THAT side-effect of menopause most woman have but no-one wants to talk about…

The first South African study to report on the impact of menopause on women’s sexuality finds that intimacy and good communication are closely linked, and that women must be encouraged to seek help.

Results show women and men are comfortable talking about vaginal discomfort but there is a need for women to talk to their health care professionals about this condition.


Having satisfying sex is an important part of life no matter how old you are. But all too often, age-related physical or emotional changes can lead to discomfort or disinterest in the bedroom. Falling postmenopausal oestrogen levels cause women to produce less vaginal lubrication, which can make sex uncomfortable and reduce the likelihood of orgasm.

A new study, the first of its kind in South Africa, focuses on postmenopausal vaginal atrophy. Results from the CLOSER (Clarifying vaginal atrophy’s impact On Sex and Relationships) survey – show that 50% of postmenopausal women are affected by vaginal dryness, and that it is crucial for doctors to initiate the discussion on the condition with their patients.

What’s more encouraging, and will hopefully increases awareness, is that 89 % of women were comfortable discussing vaginal discomfort with their doctors, and 58% felt comfortable to chat to their pharmacist.  A significantly higher proportion of black women than white was likely to consult pharmacies about their symptoms.

Vaginal discomfort is also openly discussed by couples. The study found that 80% of South African women told their partners when they first experienced discomfort, while most men interviewed said they had discussed the issue with their partners. A full 90% of men wanted their partners to engage them in these conversations.

These findings show that it’s vital for you to talk to your partner, and healthcare provider about vaginal dryness. Early detection and management are important for your long-term well-being. Don’t be afraid to ask questions about vaginal discomfort, and don’t feel embarrassed or alone – because you aren’t.


According to the study, many women avoid sex because of vaginal discomfort – they find it less satisfying or too painful, while some reported loss of libido. The women surveyed said vaginal discomfort had a negative impact on their feelings and self-esteem, with half of them believing they have lost their youth, or being upset that their bodies did not work as they did before. A third reported no longer feeling sexually attractive, and a quarter felt they were ‘less of a woman’.

Worryingly, despite the negative impact of vaginal dryness, it was left untreated in 40% of women, even though treatment is available. This highlights the need for women to be educated about it, talk about it, and feel comfortable enough to ask their health care professional.



Although only 21% of the women surveyed used vaginal hormone therapy, most said it had a positive impact on their sexual relationships, and their partners also recognised the benefits. The treatment can not only improve your sex life, it also helps couples become closer and less isolated, as the survey showed. In fact, 60% of women using this treatment reported being more optimistic about the future of their sex lives, more confident, and sexually attractive.

“Oestrogen therapy may be local or systemic, but local is preferred when symptoms of menopause are limited to the vaginal area,” says Dr Trudy Smith, a Johannesburg-based gynaecology oncologist and obstetrician. “Local oestrogen therapy is administered directly into the vagina, and can be given as either vaginal tablets, cream or ring.”


“Only small doses of oestrogen are needed to treat vaginal symptoms of menopause, and the vaginal response to local oestrogen therapy may be long-lasting, provided that you take it as indicated,” Dr Smith adds.

The package inserts for all oestrogens reflects oestrogen class labelling, there is no adjustment for oral versus vaginal therapy. Local therapy avoids most systemic adverse effects, as the oestrogen is absorbed locally in the vaginal tissue where it is needed. This results in low levels of oestrogen circulating in your blood stream, whereas oral tablets are broken down in your digestive system and liver, resulting in higher circulating blood oestrogen levels.

If you’re still wondering about treating troublesome symptoms, 74% of women using vaginal oestrogen tablets said they would recommend them, and 61% of these women reported that the treatment worked.

“Vaginal oestrogen is safe, effective and easy to use,” says Dr Carol Thomas, gynaecologist and President of the South African Menopause Society. “The changes that happen in the body as a result of menopause are normal, and there is no need to suffer in silence. Women need to be encouraged to ask for assistance, and not to be embarrassed. Convenient treatments are available and consumers need to speak to their doctor or pharmacist about their options.”


