Menopause is when your periods stop due to lower hormone levels. This usually happens between the ages of 45 and 55.
It can sometimes happen earlier naturally. Or for reasons such as surgery to remove the ovaries (oophorectomy) or the uterus (hysterectomy), cancer treatments like chemotherapy, or a genetic reason. Sometimes the reason is unknown.
Perimenopause is when you have symptoms before your periods have stopped. You reach menopause when you have not had a period for 12 months.
As healthcare professionals, we often use the term menopause as a “catch-all” whether you’re going through perimenopause or menopause.
Perimenopause is the period before the menopause.
Perimenopause starts when the amount of oestrogen made by the ovaries begins to decline. It usually begins in your 40s, although it can start earlier.
Menopause and perimenopause symptoms can have a big impact on your life, including relationships and work.
It is thought that there are at least 35 symptoms of the menopause including:
1. Hot flushes and night sweats
4. Loss of libido
5. Mood swings
7. Hair loss
8. Weight gain
13. Bladder weakness
14. Memory lapses
15. Irregular periods
16. Itchy skin
18. Joint pain
20. Brittle nails
21. Digestive problems
23. Low mood
25. Vaginal dryness
26. Difficulty concentrating
28. Emotional changes
31. Aching muscles
32. Tender breasts
33. Heavy periods
34. Skin changes
35. Panic attacks
It can be really helpful to keep a symptom tracker so you can talk to your GP or nurse about the symptoms you’re experiencing. Here are two good ones we recommend to our patients:
Things you should know
As life expectancy has increased, you can expect to be post-menopausal for at least one third of your life. This is why it’s important to think of the menopause as a long-term female hormone deficiency.
Like any other deficiency, this is associated with several health risks.
- Osteoporosis: This is a condition that weakens the bones and makes them likely to break much more easily. Bone is a living tissue which regenerates throughout our lives, and oestrogen helps to keep your bones strong and healthy. The risk of osteoporosis increases during menopause, when bones begin to break down more quickly than they can be rebuilt. Women can lose up to 10% of their bone strength in the five years after menopause, as a direct result of the drop in oestrogen.
- Cardiovascular disease: Oestrogen helps to keep your blood vessels healthy, and can also help to control cholesterol levels. This is why low oestrogen can affect the heart and blood vessels, increasing the risk of coronary heart disease, stroke and vascular dementia.
- Diabetes: Oestrogen is important at maintaining blood sugar levels and low levels of oestrogen can lead to metabolic changes occurring in the body. This can lead to an increased risk of developing type 2 diabetes
- Dementia and clinical depression: Oestrogen and testosterone are really important to maintain the function of your brain. The cells in the brain need these hormones to process information and work properly. After the menopause, women are more likely to develop dementia and also clinical depression when the levels of these protective hormones reduce.
- Other diseases: Research has shown that women who have an early menopause also have an increased risk of lung diseases including asthma, kidney diseases, bowel cancer and irritable bowel syndrome, osteoarthritis and also some auto-immune conditions. These risks increase if you have an early menopause, but it’s important to know that these risks can be reduced if you take hormone treatment such as HRT.
There are things you can do to help with symptoms. There are also medicines that can replace the missing hormones and help relieve your symptoms.
Things you can do
Lifestyle changes can really help reduce perimenopause and menopause symptoms:
- A healthy balanced diet is good for general health.
- Spicy foods, alcohol, caffeine (tea and coffee as well as chocolate and cola drinks) can make hot flushes worse so avoiding these may help.
- Up your intake of vitamins B, C, D and E.
- Drink lots of water, this could be infused with fruit, or sugar free squash, anything which helps you to remain hydrated.
- Take up regular exercise that you enjoy. It needn’t be a chore to move your body, take a walk with a friend, join a class, try relaxing activities like yoga or Pilates. Regular exercise may improve hot flushes and night sweats and improve sleep as well as helping you maintain or lose weight. Weight bearing exercise such as walking, running and dancing can improve bone strength.
- Take up meditation, breathing exercises or mindfulness.
- Get a good night’s sleep of seven to eight hours a night if you can and if night sweats or insomnia keep you awake, speak to your doctor.
The main medicine treatment for perimenopause and menopause symptoms is hormone replacement therapy (HRT), which replaces the hormones that are at low levels. There are other treatments if you cannot, or choose not to, have HRT.
Hormone replacement therapy (HRT)
HRT is a safe and effective treatment for most going through perimenopause and menopause. Your GP will discuss any risks with you. HRT involves using oestrogen to replace your body’s own levels around the time of the menopause.
There are different types and doses of HRT. Using the right dose and type usually means your symptoms improve.
Oestrogen comes as:
- skin patches
- a gel or spray to put on the skin
If you have a womb (uterus) you also need to take progesterone to protect your womb lining from the effects of oestrogen. Taking oestrogen and progesterone is called combined HRT.
Progesterone comes as:
- patches, as part of a combined patch with oestrogen
- IUS (intrauterine system, or coil)
If you have low sex drive because
of menopause and HRT does not improve
it, you may be offered testosterone.
Testosterone comes as a gel or cream.
Benefits of HRT
The main benefit of HRT is that it can help relieve most perimenopause and menopause symptoms, including hot flushes, brain fog, joint pains, mood swings and vaginal dryness. Hot flushes or night sweats often improve within a few weeks. Other symptoms like mood changes and vaginal dryness can take a few months to improve.
Taking HRT can also reduce your risk of hormone-related health problems including:
Risks of HRT
The risks of HRT are small and are usually outweighed by the benefits. If you’re interested in HRT, your doctor or nurse can discuss the risks with you.
There are non-hormone treatments if your symptoms are having a big impact on your life and you cannot, or choose not to, have HRT.
Hot flushes and night sweats
There are some medicines that can help with hot flushes and night sweats. These include:
- a blood pressure medicine called Clonidine
- an epilepsy medicine called Gabapentin
Talk with a GP about these medicines and their side effects, and if they might be suitable for you.
Antidepressants can help with mood symptoms if you’ve been diagnosed with depression or anxiety.
Cognitive behavioural therapy (CBT)
Cognitive behavioural therapy (CBT) is a talking therapy which can help with:
- low mood and anxiety caused by menopause and perimenopause
- some physical symptoms like hot flushes and joint pain