or whoever you know has been through it, engage with people regarding their own experience. Just chatting to other people and hearing their thoughts tends to validate what you're going through and makes you feel less nervous.

Question 2

I went to see my GP a little while ago because I was having irregular periods and feeling a little down with low mood. My GP suggested I might be perimenopausal, but he offered me anti-depressants instead of testing my hormones. I refused them at the time but could they help if I am menopausal?

Dr Zoe: So, let's break up this question. The main symptom here that seems to be bothering you is low mood and we’ve established that you also still have a period. So that means you could be peri-menopausal and the low mood could be associated with that. Of course, it's also possible that your low mood isn't related to the menopause at all. There are many, many different causes of low mood from menopause to mental health conditions like depression, and we should also consider other biological factors like iron deficiency, your thyroid gland might not be functioning properly etc.

The NICE guidelines don't recommend that we use a blood test to diagnose perimenopause or menopause. Usually, the reason is that during peri-menopause the blood test may come back as normal because it looks for a particular hormone called PFS. If your PFS levels are above 30, that suggests you might be menopausal. But if you're perimenopausal, it's quite normal for your PFS levels to fluctuate and you might catch it at a time when it's normal.

So, if somebody presents themselves to a GP with symptoms that are suggestive of peri-menopause, the most effective treatment is going to be HRT. My suggestion would be to try it for three months and if your symptoms improve, then great. However, if HRT doesn't make a difference, it might be a case of going back to the drawing board and actually digging down a bit deeper. The cause of this mood dip could be clinical depression so I would suggest trying an antidepressant for a few months. Again, if it doesn't work, you can eliminate it. Medicine is never as clear and simple as it requires a bit of investigative work.

Question 3

I was diagnosed with menopause around four years ago and I've been taking HRT which has been working really well for me so far. However, recently the dreaded brain fog has kicked back in and I’m finding the simplest of everyday words really difficult. I’ve got terrible anxiety, especially at work, and I’m finding it really embarrassing and stressful. What can I do about brain fog and should I talk to my male boss about it?

Dr Zoe: So, I guess two questions there that we need to break down. You’ve been taking HRT for four years and it's been working well for you so far, However, what happens is when you're going through perimenopause your estrogen levels are gradually depleting and so it may be that that they have dropped further since your initial prescription. You might actually require a different dose of HRT as you proceed through the menopause. Talk to your doctor about getting a higher dose of HRT to manage the symptoms. I suggest keeping a symptom log and writing down how things have changed from where they were before.

The workplace topic is a really interesting one because I think this is something that is changing. There's recently been a change in menopause legislation in Parliament, which is really important for women's health. This is the first time the topic of menopause has been taken seriously by government. In my experience, unfortunately, the health care system was set up by white men, for white men and women don't really get look-in.So, therefore, things that only affect women have been very much neglected for so long, and menopause is a huge part of that.

We know that women in the workplace can really suffer. And if they're having terrible menopause symptoms and there's a change happening, your boss has a responsibility to listen to your concerns and help improve your experience at work. If your boss is male, my advice is to book a meeting with them. The best way to prepare for that meeting is by letting them know in advance what you want to talk about, record as much information as you're willing to share regarding the symptoms and how they're affecting you in relation to your work. It's good to prepare by going in with some practical solutions as well. So, say, for example, if it's anxiety that's bothering you on your commute to work, maybe the suggestions would be working from home or actually doing a slightly different shift, maybe coming in a bit later in the morning, so you miss rush hour.

Come up with some suggestions on how you think that things can be changed to help you, and if you don’t feel comfortable speaking to that person directly , then there may be somebody else who you can talk to. If you work for a large organisation, then maybe somebody who is the dedicated person within the HR team or within the management team for you to speak to about this issue. Finally, if you don’t feel like you’re making progress with your boss, then speak to a GP because we can help you with that as well. We can give you a what's called a Med Three - people call them sick notes still, but they're called Med Three. With a Med Three, you can say that somebody is not fit for work, but you can also say that somebody requires, for medical reasons, adaptions to the workplace, whether that is the job, the various different tasks that they're doing, the hours that they're working, etc.

There was a big survey carried out recently that showed that three in five women who are experiencing menopausal symptoms say it affects their job. In addition, the number of women that end up giving up their jobs because of the menopause and the impact it has on them, their financial circumstances, the whole economy is massive. It's really important that women start to feel empowered to make these adjustments.

