‘We are ‘peri’, not stupid’: Dr Ginni Mansberg answers your questions on perimenopause

I asked the fabulous Dr Ginni Mansberg to answer some of our most commonly asked questions about perimenopause.

Below are a selection of the questions and answers. I just want to say that while Dr Ginni can comment on a broad basis, professionally she can not comment on your specific case, as only your doctor can do this in person, and it would be extremely dangerous to give you specific advice for you, without seeing you, or you being a patient of Dr Ginni’s.

The fabulous Dr Ginni

I love the first answer from Dr Ginni: “We are peri, not stupid.” This really struck a chord with me, because at times I have been treated as if I was stupid, and people have tried to peddle some pretty ridiculous crap on the basis it will help my perimenopausal journey. Let’s put it this way, standing in cow shit singing Kumbaya won’t cure perimenopause, but it if makes you feel great, do it, but spending thousands of dollars on a doing it under the guise it will cure your symptoms isn’t a great idea.

I hope you find the below helpful. On another note, if you haven’t read Dr Ginni’s book The M Word, you should. It’s great. I found it really helpful.

If you had to give your top five tips for health/fitness during perimenopause/menopause, what would they be?

Wow, what a great question. In fact, this was the HARDEST one to answer for me of all of Jo’s followers’ queries. I think it’s because as the least fit person I know (if you have ever seen me attempting to run, you would actually piss yourself laughing) I feel a bit fraudulent giving fitness advice. I wouldn’t dare give you any! So here are my top health and wellbeing tips instead!

  1. Get your ducks in a row. This is a hard time. You don’t need to be held back further by a crap diet or being a couch potato.
  2. Midlife for women sees changes. From weight gain to high blood pressure and cholesterol as well as thinning bones. If you’ve been giving your GP a wide berth, re-engage now!
  3. Mental health matters. Peri menopause is the highest risk time of your life for problems with your mental health. If you’re struggling, get help.
  4. Get a good GP. Lots of you do. But this is a time where trust in your doctor can save you lots of pain and add years to your life. Ask your besties, ask them to pull strings to get their doc to open their books for you. The Australian Menopause Society has a list of peri and menopause friendly docs!
  5. Get armed with the facts. I cannot believe the unmitigated garbage that is peddled to women at this time of life. You are super vulnerable because often your GP doesn’t even acknowledge what is happening let alone have any answers. I get it. But don’t be duped. You’re peri, not stupid!

I have scarring from a bad experience with electrolysis, what can I do?

It’s a bit hard without seeing the scar and the extent. I think you need to see a dermatologist for advice that is specific to you.

Are night sweats a common symptom of perimenopause

Absolutely! Hot flushes and night sweats occur in up to 80% of women during perimenopause. The later you are in your journey towards menopause, the more common they get.

Sadly, the earlier your hot flushes start, the longer they last.

I have just stopped using Livial as I have turned 60. What do I do now?

Livial is a drug known as Tibolone which is not an oestrogen but that stimulates some oestrogen receptors (like those in your bones making it awesome for treatment and prevention of osteoporosis) but not others (such as those in the breast).

The question of when to stop HRT or other drugs like tibolone is a real challenge. Menopause societies around the world say you can happily stay on it as long as you need it. There is no age cut off to stop it. (That’s not the same as the best age to start it- where 60 is usually the limit). But for most women who are on it, they don’t know whether they need it to help with their hot flushes for example unless they come off it and see what happens.

A reminder that I can’t give you any medical advice. You need to see your doctor to discuss your personal circumstances.

I have just started using ESK, it is a beautiful range, thank you.

Aww thanks so much! That means the world to me!!!

If on HRT and androgens are low, would like to know Dr Ginni’s thoughts on taking DHEA?

Unfortunately, I can’t give you any medical advice. You need to see your doctor to discuss your personal circumstances.

Having said that, when it comes to DHEA, I wouldn’t bother. In 2015 a systematic review of 23 randomised controlled trials of DHEA supplements, they concluded that DHEA supplements were useless. they did not improve sexual desire (or any other measure of sexuality), nor did they help with cholesterol, fasting glucose levels, weight (or bone mineral density). Where DHEA comes into its own, is when it is placed into the vagina. There it can help with the vaginal symptoms of menopause like dryness. You can’t get it in Australia yet but it’s coming, and I can’t wait.

