A five minute guide to the menopause

There's more to the menopause than hot flushes and HRT - but how much do most people (who haven't experienced it) actually know? Dr Hannah Short is one of two national leads for Menopause UK's #changethechange campaign, which aims to help raise awareness about menopause and all the health-related issues that come with it. Here's her five minute guide.
 

What is the menopause?

Natural menopause occurs 12 months after your last period, however hormonal changes (and, in many cases, symptoms) may start several years before this. This is called perimenopause. Induced menopause occurs either as a result of surgical removal of the ovaries or as a result of medical treatment (e.g. chemotherapy, radiotherapy, treatment for endometriosis). 

The average age for menopause is around 50, with 1 in 5 women entering the menopause below the age of 45 (early menopause). If menopause occurs below the age of 40 it is termed 'premature menopause'.

What are the signs/symptoms of menopause?

Menopausal symptoms are primarily the result of low oestrogen levels. In the perimenopause it is the fluctuating levels of this hormone that are largely responsible for the symptoms. 
 

• Vasomotor eg: hot flushes and/or night sweats
• Vaginal dryness, discharge, itching
• Painful sexual intercourse
• Prolapse
• Recurrent urinary-tract infections
• Difficulty passing urine as well as changes in frequency, urgency and incontinence
• Sexual dysfunction/low libido as a result of the above, or due to low testosterone levels. Non-hormonal factors may also play a part
• Psychological (related to hormonal changes and/or other life events)
• Mood swings, irritability, anxiety, depression
• Difficulty concentrating, forgetfulness, "brain fog"

• Menstrual irregularities (perimenopause only)
• Abdominal weight gain
• Palpitations (feeling your heart racing/thumping)
• Bowel/digestive symptoms
• Insomnia
• Joint and muscle aches
• Headache/migraine
• Fatigue
• Thinning of the skin, easy bruising, itching
• Tingling/'crawling skin' sensation (formication)
• Hair thinning, dryness and growth of unwanted hair
• Worsening of existing/development of allergies

1 in 4 women will experience symptoms that severely affect their quality of life, and in some cases these are still problematic after fifteen years. Those women in surgical menopause often experience more severe symptoms (the ovaries continue to produce small amounts of oestrogen and testosterone throughout life).
 

When to seek help

If menopausal symptoms are affecting your quality of life it is important to consult a health care professional for advice and support. Diagnosis of the menopause is usually based on clinical symptoms. Hormone levels fluctuate markedly during the perimenopausal years and there is little point in checking these (by way of a blood test) unless the diagnosis is in doubt. The main exception to this is when early or premature menopause is suspected.

Hormone replacement therapy (HRT)

For the women who can take it, HRT can be very effective in treating menopausal symptoms. It can be taken as a tablet, applied to the skin (as a patch or gel) or inserted as a vaginal pessary (for the treatment of bladder/vaginal symptoms only). The use of HRT remains controversial, and misleading information is widespread. However, in most women who start HRT within 10 years of the menopause, below the age of the 60, the benefits outweigh the risks. Furthermore, previous gynaecological or hormone-dependent cancer does not necessarily preclude treatment with HRT. The British Menopause Society (BMS) states that the choice to use HRT should be a fully informed choice, with the dose, route and duration individualised. Here's what you need to know about HRT for over 60s. 
 

Alternatives to HRT

For women who are unable or unwilling to take HRT there are other medical and complementary options available. However, the efficacy of alternative treatments is lower than with HRT, with 50-60% symptom reduction compared with 80-90%. The BMS have a fact sheet on their website about Alternative and Complementary Therapies.

As with HRT, the decision to trial alternative therapies should be individualised and made after a fully informed discussion with a health care practitioner. Regardless of treatment (hormonal or otherwise), it is important that lifestyle factors, including diet and regular weight-bearing exercise, are addressed to optimise quality of life and promote good health. Here's our guide on how to eat right and stay healthy during the menopause.

For further information please visit the Patient website, Evidently Cochrane (blogs connecting experience and evidence), Menopause UK (campaigning to #changethechange), British Menopause Society (aimed at professionals, but includes patient factsheets) and Menopause Matters (includes an active patient forum). 

Disclaimer: The information on our health pages is only intended as an informal guide and should not be treated as a substitute for medical advice. Gransnet would urge you to consult your GP before you begin any diet if you're concerned about your weight, have existing health conditions and/or are taking medication.

Other things you might like:

Perimenopause: a guide

What to eat (and not eat) during menopause

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