What is the menopause?
The word ‘menopause’ comes from ‘meno’, meaning your menstrual cycle, and ‘pause’, meaning to stop. The medical definition of menopause is when you have not had your monthly period for at least 12 months.
However, menopause is commonly used as a catch-all term to encompass perimenopause and the symptoms that come from the changes in hormone levels, whether this comes naturally or through illness or treatment.
Key menopause facts
- The average age of a person going through a natural menopause is 51-years-old, but it can happen at any time.
- If you’re younger than 45, it is called an early menopause.
- Before the age of 40, it is known as a premature menopause, or Premature Ovarian Insufficiency (POI).
- By the age of 54, 80% of women will have stopped having periods.
Symptoms of the menopause are the same as those of the perimenopause. There are around 35 symptoms, with some that are more commonly experienced. However, not all changes in your body and well-being at this time may be because of your menopause. As such, it’s important to consider your wider health and seek medical advice.
What is Perimenopause?
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 and lasts an average of four years to seven years, although this can vary.
Perimenopause extends until after your ovaries have stopped releasing eggs and you have your final period. The medical definition of menopause is when you haven’t had a period for at least a year. However, by the time of their menopause, many people will have experienced symptoms.
There are 35 symptoms associated with the menopause, below are the 10 most common.
Hot flushes and night sweats
The hot flush is experienced by up to 80% of those going through the menopause and is the most common symptom. Often accompanied by extreme sweating (known as vasomotor symptoms), a hot flush is caused by changes in hormone levels upsetting the part of the brain that regulates temperature. Basically, your body thinks it is overheating even when it isn’t, and things like hot drinks or alcohol, eating spicy food or sitting in the sun can exacerbate symptoms.
A night sweat is a hot flush that happens at night – the sweat is a chemical reaction that opens up the blood vessels in the skin causing a feeling of sudden heat. Sweat is released to dispel that heat.
Hot flushes usually last from three to five minutes and can vary in severity. Some women find them nicely warming but around 20% are instantly drenched and scarlet in the face. This can impact on work, social occasions and disrupt sleep.
Hot flushes usually continue for about two years, but some women continue to have them post-menopause.
Sleeplessness and disturbed sleep can be a common symptom of the perimenopause and menopause. They can continue on and off for years after your periods have stopped. Around 60% of menopausal women have sleep problems during the menopause.
Not only is a lack of sleep frustrating and difficult to deal with; it can lead to irritability, an inability to concentrate, anxiety, fatigue and drowsiness, none of which help you to lead a balanced life.
Your insomnia may be due to the night sweats, but they can also be caused by changing levels of hormones in your body, particularly progesterone.
Aching joints or ‘arthralgia’ is another common menopause symptom. Hips and knees, hands and fingers, and neck and shoulders are often affected, but any or all joints could ache. Oestrogen plays a part in maintaining joint and bone health, as it drops it can increase the risk of osteoporosis, osteoarthritis and increase joint pain.
Joint pain may be linked to other health issues, so it is important to have any ongoing concerns checked by a medical professional.
Many people gain weight during and after the menopause, one reason may be the change in hormone levels because oestrogen helps to regulate metabolism and body weight.
People may also expend less energy than they used to as energy levels can drop around perimenopause and menopause. Added to this, any reduction in exercise for whatever reason can cause loss of muscle mass, which also slows down the metabolism.
A lot of different pressures can come together around the time of your menopause. You may be experiencing menopausal insomnia, or your menopause symptoms might be similar to PMS symptoms you’ve had in the past. This can result in mood swings, anxiety, irritability, forgetfulness and general difficulty in coping with everyday life.
At the same time, you may have children growing up and leaving home, or supporting elderly parents whilst working full time. It can easily become overwhelming when managing changes in hormone levels too. Feelings of sadness and lack of motivation may result in short fuses or snapping, and a changing body shape may cause loss of confidence. It’s a tricky time to negotiate.
Sexual and other health considerations
The loss of oestrogen (and to a lesser extent testosterone) at the menopause can lead to problems like vaginal dryness and lack of libido.
Vaginal dryness can be incredibly uncomfortable and impact on quality of life. It may include your vagina feeling sore in general or during sex, it may cause itching or an increased need to pee. It could even lead to urinary tract infections (UTIs). This can lead to general discomfort but also affect your enjoyment of sex.
As well as vaginal dryness affecting interest in sex, you may experience a drop in libido around menopause. This can be caused by changing hormone levels or your general mental well-being.
As mentioned above, a lack of oestrogen can also affect the bladder, meaning you need to go to the loo more often or increasing incidence of UTIs.
You may feel embarrassed to discuss these symptoms , but there’s no need to suffer in silence, there are treatments out there which can help.
Whether you’ve always suffered with hormonal headaches around your period, or have barely been troubled by any, menopause can either bring relief or make them worse. As with most menopausal symptoms, the way that headaches affect you during perimenopause and menopause varies from person to person.
While some women may find that their headaches ease off, others may experience more frequent or more severe headaches during this time, some people find that they get hormonal headaches for the first time. People who have always suffered from migraines may also find that these headaches get worse during menopause.
All of this is due to the fluctuations in the hormones, oestrogen and progesterone, that menopause brings.