Question 4

Last year I was diagnosed with estrogen-based breast cancer and I've been told by my GP that I’m not eligible for HRT. I’ve been researching more natural and herbal routes to see if they can help with my symptoms. Which vitamins and supplements would you recommend to help with menopause symptoms and is there anything else that I can do?

Dr Zoe: Let’s talk a little bit about why it is that women who've had certain types of breast cancer usually can't access HRT as I think that’s quite common. So, whenever a doctor is prescribing any drug, we always carry out a ‘risk versus benefit’ assessment. And usually, if the benefit massively outweighs the risk, then we're likely to go ahead and prescribe. As with any drug, even paracetamol, there's always some risk. With HRT, there are some small risks, and the one people talk about the most is a very small increased risk of breast cancer. For most women that small risk is tiny compared to the benefit that they're going to get from taking HRT. For example, many women gain a lot of weight during menopause and it's really difficult to control that. And if that weight-gain tips them into the obesity bracket, then we know that increases the risk of breast cancer more than the HRT.

Sometimes drinking more than a few glasses of wine a week can increase your risk more than HRT. So, it is a small risk, but if a woman has previous breast cancer, and it's an oestrogen receptor positive breast cancer, then currently that is deemed to be riskier for them to take HRT. It switches the balance.

And it's debatable, depending on who you speak to, where it increases that risk, too. So, at the moment, it's usually not advised that people who've had receptor positive breast cancer take HRT. But that's not all forms of HRT, that's systemic HRT, that includes tablets, patches and gels. But it might be that your symptoms are related to vaginal atrophy, for example, so vaginal dryness, soreness and urinary tract infections. If that’s the case, then those symptoms can actually be treated with topical estrogen and you would be fine to use that.

However, as a GP, in this particular case, I wouldn't feel comfortable or confident prescribing HRT to this lady. I'd want to get her in front of a menopause specialist, ideally, or an Endocrinologist or someone who can really help make sure she's getting the best and safest type of HRT and also get some psychological support.

When we're talking about things that people can do for themselves, we need to take a holistic look at lifestyle. Calcium is really important supplement because we know that people lose bone density when they lose oestrogen. It's really important to talk about diet and nutrients, the best diet tends to be the Mediterranean diet. That's a diet rich in healthy oils, olive oil, avocados, nuts and oily fish etc. Try to introduce things like berries that are really dense in nutrients as much and embrace as many different coloured fruits and veggies as possible. Different colours tend to have different nutrients. For example, green leafy vegetables tend to have different nutrients to your bright orange and red vegetables. Research a good quality menopause supplement. Ideally, it's better to get the nutrition from a healthy diet if you can but a supplement won’t do you any harm. Hydration is really important and exercise and keeping your body moving is also key.

Question 5

I’ve been peri-menopausal for about 18 months but I’m still getting the odd period. However, I’m really struggling with sleep. I’m waking up in the night, drenched in sweat and then I struggle to get back to sleep. In the morning I wake up, exhausted because I've had such a bad nights sleep. Often I’ll have a few glasses of wine before I go to bed to help me nod off. Should I try and cut that out? And what else might help with a restful sleep?

Dr Zoe: Three letters – HRT. This lady is a perfect example of that risk versus benefit if she's having a few glasses of wine a night to get to sleep. If we are trying to establish the balance between the small increase in risk of breast cancer and the one associated with HRT, then actually, if HRT gets her to stop drinking wine, then she's likely to have a lesser risk of breast cancer. I get it, wine helps you get off to sleep, but it doesn't mean you get good quality sleep. In fact, alcohol tends to lead to poorer quality sleep. So not only is it bad for your health, it’s bad for your waistline too. Also, alcohol can induce hot flushes and night sweats, so I would suggest having a chat with your GP as HRT is likely to help you much, much more.

PODCAST #inconversation

Listen to Dr Zoe’s exclusive podcast episode with Natalie Anderson

This week join Natalie in conversation with GP and media medic Dr Zoe Williams. As a new mum post 40 herself, Zoe talks at length about the outdated labelling placed upon pregnant women in their 40’s and how each pregnancy should be treated individually. She discusses the pressures of being a first time mum in the public eye and how despite being a doctor she is still learning like any other first time parent. Speaking about the areas in which she’s passionate about in her career Zoe highlights the importance of social prescribing and how increased physical activity can alleviate the symptoms of a plethora of medical concerns. Listen in for Zoe’s expert advice, candid take on motherhood and top tips for protecting your overall wellbeing.