The Menopause

Menopause FAQs: What is the menopause and what do we need to know?

With the menopause so marginalised by the media, many women feel unprepared when they first start experiencing symptoms. Here, we’ve provided bite-sized answers to some of the most common questions about the menopause: Crucially, what to expect before, during and after. Follow the helpful links for longer reads about specific symptoms and concerns.

What is the menopause and perimenopause?

The perimenopause occurs before the menopause and is, to put it simply, the time leading up to the end of your periods. The perimenopause can last a matter of years, and is the hormonal change we undergo throughout our 40s and early 50s. As our ovaries begin to produce less oestrogen, we start to experience a range of symptoms (listed below), many of which begin when we are still having periods. Tune into Liz’s podcast for a deeper dive into the perimenopause.

Also known as the climacteric, the menopause is the point at which your periods cease and you are no longer fertile. Women are typically said to have reached the menopause after a year with no periods. However, many of the worst symptoms are suffered before the actual menopause.

What symptoms do women experience in the perimenopause and menopause?

Our periods stopping is just one of many symptoms menopausal women experience (there are around 45 symptoms in all, ranging from well-known hot flushes to lesser known problems, such as cystitis, achey joints and tinnitus). Some of us have very few symptoms, others are less fortunate – everyone’s experience is unique. Symptoms commonly include:

  • Hot flushes, night sweats and insomnia: These are common complaints and are thought to affect at least 75% of women during this period of change. Falling oestrogen levels have a profound effect on the hypothalamus, the part of the brain that regulates our temperature control. During a hot flush, the hypothalamus incorrectly assumes we are overheating, and dilates the blood vessels near the head, face, neck and chest. As a result we may sweat profusely. Night sweats can lead to insomnia, leading to exhaustion that impacts on our day-to-day life.
  • Low libido and vaginal dryness: Low testosterone levels, increased anxiety, poor self-esteem and vaginal dryness can all make sex seem particularly unappealing. For some, this can be distressing if they want to maintain an active sex life, but there are many ways to get back in the mood. Vaginal dryness affects more than sex though – it can lead to repeated urinary tract infections, painful skin thinning and skin tears.  Tune into Liz’s podcast with Dr Rebecca Lewis to find out more about the treatments for this common condition.
  • Low moods and anxiety:We have many oestrogen receptors in the brain, so it’s no wonder falling oestrogen levels lead to shifting moods and emotions. Low oestrogen levels are a significant cause of anxiety, low mood and outbursts of rage. These can be managed and worked on with helpful strategies so that we can go on to thrive mentally and emotionally better than ever before. Tune into Liz’s podcast with Niamh Barker, who gives a frank but empowering account of the severe low moods she experienced during the perimenopause and how she learnt to help her symptoms.
  • Hair loss: Hair loss is not just something that affects men of a certain age; women, particularly when our oestrogen levels drop, can experience hair loss too. Stress is also a contributor, but thinning hair can be addressed with different treatments.
  • Itchy skin: Our skin can be affected in many ways when we undergo hormonal change as our collagen supplies decline: some experience a ‘crawling’ sensation on the skin, while others develop itchy skin along with a loss of skin tone and elasticity.
  • Weight gain: Many women notice that their weight creeps up as they age and there are several reasons for this. One side effect of the tiredness we experience from disturbed sleep is that we feel too tired to get out and exercise. Our elevated anxiety and stress levels can also contribute to weight gain, as there is thought to be a link between excess cortisol in the body and an accumulation of abdominal fat. Tune into Liz’s podcast with GP Shahzadhi Harper to find out more about managing (and reversing) weight gain.

What are the menopause treatment options?

Different symptoms need to be managed in different ways, and there isn’t one magic pill that will alleviate every adverse effect we experience at this time of our life (though following the links above reveals good advice for many symptoms). Certain treatments can, however, greatly relieve many of the most distressing symptoms, such as hot flushes and mood swings, while improving overall wellbeing. Hormone Replacement Therapy (HRT) is the safe and effective recommended treatment under NICE guidelines, though some women may choose to opt for alternative remedies (see below).

