Am I too old for HRT, and is it true that testosterone could give me back my va va voom?

Thanks to celebrity campaigners like Davina McCall, menopause has gone from taboo to hot topic.

And it was about time, given that 13 million British women are currently going through the menopause. This means more women ask us more questions.

But not everyone has access to specialists and GPs with time constraints cannot always provide all the answers.

We’ve dedicated our career to helping women through this time in life, and here we answer just a few questions from readers of The Mail on Sunday about menopause and its treatment.

People say hormone replacement therapy (HRT) can treat everything from hot flashes and depression to preventing dementia, heart disease and diabetes. Is it really some kind of panacea?

HRT is often touted as the magic bullet for all menopause issues and beyond. But scientific evidence shows that the effect is limited.

Between the ages of 45 and 55, levels of the sex hormones estrogen and progesterone gradually decline. For some – but not all – this comes with a host of unpleasant symptoms, including hot flashes, night sweats, trouble sleeping, and intimate skin issues like vaginal dryness.

Some also experience anxiety, brain fog, low mood, joint pain, and exhaustion.

There is evidence that hot flashes and night sweats tend to improve with HRT. A general bad mood can also get better – but women who suffer from depression and anxiety may need to consider other mental health treatments.

Women at risk of the bone-thinning disease osteoporosis and fractures may also be recommended HRT.

Whether hormones help with the other complaints remains unclear, so be wary if you are recommended it for reasons other than those we’ve mentioned.

There is no good evidence that HRT protects against dementia – some studies suggest this is possible, while others say the opposite. The risk of dementia is based on a combination of many factors – heredity, alcohol consumption, diet, education and underlying health conditions are just a few.

Preventing other diseases, such as heart disease and diabetes, is also not a reason to take it. With your heart, maintaining a healthy weight, healthy blood pressure, healthy cholesterol levels, and not smoking are much more likely to prevent heart disease than HRT.

I’ve heard that adding testosterone to HRT can work wonders. Do I have to be there?

Testosterone is usually thought of as a male hormone, but women also produce it in smaller amounts. Levels begin to decline from age 20, and plateau at menopause. Testosterone HRT can be prescribed on the NHS for menopausal women suffering from low libido when regular HRT has not helped. Some women find it works, but others say it makes no difference.

Claims have surfaced online and on TV suggesting that HRT with testosterone for women can boost energy and overcome anxiety. When scientists have carried out tests on this, they have found no effect.

It is also critical that women who take it are checked regularly. If hormone levels in the blood are even slightly too high, it can cause a host of side effects, including acne, excessive hair growth, and even heart problems.

I have a family history of breast cancer and therefore cannot take HRT. What else can I do to relieve menopausal symptoms?

Breast cancer can be caused by hormones, which is why doctors are very careful when recommending it to women who have had the disease.

It’s not a concrete no, but specialists involved in the patient’s care will weigh the risks and benefits before advising whether it can be taken.

However, when it comes to women with a family history of breast cancer, it’s usually OK — except for some very high-risk women, such as those with BRCA gene mutations.

If you have been advised not to use HRT, another option is vaginal estrogen via diaphragms, rings, creams and gels.

A very low dose of the antidepressants mirtazapine and venlafaxine can reduce hot flashes, night sweats and trouble sleeping, as can low doses of another drug called oxybutynin.

I’m in my 70’s and want to use HRT but my GP won’t prescribe it because she says I’m too old. Shall I go private?

Usually, doctors prescribe HRT within 10 years of a woman’s last menstrual period. That’s because many doctors believe the benefits are minimal after a certain age.

But if you start taking estrogen many years after your natural estrogen has been depleted, it can cause fatty deposits in the arteries to loosen, possibly causing a stroke or heart attack.

This is much less likely if the estrogen is a low dose and delivered through the skin, such as through a patch or gel.

There are some benefits to using HRT in old age. Estrogen can make bones stronger and reduce the risk of osteoporosis. In most cases it is a matter of weighing the risks and benefits.

Instead of seeking expensive private help, ask your GP to refer you to a specialist NHS menopause service. These are staffed by consultants in gynaecology, sexual and reproductive health and genitourinary medicine, as well as specially trained general practitioners and nurses. It may be a bit of a wait, but it’s worth seeking impartial advice.

I’ve been told to only use bioidentical HRT – what exactly does that mean?

Bioidentical HRT is offered by private clinics. It means that the hormones in the HRT are almost identical to the hormones your body produces naturally.

Some private institutions claim to create formulations tailored to your body.

These doctors will usually perform blood and saliva tests on you – pharmacists will then manufacture the drugs based on the hormones found in the results.

But these drugs aren’t subject to strict safety checks, and you’re likely not getting the same hormones with every prescription.

We advise women not to take them. On the NHS we prescribe what we call body-identical hormones. The estrogen and progesterone are taken from plants and closely mimic the compounds in the body.

Importantly, they are tightly regulated in terms of their safety and efficacy.