Is ESK a good product for 65-year-old with rosacea?

I’m biased but yes absolutely. We have curated a rosacea kit which is packed with evidence-based ingredients for rosacea minus the typical irritants that see so many skincare brands cause a rosacea flare.

Collagen powders: yes or nay?

Sadly no. The collagen is broken down in the guts to its component amino acids which you can get from any protein rich foods. Your cells then use these amino acids to make human collagen. There’s not any good quality independent published evidence that oral collagen benefits the skin.

Is there a natural solution to vaginal atrophy?

Kind of. For less severe symptoms, vulvar and vaginal lubricants can be helped along with vaginal moisturisers based on hyaluronic acid. They should be used regularly (several times a week).

Is it normal to have itchy skin and hair loss when going through perimenopause?

It can be, especially at the end of perimenopause. As you lose your oestrogen, you get thinning of the dermis, decreased collagen, along with changes in your immune cells, and blood vessels. The skin is more easily traumatised and irritated. This affects the nerves inside the skin and some people are really troubled by itch.

What are your thoughts on going on HRT if you have had breast cancer?

Only 50% of breast cancer is what we call oestrogen receptor positive. These cancers grown when exposed to oestrogens and HRT is absolutely a very bad idea. But studies have shown that even breast cancers that are supposedly oestrogen receptor negative have some oestrogen receptors on them. So, we tend to avoid HRT in all women with breast cancer. But that doesn’t mean we have no options for your peri and menopause symptoms. Many oncologists are awesome at helping you!

But a reminder that I can’t give you any medical advice. You need to see your doctor to discuss your personal circumstances.

Is there a link between headaches and perimenopause? If so, why?

Sometimes. Some (but not all) studies show late perimenopause as the peak time for migraines in women. Between 8-13% of women migraine sufferers get migraines for the first time during perimenopause. The reason? Perimenopause is the peak time for stress, anxiety and insomnia, all known migraine triggers. I am intrigued by the fact that women who get worse hot flushes also get more migraines. We still don’t fully understand the reason.

Does IUD marina help with perimenopause symptoms?

Only if you are one of the 25% of women who get the floods in perimenopause. We are talking heavy, heavy periods. It is amazing for that. But even though it contains progesterone, this won’t help with brain fog, insomnia, hot flushes, vaginal dryness or mood swings.

Can insomnia be helped with magnesium supplements?

Magnesium (Mg) deficiency has been linked to muscle weakness and tiredness, insomnia, poor quality of sleep, anxiety and depression. Studies have shown that research shows that Mg supplements seem to reduce insomnia and help you sleep longer and have a better sleep quality. In some studies Mg supplements increased the melatonin (“sleep hormone”) levels and reduced the cortisol (“stress hormone”) levels.

A reminder that I can’t give you any medical advice about your insomnia. You need to see your doctor to discuss your personal circumstances.

How do you get the help you need re HRT medication when most GPs have limited knowledge?

That’s a huge Q and worth an entire book. My advice is to go to the Australian Menopause Society website and head to their find a doctor section and go from there. These days with telehealth, many of these doctors have been AMAZING for women who are unable to get their needs met with their own GPs. But if cost is an issue, get armed with the facts. Maybe print out some of the articles on the Australian Menopause Society’s website, or take The M Word to your consultation. And politely but strongly put your case!!!

“I personally found The M Word a great resource”. Jo

I am unable to take HRT due to previous breast cancer. Any advice heading to menopause/coping?

A reminder that I can’t give you any medical advice. You need to see your doctor to discuss your personal circumstances.

Women facing menopause symptoms after cancer can get various treatments depending on which menopause symptoms concern them most. We have many different treatments for the various symptoms that are pretty effective. But unlike HRT which can be a bit of a cure-all, we might need to manage your mood, insomnia, hot flush, bone health and vaginal issues separately! Your doctor should be able to help.