South Coast Herald

South Africa



Liz Earle talks about taking HRT as part of the menopause in the Daily Mail

Liz Earle talks about taking HRT as part of the menopause in the Daily Mail. She says that some of the old-style hormones prescribed by the NHS were derived from pregnant horses’ wee, and some private practitioners suggest that these are the only ones NHS doctors prescribe. She goes on to say:

But it’s simply not true. It’s perfectly possible to get naturally-derived body-identical hormones (patches and gels) from your GP. The cost to the NHS of the oestrogen gel — which I use in conjunction with a progesterone pill — is only a few pounds a month.’

(At the Menopause project we have found this not to be the case and a lot of women that we see are never told about the patches and gels by their GP)

Liz points out ‘There’s a subtle difference, incidentally, between bio-identical HRT, which is generally tailored by a specialist pharmacist to an individual woman’s needs, and body-identical HRT, which comes as a standardised product made by a pharmaceutical company’.

Also check out her recipes for HRT cake and spelt pancakes although I prefer our recipe that uses coconut oil instead of butter.

Read more:
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Hitting the Road to Raise Awareness

We are pleased to hit the road and give all you lovely people an opportunity to find out more about our Menopause Project and meet us in person.

The wonderful people at Southbank Centre have invited us to be part of their WOW-Women of the World Festival on Sunday 11th March. The WOW Festival is an empowering event for women and takes place annually coinciding with International Women’s Day. We will be part of the panel discussion Your Own Personal Heatwave.

Copy of Menopause Awareness Event March 2019If you can’t join us WOW Festival come and meet us at our Menopause Awareness event on 27th March 6-8pm in Hackney. Come along and be pampered with a free massage and refreshments, talk to health professionals, get information and advice to help demystify the menopause. There will also be information about our fortnightly support group and our new workshop starting in April.

We would love to see you at one of these events, please also help spread the word  anyone else that you think might find this useful.

Don’t let the menopause get you down , come and have some fun with us and don’t forget the free massage sessions on 27th March.

One woman’s experience of Reclaim the Menopause’s workshops and activities

No periods for four months. Bloody dawn chorus again. Love birdsong but not at four-thirty every sodding morning. Turned 50, so is it the menopause? The average age is 51 and the definition is no periods for a year. Before that, you are perimenopausal – hormones all over the place, periods stopping and starting. Yup, they came back with a vengeance, two in two weeks, Super Tampax and pads couldn’t stem Aunty Flo.

Saw a leaflet for a menopause awareness event, picked it up and ignored it. Can you imagine? Sitting around talking about it. What if someone I know is there? Maybe, it’s just stress. After all I’m only 50, still young. I think of myself as 38 on a good day, 98 on others. An email pops up from the new wellbeing centre, Core Clapton. Tonight is the menopause event, perhaps I should go. It’s a wet Monday night. It’s only around the corner. It’s an excuse to get out of the house, avoid the torture of generating conversation with a grunting teenager, if he comes down for dinner.

So with hood up, I skulk around the corner. Did they have to put such a big sign in the window? Twenty or so women. Black, white, Asian. Phew, don’t know any of them. HRT cake is being served at the back alongside more enticing treats. A panel of a psychologist, a doctor and a sex shop manager are introduced. The psychologist is an earnest young woman who specialises in Cognitive Behavioural Therapy (CBT) and her mum has gone through the menopause. The bearded male doctor is in his 30s and seems a bit shy. The sex shop manager is a bubbly woman with bushy black hair and a low cut dress. She is encouraging us to visit her women-only sex shop because she says the menopause doesn’t mean your sex life is over, in fact, it could take off.

Bizarrely, while they are going through their presentations, a 20-something young man is filming it all on an I-pad. Why? Makes me feel uncomfortable but don’t want to make a fuss. When it’s opened up to Q and A’s, he asks if there’s any information for kids as he remembers his mum suddenly being really stroppy when he was a teenager. Maybe that’s what’s going on at home. A Tsunamic surge of hormones hitting the coast from two directions.

It turns out they are offering a 12-week free course. It’s funded by Hackney Learning Trust. Well, it’ll get me out of the house on a Monday night, although on one of them I’ve already booked to see Venus in Fur, a play about female sexuality. The sex shop manager would be proud of me.