Counselling, particularly Cognitive Behavioural Therapy (CBT) can additionally help us to build the skillset to help ourselves by transforming our attitudes to the menopause and the next chapter of our lives.

What is HRT, what are the benefits of HRT and it is safe?

HRT is simply the treatment used to alleviate the symptoms caused by our declining levels of the hormones oestrogen and progesterone by topping up the body’s falling supplies. A combination of oestrogen and progestogen is usually prescribed, though oestrogen-only HRT is recommended for those who have had a hysterectomy.

Previous studies linking the old-fashioned tablet form of HRT with breast cancer have now been discredited as misrepresentative and in the vast majority of cases, the latest research clearly shows that the protective health benefits of this treatment outweigh the risks. As well as improving hot flushes and mood swings (along with so many other menopausal symptoms), HRT also dramatically lowers the risk of coronary heart disease and osteoporosis.

HRT can come as a topical gel, skin patches, an implant, or in tablet form. GP and menopause specialist  Dr Louise Newson provides a great deal of information about HRT in this Wellness with Liz Earle Wellbeing podcast.

What are the alternatives to HRT for menopausal symptoms?

To alleviate symptoms such as hot flushes, mood swings, and vaginal dryness during the perimenopause, some women turn to a herb called black cohosh. A few studies have shown that some women benefit from a reduction in night sweats and hot flushes when taking the herb. Black cohosh can, however, interact with certain medications, and questions have been raised as to whether it can cause liver damage, so be sure to consult a GP if you want to start taking it.

It is important to note that most alternative and complementary treatments aren’t recommended by the NHS as it is unclear how safe and effective they are. The so-called ‘Bio-identical‘ HRT hormones are also not recommended as they are unregulated and can have adverse side effects. While body-identical hormone HRT (the trans-dermal gels and patches) are available on prescription, bio-identical hormones are sold through private clinics, often at huge expense.

What is the average age for reaching the menopause?

The average age of the menopause is 51 in the UK, though it of course varies from person to person. This age is younger for women of Asian origin. Early menopause occurs before the age of 45, and if your periods totally stop before the age of 40 it is referred to as ‘premature ovarian insufficiency’.

Is there a ‘menopause diet’?

There are many foods we can eat that may help certain symptoms. Some plants, for example, contain ‘phytoestrogens’ – compounds found in foods such as soya and flaxseeds – which can act in a similar way to oestrogen. Find out more about which foods may help symptoms here. One delicious, phytoestrogen-rich option is Liz’s menopause cake.

What other lifestyle changes should I make help with the menopause?

Some find taking these vitamins and minerals can help them to manage certain symptoms such as hot flushes and low mood. We can also help improve our posture, bone and muscle strength through particular stretches like these.

Is there a menopause test? How do I know I’m menopausal?

For many women, the menopause catches them unawares – Niamh Barker experienced alarming mood swings for months before realising that they may be leading up to the menopause. A GP should usually be able to ascertain from your reported symptoms whether you are menopausal, though they may take a blood test if you are under the age of 45 to rule out any other conditions.

According to the latest NICE guidelines, blood tests should not be used after the age of 45 as our hormones fluctuate week by week after this age and so give unreliable results.

What happens after the menopause?

While symptoms usually begin during the months or years leading up to the menopause, certain symptoms, such as hot flushes and night sweats, may persist for around four years after your last period. When we are no longer producing oestrogen, we can be at greater risk of osteoporosis and heart disease, so maintaining our health through appropriate exercise is very important. The latest thinking is to continue to take HRT for years after the menopause (according to the NICE guidelines there is no upper age limit or restriction as to how long you can take HRT for) as this not only keeps debilitating symptoms at bay, it also protects our heart and bones too.

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