Life is too precious to let your menopause affect you!
Your own experience of your menopause will be very different to other women’s.
You may not be finding it a pleasurable or positive experience.
Menopause – the definition and an explanation
The menopause is a completely normal event that around 50% of the population will go through, so be assured you’re not alone. Officially, menopause is when your periods have stopped (for over a year) but the term often includes the years leading up to this point (perimenopause) and for several years after (postmenopause).
Your periods stop because your ovaries have run out of eggs to release each month and this causes them to make a lot less of the hormones estrogen, progesterone and testosterone. When it happen depends on many factors such as genetics, underlying conditions, surgery or treatments you may have had – even the number of eggs you had at birth. We can’t predict when it’ll start because of these numerous factors.
As well as periods changing and then stopping altogether, there are many other symptoms of menopause because these hormones play several roles throughout your body. The most common symptoms are hot flushes, night sweats, mood changes, tiredness and insomnia, poor mental focus and concentration, headaches, joint pains, low sex drive, vaginal dryness and urinary and bladder problems.
The big question – how long does menopause last?
Today, the average age of the menopause is 51 years and women typically
live for another 30 or more years after this, but now we have many advanced
resources to help make this phase in your life a lot easier.
How long can you expect to see changes to your hormones for?
Most people can expect to experience symptoms for about four years after their last period and 1 in 10 people can experience symptoms for up to 12 years. It’s not always easy to know which symptoms are related to hormones and which are related to other factors in life. Regardless of your circumstances it’s important to remember that your menopause journey is individual to you.
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.
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.
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.
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.
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.
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.
Periods – understanding the menstrual cycle
The menstrual cycle describes the process that occurs every month from
when you start your period until you get another period. When an egg is
produced and released by the ovaries, the lining of the womb thickens, the
egg travels down the fallopian tubes and is either reabsorbed by the body
and the womb lining comes away in a period (if a pregnancy doesn’t occur)
or if it does, the egg is fertilised and implants in the lining of the womb.
The cycle is controlled by hormones and rising levels or estrogen cause the ovary to develop and release an egg (ovulation) and estrogen helps thicken the lining of the womb. In the second half of the cycles, the hormone progesterone helps the womb to prepare for implantation of a developing embryo. If there is no pregnancy, levels of estrogen and progesterone fall, and womb lining comes away, leaving the body as a period.
The length of the menstrual cycle varies greatly, but the average length of the whole cycle is 28 days. Regular cycles that are anywhere between 21 to 40 days, are normal. The time from the release of an egg to the start of a period is around 10 to 16 days; the period is made up of blood and the womb lining. The first day of a period is day 1 of the menstrual cycle, periods usually last around 2 to 7 days and the average length is 5 days. On average you lose about 3 to 5 tablespoons of blood in a period, but some bleed more heavily than this – there are treatments available if heavy periods are a problem for you.
Vaginal secretions (or discharge) change during the menstrual cycle. Around the time of ovulation they usually become thinner and stretchy, a bit like raw egg white. See a healthcare professional if you notice significant change in your vaginal secretions.
Unusual vaginal bleeding and what you should do about it
It’s common for there to be some bleeding vaginally during the perimenopause or menopause. It might be expected as part of a period or ‘withdrawal’ bleed when taking a break from your contraceptive pill or it may seem out of the ordinary for you. It’s also common for bleeding to happen when taking HRT, especially for the first few months as your hormones settle down. Some ways of taking HRT are designed to have breaks in them to bleed if you’re still having periods.
Even though it’s very common for there to be some spotting or bleeding either before your periods have stopped or afterwards, and on different forms of contraception and HRT, unusual and persistent bleeding should be thoroughly investigated. It’s always better to get an expert opinion on these things if something doesn’t seem right.
There are several reasons for this, the main one being to rule out certain types of cancer, but it’s also useful to know the reason for the bleeding, to gain reassurance, receive suitable treatment for the bleeding and improve your quality of life by reducing the bleeding successfully.
