FAQs Archive - Page 2 of 9 - Chelvey Menopause

Q: What treatments are available?

No testosterone treatment is licensed for women in the UK. The most commonly prescribed products are those that are licensed for men but are used at lower doses for women. Testosterone comes in a cream, gel pump or gel sachet depending on which brand is prescribed and is applied daily or every other day (again depending on which preparation is being used).

Q: How long does it take to work?

It can take up to 6 weeks to start to notice the benefit from testosterone replacement and maximal benefit should be seen by 6 months.

Q: How often do I need follow up?

It is important to have a blood test 3 months after starting treatment and then 6 monthly to monitor levels thereafter. Women on testosterone should have a clinical review at least annually whilst on treatment.

Q: Do I need a blood test before starting testosterone

It is important to have a blood test before starting testosterone. This is to ensure that the levels of testosterone in your blood already are not high or at the higher end of normal where giving added testosterone is more likely to cause side effects.

Q: Do I have to be on HRT to have testosterone?

Yes the current guidance is that testosterone should only be prescribed if a woman has adequate levels of oestrogen on HRT. This is partly because replacing oestrogen to good levels often improves many of the symptoms (including libido) that may also have been attributable to low testosterone. Whilst it has not been shown to be dangerous to use testosterone without being on oestrogen, the side effects mentioned above are more likely to occur if testosterone if used alone in peri-menopausal and menopausal women.

Q: Why do I need to think about this now? Im young, im sure my bones are fine…

Knowledge is power and a little bit of education about what affects bone development and function goes a long way towards understanding the importance of lifelong strategies to protect our bones from osteoporosis. As with so many things in medicine, prevention is better than cure and with life expectancy extending all the time, maintaining mobility and independence into our elderly years becomes ever more relevant. Every little helps and there’s no time like the present to start thinking about your bones.

Q: How is osteoporosis diagnosed?

To diagnose osteoporosis we use something called a DEXA scan. This stands for Dual Energy x-ray absorptiometry. This is a very low dose of radiation- no more than the background radiation in the world round us. It is a quick and non- invasive scan taking around 10 minutes and does not involve going into an enclosed tunnel. It measures how much of the radiation the bone absorbs and thus gives a reading of how dense the bone is, looking particularly at the spine and the hip. Currently only those at the highest risk of osteoporosis can be referred for a DEXA scan on the NHS. If you think you may have risk factors that could affect you bone density then speak to a healthcare professional about a DEXA scan.

Q: What are the risk factors for osteoporosis?

1.Genetics- if a parent had a hip fracture the risk doubles 2.Smoking and high amounts of alcohol (>3 units per day) 3.BMI <18.5 or previous anorexia 4.Some medications eg steroids or cancer treatments 5.Other medical conditions- eg rheumatoid arthritis, type 1 diabetes, chronic liver disease 6.Sedentary lifestyle 7.early menopause and premature ovarian insufficiency

Q: Why does osteoporosis happen?

Yes hormones again! Oestrogen plays a crucial role for women in maintaining bone density- it reduces the numbers and activity levels of the cells that lead to bone being broken down (osteoclasts) and keeps them under control. When oestrogen levels fall around the menopause these cells become much more active and break the bone down quicker than it can be reformed. The rate of bone loss for women at this time is about 2-3% per year for the 5ish years around the menopause (though this varies hugely from woman to woman) with some women having a higher rate of bone loss for longer. In a cruel twist of fate we know that women don’t achieve the same peak bone mass as men AND we lose bone rapidly at the menopause- so it’s a double whammy for female bones which is why osteoporosis is much more common in women than men. Of course, the higher your peak bone mass in your twenties and the less bone you lose before the menopause accelerates bone thinning, the lower the overall impact of the rapid bone loss around the menopause will be. This goes some way towards explaining why it’s so crucial to be aware of your bones as early as possible.

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