Menopause

What is the menopause?

Menopause is when the menstrual cycle ends, and is a natural part of a woman’s life. This usually occurs between the ages of 45 and 55 and is a result of reduced sex hormone levels in your body. In the UK, the average age for a woman to reach the menopause is 51.

The stages of menopause

• Perimenopause – this is when the menstrual cycle becomes less regular as it leads up to the menopause. Although it can be a slow and gradual process, you may experience a range of mild to severe symptoms.

• Postmenopause – this is the time period after menopause has occured. It starts 12 months after the final period.

Sometimes menopause can occur earlier than expected. These instances are called:

• Premature menopause – this is when menopause occurs before the age of 40.

• Early menopause – this is when menopause occurs between the ages of 40 and 45.

What are the symptoms of menopause?

Menopause symptoms usually begin months or years before your period completely stops. The symptoms also affect women in different ways. Some may experience all or most of the symptoms while others a few to none of the symptoms.

There are 3 key things that are affected by menopause: the menstrual cycle, your mental health and physical changes.

Changes to your periods

This can look like:

• Irregular period patterns that can become shorter or longer

• Periods becoming heavier or lighter

• Periods eventually stopping permanently

Mental health

Common mental health symptoms that could be caused by menopause include:

• Low mood

• Mood swings

• Anxiety

• Depression

• Brain fog and problems with concentration

Physical changes

Physical symptoms that you may experience include:

• Hot flushes (suddenly feeling hot or cold)

• Difficulty sleeping

• Weight gain

• Dry and itchy skin

• Palpitations (heartbeat becomes more noticeable or fast)

• Reduced sex drive

• Vaginal dryness, burning or itching

• Pain or discomfort during sex

• Joint pain

• Muscle aches

• Headaches and migraines

What causes menopause?

Menopause is caused by the depletion of the hormone oestrogen. This hormone is produced by the ovaries and it’s involved in a lot of normal bodily functions (for example bone strength and menstruation).

As we get older, our ovaries produce lower amounts of oestrogen, and the bodily functions which involve oestrogen are affected. This leads to symptoms that can affect day-to-day life.

How is menopause diagnosed?

If you’re over the age of 45, a doctor can make a diagnosis of menopause or perimenopause based on the symptoms you’re experiencing.

If you are below the age of 45 and experiencing menopausal symptoms, you may also be asked for a blood test to diagnose early menopause.

Treatments for menopause

There’s nothing to stop menopause happening. It’s a natural process that occurs in all women as they age, and some symptoms will resolve without treatment.

There are various lifestyle changes you can make to manage or ease some of the most common symptoms of menopause.

These include:

• Getting regular rest

• Eating a healthy diet filled with calcium-rich foods

• Exercising regularly to keep your bones and muscles strong

• Taking part in relaxing activities to help with mood changes

• Wearing light clothing to relieve hot flushes

• Keeping your environment cool to help with the hot flushes

• Stopping smoking and alcohol

• Getting regular exposure to sunlight 

• Taking vitamin D supplements to help bone strength

In some cases, medication can be prescribed to help manage symptoms. These include:

• Antidepressant medication to help with low mood

• Vaginal creams to help with vaginal dryness

• Clonidine and gabapentin to help with hot flushes and night sweats

• Testosterone to improve libido

Hormone replacement therapy (HRT)

HRT is a common treatment for menopause symptoms. It replaces oestrogen that’s lost during menopause which can drastically reduce symptoms.

HRT comes in various forms and strengths, so it’s important that you find the most appropriate form of HRT that suits you. Oestrogen can come in the form of:

• Tablets

• Gel or spray

• Patches

• Implants 

The choice of oestrogen will be decided by a GP.

If you still have your womb, you will be given another hormone called progesterone alongside the oestrogen to help protect its lining. Progesterone can come in the form of:

• Tablets 

• Patches

• Intrauterine system (the coil)

Risks of HRT

HRT comes with some risks that are rare, but it’s important you speak to a GP before you start a HRT regimen. Some risks of HRT include:

• Breast cancer – There’s an increased risk of breast cancer if you use combined HRT (oestrogen and progesterone). This means it’s important for you to check your breasts regularly whilst on this medication, and avoid it if you have a family history of breast cancer.

• Blood clots – There is evidence to show that HRT tablets can slightly increase your risk of developing blood clots.

How long does menopause last?

The length of menopause can vary greatly depending on the person. You may experience menopausal symptoms for months or years even after your menstrual periods have completely stopped.

When should I seek help?

It’s important that you get help from a GP if you find that you are not able to manage your symptoms on your own or if you are thinking about starting HRT.

Other health risks associated with menopause

The reduction in hormone levels that occurs during menopause can also increase your risk of developing other conditions such as:

• Osteoporosis (weak bones)

• Heart disease and stroke

• Urinary incontinence