I am 65 years old and still on HRT. I am afraid to come off it. What is your opinion?

Unfortunately, I can’t give you any medical advice. You need to see your doctor to discuss your personal circumstances.

The question of when to stop HRT is a real challenge. Menopause societies around the world say you can happily stay on it as long as you need it. There is no age cut off to stop it. (That’s not the same as the best age to start it- where 60 is usually the limit). But for most women who are on it, they don’t know whether they need it to help with their hot flushes for example unless they come off it and see what happens. If you choose to do that, do it in winter because we all have severe hot flushes in January, and you won’t know whether it’s hormonal!! You can always go back on it if you need to.

I have milia on my forehead, acne on my chin. What is going on? What should I use to treat it?

Milia might go away on their own. But if they hang around, you don’t necessarily have to do anything. They’re benign so you can just leave them.

If you just don’t like them, you can ‘deroof’ them. That means taking a sharp sterilized needle and piercing the top, then gently squeezing out of the contents of the Milia. A blackhead remover can also be used. Some doctors use cryotherapy to get rid of them (freezing them off). If you have lots, they respond reasonably well to topical vitamin A.

In terms of acne, head to this blog for some amazing information.

Why do we get so much gas in menopause and how can we solve it?

Unfortunately, I can’t give you any medical advice. You need to see your doctor to discuss your personal circumstances. Any change in bowel habit needs a trip to your doctor! And a reminder to do the bowel cancer screening test that comes to you in the mail every other year from the Government!

Gas is usually a symptom of constipation. And while there simply haven’t been enough studies on the link, I can tell you, my patients get a lot of constipation, bloating and gas around perimenopause and menopause. Lots of things contribute to this.

  1. Menopause has been shown to alter the gut microbiome
  2. Often we’re exercising less because we’re exhausted or our hot flushes are out of control when we exercise, not to mention the incontinence!
  3. Stress, anxiety and insomnia all impact our gut behaviour

I wrote a WHOLE chapter about combatting it in The M Word. So my solution is to buy the book and head to Tired, Bloated and Itchy for all the answers!!!

My bowel movements have changed during perimenopause. Help?

See above!!

I have the ESK C Forte, but it pills. How do I stop it from pilling?

This can happen if the skin isn’t absorbing the C Forte quickly enough.
Sometimes using less or waiting longer before applying the next product can
work. Also swapping the C Forte for the C Lite might work.

I have noticed I am getting little skin tags on my neck. Is this normal (58-year-old menopausal)?

Acrochordons or skin tags get more common the older you are, and they appear in 59% of us by the time we hit 70 years of age. They’re more common in areas where there is some friction, like the arm pits and the eyelids and have been linked to obesity.

I have patches just above both elbows of eczema. Is this hormone related?

Unfortunately, I can’t give you any medical advice. You need to see your doctor to discuss your personal circumstances.

But dry skin patches are more common after menopause. As you hit menopause, you lose skin hydration in general and the pH level of our skin changes. With these changes, your skin becomes more sensitive, and drier. You are more likely to develop rough patches and itchy, more easily irritated skin.

I am so low; I am in perimenopause and just can’t seem to feel like my old self. Would HRT or antidepressants be helpful?

I would recommend a chat with your doctor to get some support and the right treatment during this time. I wish you so much luck.

I went to my GP to get my hormones tested and he said I was in menopause, but I still get a period. Is it a waste of time getting bloods done to test hormones?

Unfortunately, I can’t give you any medical advice. But I can tell you that the definition of menopause is 12 months since your last period, regardless of blood test results that are pretty useless around perimenopause. Women who start bleeding again > 12 months after their last period need to be thoroughly assessed. This is what we call post-menopausal bleeding. I hope you are feeling ok!

Can HRT help even if you don’t suffer from symptoms? Could they help with bone health, memory etc?

HRT is a good treatment for osteoporosis in some women. It is not used for memory improvement as studies have been inconsistent when it comes to preventing dementia.

I have really dry skin. Can I still use Vitamin A and C? 

