ONCE you hit your late 40s, every sweaty moment, muscle cramp and mood swing can have you questioning if it has started. By it, we mean the menopause.
But, as anyone who’s been through it – or is in the throes of it – will testify, there’s more to it than that.
The first symptoms of the menopause can be felt years before your last menstrual cycle, and there’s no one-size-fits-all experience. Dr Louise Newson, GP and founder of The Menopause Charity and free Balance app, tells Fabulous: “Some women barely have a symptom, while others struggle on for several years. But I have three pieces of advice.
"The first is to educate yourself and read up on symptoms and treatments that can help. Secondly, listen to your body. It’s easy to put signs, like tiredness and low libido, down to being busy and stressed. Thirdly, if symptoms are affecting your quality of life, see a doctor to discuss a treatment plan.”
Our Menopause Matters campaign is calling for free HRT on the NHS, for every workplace to support menopausal women, and that we all work together to bust taboos. So here we look at the different stages of the menopause and the symptoms to expect.
The different stages
Before her final period, a woman will experience perimenopause, Dr Radhika Vohra, GP and trustee of The Menopause Charity, tells Fabulous. This is when your ovaries produce less oestrogen and progesterone – two key sex hormones. As levels dip, it’s common to notice changes to the body, from your bones to your mental health.
Dr Vohra argues this is the most important time to get clued up. “The perimenopause can start up to seven years before your last period,” she says. “It’s important to be proactive, because if you wait until after that point, you may have suffered far longer than you needed to.”
“By definition, women are perimenopausal until their last period,” Dr Vohra says. “And then you are classified as menopausal one year after your final menstruation.”
The average age is 51, but it can be any time from 45 to 55, according to the NHS. One in 100 women reach menopause before the age of 40, which is known as premature or early menopause.
However, Dr Vohra says the technical definition isn’t always useful. “I don’t think it’s practical for women to wait for a year after their last period before getting help for the menopause,” she says.
A year after that final time of the month, a woman is considered to be entering the post-menopausal stage. It quite literally means “life after the menopause”, and most women will spend about a third of their lifespan in it.
But symptoms can carry on for years, Dr Vohra warns. “Every woman is different,” she says. “I’ve seen some women having hot flushes and still taking HRT well into their 80s.”
Hot flushes, brain fog and a change in your periods are likely to be the menopause symptoms you’ve heard of. But, believe it or not, there are almost 50 different recognised symptoms of the menopause. While some women could experience around a dozen, others may only notice the odd one or two. “It’s not black and white, it’s like a menopause spectrum,” Dr Vohra explains. Here, she reveals some of the most common signs to watch out for…
Change in periods
One of the main signs of the perimenopause is a change in your periods – they can be closer together, further apart or heavier. However, this isn’t a universal sign. For some women, oestrogen will fall more slowly, meaning periods can stay the same, while also causing other symptoms elsewhere in the body.
Often women will notice a drop in their sex drive, says Dr Vohra. It can be hard to pinpoint the exact cause – it can be linked to feeling unwell, a lack of confidence or weight gain.
“However, chemically, the ovaries do stop making testosterone, which plays an important role in libido, energy levels, sexual response and wellbeing. Speak to your doctor, as there are testosterone therapy treatments that can help.”
Another common problem is vaginal dryness. This is down to the drop in oestrogen, which impacts the body’s natural lubricant, leaving women in pain and discomfort during sex. The NHS recommends using water-based lubricants before sex, vaginal moisturisers, enjoying foreplay more and avoiding perfumed soaps and washes down below. See your GP, as HRT can also help.
PMS gets worse
Didn’t think it could get any worse? Well, turns out it can! “Women may have body aches, they may also feel more tired, either at certain times of the month or in the run-up to their periods, because the oestrogen levels drop naturally just before your period.
"These PMS symptoms can get worse in menopause due to fluctuating hormone levels.”
How to talk to your GP
WHETHER you’re menopausal or peri-menopausal, having an understanding GP can make all the difference. If you don’t feel like your doctor is sympathetic or “gets” it, there are things you can do . . .
DO YOUR HOMEWORK: Call your surgery and ask to see another GP – ask for one with interest in women’s health or menopause. Most practices have at least one GP with extra qualifications or an interest in these areas.
GET A SECOND OPINION: If at first you don’t succeed, try again. Don’t be afraid to ask for a second opinion, from another GP, if you feel you’re not being listened to. I’m always delighted when patients come in with an article they’ve torn out of the newspaper, or a printout of something they read online. It means they’re invested in their health as much as I am. It means we’re on the same team.
TRACK IT: if worried about explaining your symptoms properly, try a tracking app. The Balance app is free and is a down-loadable diary to help you track symptoms. You can take it to show your GP, it’s a great way to show what you’re going through.
KNOW THE DRILL: If you are over 45 and showing signs of menopausal symptoms, GPs do not need to check your hormones with blood tests. Clinical guidelines suggest that, over 45, GPs should diagnose based on symptoms, not hormone levels. Only women under 45 should be sent for hormone checks.
ASK WHY: If your GP is reluctant to prescribe HRT, don’t be afraid to ask for the reason. It might be that you have something in your history – you’ve had breast cancer, for example – that means you might not be suitable.
BE ALTERNATIVE: Ask about other options. For example, Vagifem is an oestrogen cream often prescribed for sex-related symptoms like a dry or itchy vagina.
Just like puberty and pregnancy, the change in hormones can trigger mood swings. “Irritability and anxiety are very common, and also feeling unduly anxious about things that you would normally have managed fine,” explains Dr Vohra.
“During Covid, it’s been really easy to put this down to pandemic worries. But I’ve seen women who have told me: ‘I can’t drive, I can’t go on the motorway.’” Things that have previously been second nature can become difficult and self-confidence can get quite low at this time of life.”
“Not sleeping is a really big one,” says Dr Vohra. Problems can range from night sweats, anxiety and aches keeping you awake, to full-blown insomnia. And it can leave you struggling during the day.
This is the classic symptom and episodes can last around five minutes, starting in the chest. It’s an overwhelming, warm feeling that can cause you to sweat or blush. “Hot flushes aren’t harmless,” says Dr Vohra. “They are an inflammation process in your body and inflammation can be linked to other problems, such as increased blood pressure, high cholesterol and a risk of depression and joint pain.”
When to get help
It’s important to note that you don’t have to be menopausal to seek help.
Dr Newson explains: “Women who are perimenopausal will also benefit from treatment.”
Dr Vohra agrees that as soon as you notice symptoms affecting your life, it’s time to seek medical help.
Dr Newson adds: “Menopause is essentially a long-term hormone deficiency, and the best way to correct that is by replacing those hormones with HRT.
It is now recognised as the most effective treatment for menopause, and can safeguard your future health by helping reduce the risk of osteoporosis, cardiovascular disease, type 2 diabetes and Alzheimer’s.”
If you think you might be menopausal, you can use the free app Balance to track symptoms to show your GP. For information, check out The Menopause Charity, The British Menopause Society or My Menopause Doctor.
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