Postmenopause is the phase after the menopause (which is one year after your last period) and you might still experience some symptoms during this time.  Some people still suffer with hot flushes into their 70s and 80s, for example, but others don’t.

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Even if you have minimal symptoms it’s worth considering replacing the hormones your body no longer produces to protect you from getting osteoporosis (bone-weakening disease) and protect your heart and blood vessels from disease.  There’s also some evidence that HRT can lower your risk of type2 diabetes, bowel cancel and dementia.

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Perimenopause – the definition and explanation

Perimenopause is the period of time when your symptoms start, before the official menopause phase (a year after your last period).

 

What can you expect from perimenopause?

You may still have periods but there might be some changes, such as being more or less regular, or changes in how heavy they are.  You may also notice changes to your mood, have the odd hot flush, more frequent headaches or worse PMS, for example.  This is because your ovaries stop working gradually over time (unless you have a surgical menopause) and your body starts reacting to the declining level of hormones, estrogen particularly.  For many people this can happen several years before periods stop altogether, for others, it may only be a few months before your periods stop completely.  We’re all different and your menopause is completely individual to you.

 

Hormones and the roles they play in your body

Throughout our bodies we have receptors which are responsible for receiving estrogen, progesterone and testosterone.  We have receptors for these hormones in our brains, joints, muscles, heart, blood vessels, urinary tracts, eyes, vagina – all over our bodies.

 

Your body is used to having a good supply of estrogen.  It protects the arteries in the heart, helps keep your bones healthy and strong, regulates your mood, helps your brainpower and memory, and keeps any area that needs moisture well-lubricated.

 

Testosterone helps to keep the bulk in your muscles, it regulates your sex drive, helps your mental focus and concentration, and your energy levels.

 

Progesterone’s role is to regulate the menstrual cycle and is important during pregnancy.  It’s also used as part of HRT (hormone replacement therapy) to keep the lining of the womb thin and healthy.

 

When these hormones reduce, it can give rise to a variety of different symptoms across the whole of your body as these receptors aren’t receiving the same amount of hormones as they used to, which is why the perimenopause can bring so many different symptoms across the whole of your body.  This is why everyone’s experience of the menopause is so different – because everybody is unique.

 

Contraceptives, hysterectomies and menopause diagnosis

If you’ve had a hysterectomy or if you’re taking certain types of contraceptive, like the progesterone-only mini-pill or the mirena coil, it may be a little more difficult to tell if you’re menopausal or not as you might not have periods – the tell-tale sign of perimenopause.

 

If you’re over the age of 45 the chances that you’ll be experiencing some symptoms of the perimenopause are quite high, so the best thing you can do is to keep an eye out for any symptoms that start to appear.  Sometimes they’re obvious, but others can be very subtle, so it’s best to keep an eye out for any changes to your body.  It’s important to read about and understand the impact of your hormones so you can be more aware of any changes that might be happening.

 

Surgical menopause and what you can expect to happen

If you have a hysterectomy (an operation to remove the uterus/womb) you may also have your ovaries removed at the same time.  This induces the menopause and is known as a surgical menopause, whatever your age.  If one or both of your ovaries is left intact there is a chance within the next five years that you’ll start the menopause.

 

Medical or surgical treatments for endometriosis or severe premenstrual syndrome can also bring on an early menopause, either by removal of the ovaries or ‘shutting them down’ through the use of medication.

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If you have a gynaecological cancer (womb, ovarian, cervical, vaginal or vulval), certain types of chemotherapy, radiotherapy or surgery may bring on symptoms of the menopause and it can happen quite suddenly.  There are also some types of drugs used for treatment of breast cancer that block hormones working and bring on menopausal symptoms while you’re taking the treatment.

 

There are many ways the menopause can be triggered earlier than a natural menopause and this can either be permanent or temporary.  Those who are likely to go through menopause as a result of medical or surgical treatment should be offered support as they are likely to experience a sudden start to their symptoms.  They should be given information about menopause before they have their treatment and ideally be referred to a healthcare professional with expertise in menopause.  HRT is very effective in helping symptoms caused by a surgical menopause but younger people often need higher doses of hormones, especially estrogen and testosterone, and this can often require a specialist in menopause to achieve the best outcome regarding managing menopause symptoms.

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Early menopause and POI – what is it and why does it happen?

If your periods stop for more than a year and you’re under 45 years old this is classed as an early menopause and if you’re under 40 years old you might be diagnosed as having premature ovarian insufficiency (POI).

 

POI is when your ovaries stop working properly and no longer produce normal amounts of hormones, and therefore they may not produce eggs.  This causes your periods to become irregular or stop altogether and can also trigger symptoms of the menopause.  POI happens to 1 in 100 women under 40 and 1 in 1000 women under 30, so remember you’re never alone.  If any of your relatives had any early menopause, it might mean you could too.

 

Others may become menopausal at a younger age because of surgery (removal of womb or ovaries), treatments for cancer including radiotherapy and chemotherapy, or treatments for endometriosis or severe PMS.

 

If you’re under 45 you may need a blood test to check your FSH level (follicle stimulating hormone) and it will be repeated 4-6 weeks later, if it’s risen on both occasions it’s likely you’ll be diagnosed with early menopause or POI.  If you’re under 35 you may have chromosome tests to rule out a chromosomal cause of your symptoms and you won’t need tests to diagnose the menopause if your ovaries have been removed.

 

In the UK, The Daisy Network is a charity and support network for those who have an early menopause or POI.  Make the most of the support networks that are available to you as they can help in numerous ways depending on how you need them.

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Finding the right solution for you and your body

There are many ways to help combat the effects of the menopause and they can be specifically tailored around you.  The most effective treatment for improving menopausal symptoms is to replace the hormones that your body has lost, essentially giving you a hormone top up.

 

Hormone replacement therapy (HRT) helps restore hormone levels and it contains estrogen and progesterone, and testosterone, if needed.  It’s also very important that you maintain a healthy lifestyle and diet because certain foods and drinks can impact your symptoms too.

 

Regular exercise helps to improve your physical health, your mood, energy levels and your heart and bone health.  It’s always useful to find support from others going through menopause too, and be open with those closest to you about how your symptoms affect you.

 

Some people find cognitive behavioural therapy helpful, and others explore alternative therapies and/or herbal remedies.  You can choose whichever treatment is right for you.