Menopause: What Every Woman Needs to Know
Menopause is when a woman hasn’t had a period for one year – the menstrual cycle has paused. We might experience symptoms of the menopause (such as hot flushes, anxiety and tiredness) many years before our final menstrual cycle, however. Read on to discover when the menopause begins, the most common menopausal symptoms and when to see a GP for treatment.
What is menopause?
Menopause begins one year after a woman’s final period. Perimenopause is the term used to describe the years before menopause when the ovaries stop producing eggs and the levels of our body’s sex hormones (estrogen, testosterone and progesterone) fluctuate and start to fall.
When does the menopause start?
The average age of menopause in the UK is 51 years. It can occur significantly earlier, however. If the last period occurs between the age of 40 and 45, this is classed as an early menopause. Menopause before the age of 40 is known as premature menopause or Premature Ovarian Insufficiency (POI) — this happens to 1 in 100 women. You are more likely to experience an early menopause if there is a family history of POI. It can also be triggered by a hysterectomy (removing the ovaries); cancer treatment — such as radiotherapy to the pelvic area; and certain autoimmune conditions.
Though most women hit menopause in their early 50s, many will experience menopause symptoms in their 40s during what is known as the perimenopause. This is because hormone levels can start to decline many years before the final menstrual cycle.
For more information about early menopause, listen to our podcast with Dr Hannah Short.
What are the symptoms of the menopause?
Most women experience menopausal symptoms but the duration and severity can vary. Menopause symptoms usually start a few months or years before our final period (during the perimenopause) and can persist for some time after. Most will experience menopausal symptoms for 4 years but 1 in 10 women will experience symptoms for up to 12 years.
Sadly, menopausal symptoms can be severe and life-limiting. 80% of women report that menopausal symptoms interfere with their quality of life and 25% describe symptoms as severe.
Common symptoms include:
- Light, heavy or irregular periods
- Hot flushes
- Night sweats
- Low mood
- Reduced sex drive
- Vaginal dryness and pain during sex
- Brain fog (problems with memory and concentration)
- Tiredness and poor sleep
- Aching joints
- Hair loss
- Skin changes
- Worsening PMS (premenstrual syndrome)
- Headaches and migraines
- Heart palpitations
- Urinary symptoms (urgency to get to a toilet or recurring cystitis)
- Tinnitus and hearing loss
- Weight gain (particularly around the abdomen)
As well as the immediate symptoms, women are much more susceptible to weakened bones (osteoporosis) during the menopause and perimenopause.
When to see your GP
Treatments are available for symptoms of the menopause so there’s no need to suffer in silence. Women do not need to wait until their periods stop to see a GP. In fact, it’s important to diagnose symptoms as early as possible as they’re likely to get worse as estrogen levels fall further.
Those under the age of 45 can have a blood test to check that declining estrogen levels are at the root of symptoms. A blood test will measure follicle stimulating hormone (FSH) levels – high FSH levels are a good indicator of early menopause. If over the age of 45, women do not need a blood test to diagnose menopause. According to the NICE guidelines, all GPs should treat those 45+ based on their symptoms alone, with no need for blood tests (which can show false readings due to regular hormone fluctuations).
How to treat menopausal symptoms?
Hormone Replacement Therapy (HRT) is by far the most effective treatment for menopausal symptoms. It works by topping up the estrogen levels that have declined throughout perimenopause and menopause. In women that have not had their uterus removed, estrogen is combined with progesterone to protect against uterine cancer (cancer of the womb.) It’s available as a tablet, patch or as a gel which is massaged into the skin.
In addition to treating menopausal symptoms, HRT can greatly reduce other health risks associated with later life such as osteoporosis and heart disease.
To learn more about HRT, download Liz’s bestselling e-book, The Truth about HRT.
How to manage menopause symptoms?
While HRT is beneficial for most women, there are a minority who cannot take it for medical reasons and others who do not wish to take it. In these cases, non-hormonal therapies and healthy lifestyle changes can sometimes help to manage some menopause symptoms. Even those taking HRT can benefit from supporting their treatment with healthy lifestyle changes.
While these strategies may make menopause symptoms more manageable, they will not reduce the risk of osteoporosis and heart disease — only HRT can do this.
Eating a healthy diet
Eating a healthy diet can help to manage menopause symptoms. Calcium-rich foods are especially important for supporting aching joints and weakening bones.Reducing sugar intake and eating low GI foods can also help with anxiety, poor sleep and mood swings. Adding gut-friendly, fermented foods to our diet has also been shown to boost mood. Those struggling with vasomotor symptoms (hot flushes and night sweats) can benefit from avoiding spicy foods.
Read more about foods to eat during the menopause.
Isoflavones and phytoestrogens
Isoflavones and phytoestrogens can be found in foods such as soy, flaxseeds, lentils and oats. There’s some evidence that they can improve menopausal symptoms by mimicking estrogen. They don’t work for all women however, they tend to be quite pricey and the risks of taking high doses as a supplement are still unknown.
Try Liz’s Menopause Muffins – they’re low in sugar and rich in phytoestrogens.
Many women increase their alcohol consumption during the menopause as a way to manage stress and aid sleep. Evidence suggests, however, that alcohol can worsen menopausal symptoms. While alcohol can reduce short term stress and anxiety, it’s a depressant that is likely to worsen these symptoms over time. Similarly, while alcohol can help us drift off, it can encourage poor quality sleep leaving us tired and sluggish the following morning.
There is some evidence to suggest that active women experience fewer menopausal symptoms. Weight-bearing exercise is important for maintaining bone strength as estrogen levels decline. Exercise is also known to boost mood.
In need of some exercise inspiration? Get Liz’s best-selling at-home exercise plan, A Stronger, Slimmer You
Cognitive behavioural therapy (CBT) is a talking therapy available on the NHS. There is some evidence that it can relieve anxiety and low mood related to the menopause. Some research has shown that CBT can also reduce the frequency of hot flushes.
Herbs and supplements
Agnus castus, black cohosh, red clover and dong quai are just a few of the herbal treatments reported to help menopausal symptoms. They are not recommended by the NHS as there is little good large-scale evidence (beyond a placebo effect) to support their use, but many women continue to report that they are helpful. If you do decide to take a herbal treatment, look out for the traditional herbal registration (THR) logo to ensure it is regulated.
There is no evidence that anti-depressants help with low mood related to menopause. They have been shown to help treat hot flushes and night sweats in women who are unable to take HRT, however. Other drugs such as gabapentin (an anti-epilepsy treatment) can also relieve symptoms.
Still have questions about the menopause? Liz answers menopause FAQs here.