DR Zak is once again on hand to answer reader questions - this time about high blood pressure and the menopause.

This week I am delighted to answer questions from two readers, one on the subject of cardiovascular medicine, the other regarding the menopause.

My advice is given in line with current thinking and practice, but cannot be a substitute for consulting your own GP.

I attended for an NHS health check and was flabbergasted to be told I had high blood pressure. I can’t understand how. I’m only 45, I’ve never smoked, I rarely drink and I cook from scratch most of the time – Andrew

Dr Zak: “High blood pressure cannot be diagnosed on one reading alone, unless it is very high. Usually, it is made on several figures, which are either collected over a period of a few weeks by the patient using their own device, or a 12- or 24-hour blood pressure machine supplied by the surgery and which is worn while you go about your daily activities.

As you say, you lead what sounds to be a very healthy life. All these may reduce the risk of developing high blood pressure.

Yet despite this, many healthy individuals do develop high blood pressure, also referred to as hypertension.

With age, calcium is laid down in our arteries, making them harder and less able to relax. This is one reason blood pressure rises as we get older.

High blood pressure can develop in younger individuals. It is good practice to look for a cause, for example narrowing of the arteries to the kidney, or in very rare cases a tumour of the adrenal glands. Yet in the majority of instances, no clear cause is found.

I would not be despondent if it turns out after several readings that you have high blood pressure. It is important to acknowledge and treat it. Uncontrolled high blood pressure is one of the leading causes of heart attack, heart failure and stroke. Continuing with all your positive lifestyle choices may also help reduce the amount of medication you require, and keep you physically and mentally well.

All my friends are telling me I should be on HRT. I’m not one for taking pills, but after I talked to several of them, I wonder if it is something I ought to be using? – Myrna, 50

Dr Zak: “The menopause and HRT have received a lot of publicity lately and quite rightly so. While this has certainly raised understanding of the menopause, it may have also fuelled several myths and created a certain amount of confusion.

The symptoms of the menopause are largely due to declining levels of the hormone oestrogen. You can have a natural menopause. This is what the majority of women experience. A sudden menopause is if the ovaries are surgically removed. Typically, this involves the removal of the womb (uterus) as well. This is known as a total hysterectomy and brings about an immediate menopause.

A natural menopause is reached once you have not had a period for over 12 months. In this UK this is around 50-51 years of age. However, we now understand the perimenopause may start from as early as a woman’s late thirties. Symptoms include hot flushes, brain fog, anxiety and depression, muscle and joint aches, dry skin, hair thinning and weight redistribution/gain. This list is by no means exhaustive.

If you undergo menopause before the age of 45, it is recommended that you be prescribed HRT until the age of around 50. This is so that you get enough oestrogen to reduce your risk of osteoporosis (thinning of the bones), which can increase your risk of a fracture.

If you have your menopause after the age of 50 then there is no guidance that states you must have HRT.

However, if you have significant symptoms that can be attributable to the perimenopause, it would be worth discussing these with your GP to discuss HRT, as well as other alternatives.

You do not need to have gone through the menopause to start HRT. You should not dismiss the menopause and think “I just have to get on with it” if you are struggling.

Nor should you be fearful of the risks of HRT. Many scare stories, based on poorly conducted studies, have previously stopped women getting appropriate advice and help. It is only recently that sensible discussion has highlighted the issue in the correct manner.

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