Do you feel exhausted all day, every day? In the morning, does the thought of even getting out of bed seems impossible thanks to a complete lack of energy? Fatigue, or chronic tiredness, is one of the most debilitating symptoms of menopause and can hit without warning.
Although insomnia and interrupted sleep, which come as a result of the changes in your hormone levels during menopause, can be to blame, that’s not the whole story. What if you’re sleeping well but still feel overwhelmingly tired? The drop in oestrogen levels that comes with menopause can severely affect your energy levels. In addition, the stress and anxiety that can come with this age and the way we live, such as simultaneously caring for children and ageing parents, juggling work and family life, and the mental load can take its toll, especially if you’re not caring for yourself properly.
Women can experience irregular periods for years – anything between two and 10 – before they stop completely. However, some women find that their periods just stop after years of being regular as clockwork. Although your periods can be irregular around menopause, if you experience any spotting between periods please speak to your GP initially, they can refer you on to us if there are any issues.
Again, it’s the fluctuation and decline in the levels of the hormones oestrogen and progesterone during menopause that are to blame. Other factors, such as stress, can also play havoc with your natural cycle.
It can be frustrating and difficult to manage if your periods arrive unpredictably, and it can also be worrying. It may be a part of menopause and nothing to worry about, but if you are concerned, get in touch with your GP.
Underlying health factors can also be to blame, so make sure that you get yourself checked out to rule out any other causes. Remember that it is still possible to get pregnant when perimenopausal. Even if you haven’t had a period for months, they could still return so make sure that you have appropriate contraception.
We’ve all walked into a room and stood looking around, without the faintest clue as to what we went in there to do. Or stared hopelessly at the screen at work, having completely lost a train of thought. Occasional lapses in memory and a general ‘mind fog’ are frustrating but are a common symptom of perimenopause.
Oestrogen is known to have multiple effects on brain function, affecting the development and ageing of brain regions that are crucial to higher cognitive functions such as memory. It’s the fluctuation and decline in oestrogen levels caused by perimenopause that could be responsible for memory changes, difficulty thinking, and problems with concentration.
As with any symptoms of the menopause, it’s important to talk to your GP so that they can rule out any other underlying causes of your memory loss.
There are a number of treatments available that can help to alleviate your symptoms depending on how severe they are. We would recommend that your starting point should be a conversation with your GP.
Types of treatment available are:
Adjustments to diet and lifestyle
Making healthy food choices wherever possible, taking regular exercise, making time for yourself and getting enough sleep will also help you to manage your menopause symptoms.
Hormone replacement therapy (HRT)
Menopausal symptoms can be effectively treated with hormone replacement therapy (HRT), and in most cases the benefits of HRT outweigh the risks. However, there may be circumstances where you cannot take HRT, for example if you are undergoing treatment for certain cancers or you may prefer not to take HRT.
As the name suggests, hormone replacement therapy (HRT) replaces the hormones which decline in your body around the time of the menopause and perimenopause. It can relieve many of the symptoms that have an impact on quality of life at this time, in particular hot flushes and night sweats.
Complementary therapies don’t fall within the traditional mainstream healthcare system. However, they may be used alongside conventional medical treatment to help you manage your symptoms. Here are a few examples:
- Cognitive Behavioural Therapy (CBT) can alleviate depression and anxiety as well as improve hot flushes and sweats. The National Institute for Health and Care Excellence recommends that people experiencing menopausal symptoms are given information about treatments such as CBT to help them manage certain symptoms.
- Research has been conducted into reflexology to improve sleep and hot flushes in menopausal women. Results are varied, however, one study conducted by researchers in Iran suggested that reflexology is an effective approach for sleep disorder and it also reduced frequency of hot flushes amongst some subjects.
- Research has proved that acupuncture can help menopausal symptoms, balancing hormones, reducing hot flushes, insomnia and anxiety.
- Massage can reduce stress, relieve menopausal symptoms and boost circulation of blood while promoting general relaxation.
Antidepressants and other medications
There are a few other medications that your doctor can prescribe for your symptoms. These include antidepressants such as citalopram or venlafaxine which may help hot flushes. Medications such as clonidine and gabapentin have been tried and may also reduce hot flushes, but they have side effects of their own such as tiredness, weight gain and nausea.
The National Institute for Health and Care Excellence, which produces guidelines for healthcare professionals says that low mood is a common symptom of menopause and different from depression. Its guidelines on managing menopause symptoms say that: “If you’re feeling low as a result of menopause you may be offered HRT +. Another possible treatment is CBT (cognitive behavioural therapy) + and you may be offered this if you have low mood or anxiety as a result of menopause.
“It has not been shown that antidepressant drugs called SSRIs and SNRIs can help with low mood during menopause if you haven’t been diagnosed with depression.”
Remember that not all symptoms will necessarily be linked to the menopause, so if you’re in any doubt, check with your GP and ask about the best course of action for you.
Rock My Menopause
The information on this page has been provided by Rock My Menopause. Rock My Menopause is a campaign of the Primary Care Women’s Health Forum (PCWHF), a group of 10,000 healthcare professionals with a special interest in women’s health. The PCWHF, provide expert medical guidance, direction and information about the menopause. Their work includes providing up-to-date quality education about HRT prescribing, ovarian cancer, contraception, pregnancy, PMS and more.
For more information and advice about the menopause and women’s health, visit their website.
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