The leader of the course is on a crusade to break the taboo of the menopause, start a public conversation. There are more than four million women in the UK between the ages of 45-51 experiencing the menopause. About 80% of women in the UK will experience the impact of menopausal symptoms, at least 45% will find the symptoms distressing. Mothers prepare you for your periods but no one prepares you for the menopause. Nobody talks about it. Not even your women friends. Our leader is quite political about it. Says it could be seen as a positive change of life, no periods, kids leaving home, more freedom and she says older women should be revered as wise, as they are in some cultures. She blames the media and advertising industry for the emphasis on perpetual youth. How many older women role models are there? She asks. Joan Bakewell, Navratilova. Answers on a postcard . . . or tweets, please. Nobody talks about the menopause because there’s nothing sexy about it . . . or so it seems.

It’s a small, supportive group, around eight of us turn up regularly. We share things quickly – don’t even know their surnames but know about their sex lives and symptoms. Some symptoms I didn’t realise were linked to the menopause, anxiety, insomnia, depression, mood swings, hair loss, itching, bloating, rage, memory loss, night sweats, changes in appetite, sexual and culinary. And of course, hot flushes.

The course covers CBT, breathing exercises, mindfulness, nutrition, flower remedies, stress management, problem solving, biology and sexuality. They allow a nurse in to talk about the benefits of HRT but generally they advocate a non-medical approach. Excellent handouts and a newsletter are provided.

On a cold December night, week eight of the course, we gather in Hoxton Square, Shoreditch at Sh!, the women’s sex shop for our special Christmas outing. It opened 25 years ago and used to be down a back street with darkened windows. Now its entrance is clear glass and tasteful. There’s a good turn-out. We’re offered mince pies and mulled wine while we stand around a display of dildos. A pink one with ears looks like a rabbit – apparently, it keeps your clit happy at the same time as your vagina. Sweet. Our leader says you have to stay active down below to avoid vaginal atrophy, even if it means DIY.

We’re led downstairs to sit in a semi-circle, surrounded by whips, chains and a Santa’s little helper outfit on a mannequin. The sex shop manager welcomes us. The ice-breaker is to declare what you call your vagina, lady garden, front bottom, missy, punaani – Jamaican patois, in case you didn’t know.

The sex shop manager passes around photos of plaster moulds of vaginas that were done by an artist. It shows a huge variety of shapes and sizes. Men famously compare their dicks but how many vaginas have you seen? Vaginal dryness can be an issue post-menopause, so the manager makes us try out a huge range of lubricants – on the back of our hands – including some that are edible. One tastes of banana. We move on to vibrators – all fully loaded with batteries, black ones, pink ones, ribbed, penis shaped. Again, we try these in our hands or on our stomachs. Apart from one woman, who didn’t understand or hear the instruction and gets a bit carried away.

The vibrators get larger and larger until one brings tears to the eyes. It’s called a magic wand and was brought out by a Japanese company as a massager in the 1960s. A sex therapist promoted it as a sex toy and sales rocketed. Apparently, the company tried to dissociate itself from one of its bestsellers.

After lots of giggling and whooping, our host lets us wander around the shop, trying things out. She recommends love balls to pop up your fanny to improve your pelvic floor muscles, if nothing else, and a potion called ‘On’ to spice up your sex life – it causes blood to rush to your clitoris and lasts about 45 minutes. Wey-hey girls!

With a 20% discount on the night, most of us go home with something for the weekend.

It was our last session this week. Time to reflect. What could be an existential crisis could also be a time of positive change, looking after yourself, not worrying about what other people think of you, stepping out on a Monday night. Meeting a diverse group of supportive, wise women has been a delight. We plan to meet up every other week at the ongoing support group. A lifeline at a very tricky and often lonely time of life for a lot of women.

Thanks to everyone at Hands Inc. and its funders. I hope they get the funding to roll out beyond Hackney.

Nicola: Workshop participant October 2017 – January 2018

Follow Nicola @nicolawadehill



‘I don’t want to try HRT – I’m worried about breast cancer’

By Kathy Abernethy

Monday 15th January, 2018

Debunking common patient myths and misconceptions

The myth

Many patients believe that hormone replacement therapy (HRT) causes breast cancer.

Women are concerned that taking any form of HRT – even for a short time – will increase their chances of getting breast cancer. The anxiety over this belief is so great that women are often reluctant to use HRT, even for troublesome symptoms or when the treatment is required for young women with premature ovarian insufficiency (for whom hormone replacement, unless contraindicated, is advised).