YES!! For an unlucky few, Vitamin C can result in dry irritated skin, but for most,
it is a great ingredient and because it is usually in an oil base, even without the
benefits of Vitamin C, the product will often be hydrating for the skin.
Prescription Vitamin A and Retinol can often be irritating or drying, particularly
when first being used. But Retinal, while highly effective is neither irritating nor
drying. That means that dry skin isn’t a barrier to using Vitamin A and (usually)
Vitamin C.

How do I get rid of redness after breakouts?

Redness is inflammation in the skin and is associated with some form of trauma –
that usually involves some compromise to the skin’s barrier as well. The way we
deal with redness is to remove irritants, keep the skin moisturised and use active
ingredients which help the skin repair its barrier function. Protecting the skin
from UV damage (which causes inflammation) is also critical.

Specifically:
1) Using non foaming, soap free cleansers,
2) Using skin barrier repairing ingredients such as Vitamin B3. I am also loving Hyaluronic acid and Ceramides, which have good emerging evidence for helping repair skin
barrier
3) Broad spectrum sunscreen. Preferably zinc based

Are there any benefits of NOT taking HRT? I’m not taking it, but just trying to look after myself. There seems a heavy movement now towards taking it for many other health benefits, which makes me feel anxious and think I should maybe have taken it some years ago. Nobody talks about any benefits of not being on HRT if symptoms are manageable. 

That’s an interesting question! Every menopause society in the world agrees that you take HRT if you need (and for as long as it helps you) it but not if you don’t need it. One in 8 women still get breast cancer and HRT isn’t great if you have breast cancer. Plus, man it is soooo expensive! Don’t get me started about the fairness of having such an important medical treatment being available only to reasonably well-heeled people. Let’s just say that if you have sailed through menopause without HRT, happy days!

My skin is so itchy, is this normal during perimenopause/menopause?

Unfortunately, I can’t give you any medical advice. You need to see your doctor to discuss your personal circumstances.

But dry itchy skin is more common during peri and after menopause. As you hurtle towards menopause, you lose skin hydration in general and the pH level of our skin changes. With these changes, your skin becomes more sensitive, and drier. You are more likely to develop itchy, more easily irritated skin.

My sex drive is non-existent. The head wants to, but the body just can’t be bothered. Is this normal and what can I do to get my sex drive back?

Unfortunately, I can’t give you any medical advice. You need to see your doctor to discuss your personal circumstances.

Low libido is such a complex problem in peri and post-menopausal women. Stress, anxiety, depression, hot flushes, insomnia, dry vagina, incontinence and falling testosterone levels all play a role. I have written an entire chapter about getting your libido back (including the role of supplementary testosterone) in The M Word, my book on menopause. Hope it helps you.

I haven’t had a period for months, but my ovaries are killing me. Is this normal during perimenopause and just before menopause?

When you say your ovaries are killing you, do you mean that you have pain in the pelvic area?

Unfortunately, I can’t give you any medical advice. You need to see your doctor for a thorough assessment and work up to assess your pain. Not all pelvic pain is from your ovaries!

I am bleeding/flooding. Is there something I can do to stop this or lessen the flow?

Unfortunately, I can’t give you any medical advice. You need to see your doctor to discuss your personal circumstances. You need to see your doctor for a thorough assessment and work up to assess your bleeding. This will determine how it is managed!

What is the best ESK product for spotty adult skin? My skin feels and looks angry.

Spotty adult skin that’s angry can either be acne or rosacea. So, my first step is to call my genius customer service team on 1300884875 to help you work out what the hell is going on with your skin. They’re so lovely and are always keen to help! Rosacea and acne have a lot of common properties, but rosacea skin is super sensitive so you would switch up your cleanser and avoid certain products, especially alpha hydroxy acids and vitamin C.

ESK Skincare has a fantastic range of products to help combat your specific skin concerns.

Regardless my 100% recommendation for you is our Ultimate A. It has Vitamin B3, which is moisturising and anti-inflammatory and Retinal which will help with the spots. And for free it will help build you some collagen and reduces fine lines and wrinkles!
We have had incredible feedback from our Spotless dissolving microneedle patches (targeting spots) in both acne and rosacea sufferers for their spots!