Mr Brett Winter-Roach talks about the Menopause

Menopause: Separating Fact From Fiction with Spire Cheshire’s Mr Brett Winter-Roach

Hot flushes, brain fog, HRT worries and a lot of mixed messages online. Ian James sat down with consultant gynaecologist Mr Brett Winter-Roach from Spire Cheshire Hospital to get some straight answers.

Menopause is one of those subjects we’ve all heard about, but plenty of us couldn’t explain properly. Add in social media, “Dr Google” and a few decades of scary headlines, and it’s no wonder so many women feel unsure where to turn.

So Ian put the big questions to Mr Brett Winter-Roach, a consultant gynaecologist who has been seeing patients at Spire Cheshire Hospital since 2008. He told us he’s seeing more and more women who want specialist advice on menopause, or who simply want to sense-check what they’ve read for themselves.

What actually is the menopause?

Brett was clear from the start. Strictly speaking, menopause is when periods stop, usually somewhere between the ages of 45 and 55. To be precise, it’s when you’ve gone a full twelve months without a period.

The lead-in to that point is the perimenopause, and it can start much earlier than people think. Periods might become irregular or skip a month, alongside hot flushes, night sweats and other changes. Brett explained that perimenopause can begin several years before the menopause itself, sometimes up to a decade, so a woman in her late thirties noticing these changes isn’t imagining it.

The emotional side of the change

Ian asked about mental health, and Brett called it a really important question. Menopause can mark a big shift in a woman’s life, and for many it brings anxiety, worry and low mood.

He was careful to say menopause doesn’t cause depression, and that he isn’t a mental health specialist. But for someone already living with mental health difficulties, this stage of life can bring those concerns to the surface. He also noted that conditions such as ADHD are often diagnosed around this time, because the strain of perimenopause can unmask something a person has been quietly coping with for years.

He also made a point worth hearing: joking about women “losing it” during the change can shut down real conversations and leave people feeling isolated, just when they need support most.

Is HRT safe?

For most women, yes. Brett said there was a long period when the risks of hormone replacement therapy (HRT) were overstated and women who would have benefited were put off. Today, the evidence shows HRT is safe for the majority.

That said, it should always start with a proper conversation with your clinician about your medical and family history. If you’ve had breast cancer, or have a close relative who has, that needs careful thought. But a more distant family history doesn’t automatically rule HRT out, particularly for women under 50, where any increase in risk is small for most people.

How is HRT taken?

There are more options than many people realise:
● Tablets, often combining oestrogen with a progestogen (a form of progesterone)
● Patches, usually changed once or twice a week
● Gel, rubbed into the skin from a metered pump
● Vaginal oestrogen, as pessaries, tablets or cream, for dryness, soreness and bladder symptoms

Brett explained that if you still have your womb, you’ll usually need progestogen alongside oestrogen, because it protects the womb lining and lowers the risk of womb cancer.

He also mentioned testosterone, which women produce too. Levels fall during the menopause, and national guidance says it can be considered for low sex drive if HRT alone hasn’t helped. It’s usually started by a specialist.

Is it for life? And will it make me gain weight?

Not necessarily for life. Brett said good practice is a review around once a year to make sure your treatment is still right and safe for you. And the simple answer on weight is that HRT doesn’t cause weight gain. If you feel better, you may well be more active.

He also stressed looking after the whole person, including diet, exercise and sleep, and highlighted cognitive behavioural therapy (CBT). NICE guidance recommends menopause-specific CBT as an option for hot flushes and night sweats, either alongside HRT or for women who can’t or don’t want to take it.

When should you seek help?

If symptoms are affecting your quality of life, your work or your relationships, Brett’s advice is to speak to your GP first. And if you’ve started HRT through an online clinic without ever being seen face to face, and you’re having problems such as irregular bleeding that won’t settle, get it checked.

He flagged a couple of red flags too:

● Tummy (abdominal) pain shouldn’t be put down to the menopause, so get it looked at
● Burning or cystitis-type symptoms that keep coming back despite antibiotics may be linked to menopause-related thinning of the vaginal and bladder tissue, and can often be treated

You don’t need to suffer

Brett’s message was simple. Take advice early. There’s usually someone who can get you on the right track quickly and rule out the things you might be quietly worrying about. And don’t let the stigma around mental health stop you from asking for help.

To book an appointment with the gynaecology team at Spire Cheshire Hospital, call 01925 215 087 or visit spirehealthcare.com.

 

This article is for general information only and isn’t a substitute for personal medical advice. If you’re worried about your symptoms, please speak to your GP.

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Spire Cheshire