Unscheduled bleeding might happen when you use a contraceptive method that stops periods altogether or you’re on continuous combined HRT because your periods have stopped already, in theory, there should never be any bleeding and therefore any bleeding is classed as unscheduled.
Unusually prolonged or heavy periods and unscheduled or breakthrough bleeding should be investigated further. Healthcare professionals will ask you lots of questions about the bleeding so it’s always a good idea to keep track of when it happens, how long it lasts for and how heavy it is. You may be referred to a gynaecologist for further investigations, diagnosis and treatment.
Find out why PMS can leave you feeling distressed
Premenstrual syndrome (also known as PMS) is when you experience distressing symptoms in the days, or even weeks, leading up to starting your period. PMS includes psychological symptoms such as depression, anxiety, irritability, loss of confidence and mood swings. There are also physical symptoms, such as bloatedness and breast tenderness.
PMS is identified when symptoms occur and have a negative impact during the luteal phase of your menstrual cycle. The luteal phase occurs between ovulation (normally mid-cycle, around day 14) and starting your period (usually around day 28).
Although the average length of the menstrual cycle is 28 days, it can vary greatly between each person and you may find the length of your cycle varies from month to month. Many notice their premenstrual symptoms, but they are not really affected by them in any significant way.
Tired of feeling tired? We know the feeling …..
Symptom: Tired or low energy
What is it?
Tiredness, fatigue, low energy – we’re all familiar with this feeling
and dragging yourself out of bed and doing the simplest of tasks
requires monumental effort. Tiredness because of fluctuating, or
declining, hormones can be overwhelming and persistent. It can make you feel like all you’re capable of doing is staying on the sofa and watching TV. If your nights are interrupted by insomnia or night sweats tiredness can interrupt your day.
Why does it happen?
It’s no wonder we can feel so tired when we look at the range of possible symptoms that can interrupt a good night’s sleep and learn more about the role hormones play in helping us get those all-important 8 hours.
Fluctuating estrogen can lead to hot flushes, night sweats and needing to go to the loo lots. Lower levels of progesterone can lead to anxiety, restlessness and frequent waking in the night. Testosterone has also been found to help us stay asleep for longer and get a better quality sleep. And the hormone melatonin, the one that regulates sleep, is affected by your levels of these other key hormones that decline during the menopause.
Is there a treatment?
Replacing the missing hormones by taking HRT can really improve tiredness and some people benefit from taking testosterone as well as estrogen. Many people take progesterone tablets as part of their HRT, one type in particular (micronised progesterone) is a natural sedative, and so can help to cause drowsiness and induce sleep. Micronised progesterone is usually taken at night time for this reason.
Do you find yourself forever counting sheep?
Symptom: Difficulty sleeping
What is it?
Insomnia (also known as sleeplessness) is where people have trouble sleeping. You may have difficulty falling asleep in the first place, or staying asleep as long as you’d like to.
Why does it happen?
It’s often down to hormones. Estrogen is very important in our bodies and one of its biggest tasks is to help us sleep. As we age the amount of estrogen in our body decreases, meaning it can be harder to fall asleep at night. Did you know, women actually produce more testosterone than estrogen before the menopause and lower levels of this important hormone can lead to sleep problems?
There’s another hormone in the mix too: progesterone. Progesterone increases the production of another chemical in your brain (called GABA) that not only helps sleep but also improves your mood and relaxation too. As progesterone decreases with age, you can find it harder to sleep, but also harder to regulate your moods too.
Is there a treatment?
Taking the right dose and type of HRT to replace your missing hormones can often really improve sleep. Many people take progesterone tablets as part of their HRT. One type in particular (Utrogestan) is a natural sedative, so can help to cause drowsiness and induce sleep. Some people find taking a good quality magnesium supplement can also help improve sleep. We recommend that you seek medical advice from your GP. You’ll be able to discuss your symptoms and the various types of medications that are available to suit you and your current health conditions.
Information taken from
Dr Louise R Newson BSc(Hons) MBChB(Hons) MRCP FRCGP