Like many myths, it came from evidence that has been misinterpreted or generalised from out-of-date studies and resources. The link between breast cancer and HRT is well recognised and, in recent years, the issue has been further clarified. Nonetheless, the negative stories from previous clinical studies still dominate the opinions of women and even some healthcare professionals.

The reality

Most women use HRT for a short period of time and solely for the relief of menopausal symptoms. There may be early side effects and an initial adjustment of dosage may be required, but for many women who are menopausal yet generally healthy, the risks from using HRT are low. It should be noted that individual assessments are needed to be sure that women for whom HRT is contraindicated are advised accordingly.

The 2015 NICE guidance clarified the risks of breast cancer for women when using HRT during menopause:1

  • The baseline risk of breast cancer for women around menopausal age varies in each woman according to the presence of underlying risk factors, such as age,

  • weight and alcohol consumption.

  • HRT with oestrogen alone is associated with little or no change in the risk of breast cancer.

  • HRT with oestrogen and progestogen can be associated with an increase in the risk of breast cancer.

  • Any increase in the risk of breast cancer is related to treatment duration and reduces after stopping HRT.

Breast cancer is a common cancer and, whether on HRT or not, women must check their breasts and report any changes promptly. Some women will have a higher baseline risk than others, perhaps due to family history. Starting HRT around perimenopause if the patient has had a hysterectomy, for example, and needs oestrogen-only HRT, will not increase the baseline risk.

Combined HRT increases risk of breast cancer when the patient has used it for more than five years. The NICE guidance also states that an extra five women per 1,000 using combined HRT for 7.5 years are susceptible to breast cancer from a baseline of 22 per 1,000. So, out of a typical 1,000 women using HRT, 22 might get breast cancer anyway (baseline risk), but after 7.5 years’ use of combined HRT an additional five women might develop the cancer while 973 will likely not.

 Other risk factors include being overweight and drinking two or more units of alcohol a day. The risk of each is similar to or, in the case of obesity, more than that of five years’ combined HRT use. Smoking too is a risk factor, while exercising five times a week is slightly protective.2,3

Nurses advising women about the menopause, or indeed making choices for themselves, need to be familiar with these statistics and put them in context for patients. HRT remains the most effective treatment for menopausal symptoms and – although many women will not want or need it – for some, menopausal symptoms can be very bothersome, affecting home, work and social situations.

To avoid evidence-based treatment because of unfounded fears means that women’s lives are being affected on a daily basis. Women deserve a personalised risk assessment if they wish to consider HRT. This takes into account their medical history, family history and general health. HRT for symptoms of menopause will carry a low risk, but for those for whom potential risks might be higher – eg, family history of breast cancer or carrying a BRCA gene mutation – an informed discussion will help them to make the right choice for them.


  1. NICE. NG23: Menopause – diagnosis and management. London: NICE; 2015

  2. Jones ME, Schoemaker MJ, Wright LB, et al. Smoking and risk of breast cancer in the Generations Study cohort. Breast Cancer Res. 2017;19:118

  3. Gonçalves AK, Dantas Florencio GL, Maisonnette de Atayde Silva MJ, et al. Effects of physical activity on breast cancer prevention: a systematic review. Journal of physical activity & health. 2014;11;445-454


BBC Radio 4 Woman’s Hour Menopause Week 15th-19th Jan 2018


BBC Radio 4 Woman’s Hour is covering the menopause all week so tune in to have your say or find out more. Here is the link for today’s phone-in show

Here is a peek at what they will be covering for the rest of the week. On Wednesday Eileen Bellot from our Reclaiming the Menopause Project will be joining the programme discussing the impact of the menopause.

Tuesday 16th Jan: Menopause Survey Findings

Wednesday 17th Jan: The Impact of Menopause on Relationships & Family

Thursday 18th Jan: Menopause & Work

Friday 19th Jan: Menopause treatments (conventional and alternatives). How we can help ourselves?  Focus on women who’ve set up their own websites and women in the public eye who are now speaking out.

We are just a phone call away

Although I have not managed to get to the workshops, just that one phone call with you made all the difference to me. It made me realise that I was not ill and that I was not alone.  I was able to go to the GP armed with information but he did not like the fact that I appeared to be more knowledgeable than him!

JL Tottenham