Although menopause affects half of the population, it’s a topic that doesn’t get the attention it deserves – whether that’s understanding how to recognise the first symptoms, or knowing how to manage them. In this guide, we’ll be offering our support and advice on menopause, covering what it actually is and why it happens, to treatments that can make things easier.
What is the menopause?
The menopause is when a person stops having periods. This happens when the ovaries stop producing the hormone oestrogen, and when they no longer release eggs. Prior to menopause, you may notice that your periods become less regular as your oestrogen levels fluctuate and gradually drop – this is known as perimenopause. During this time, you may experience menopause symptoms whilst still having your period. If you haven’t had your period for 12 months, by medical definition, this means that you’re menopausal.
When does the menopause happen?
Menopause usually happens between the ages of 45 and 55, but in some individuals, it can occur earlier. An early menopause can happen naturally, however it can also be caused by certain conditions – such as chromosome abnormalities, autoimmune diseases and certain infections. Radiotherapy and chemotherapy can also cause either permanent or temporary ovarian failure, which can lead to a premature menopause. You can find out more about premature and early menopause in our previous article.
Symptoms of menopause
The symptoms that you may experience during perimenopause, and after you stop ovulating, can differ from person to person. These can range from mental to physical, and can also differ in severity. Some women may not be impacted at all, whereas others may see significant changes to their daily life.
The symptoms most commonly associated with menopause and perimenopause include:
- Irregular periods that, over time, stop altogether
- Mood changes, such as low mood and self-esteem, anxiety and mood swings
- Trouble with memory or concentration (brain fog)
- Trouble sleeping
- Hot flushes and night sweats
- Heart palpitations
- Headaches and migraines that are more painful than usual
- Muscle aches and joint pains
- Weight gain
- Dry and itchy skin
- Lower libido
- Vaginal pain, dryness and itching
- Pain during sex
- Frequent urinary tract infections (UTIs)
Some of these symptoms may overlap with other medical conditions – for example, irregular bleeding (which is a common menopause symptom) can indicate another underlying health condition. If you’re ever unsure of whether these symptoms are due to menopause, it’s always best to book an appointment with your GP.
Menopause diagnosis
Your GP can provide you with support and advice on how to manage menopause, providing information on the different stages, which symptoms to expect, and how to adjust your lifestyle to make management easier. They’ll also run you through the different treatment options available for these symptoms, highlighting the pros and cons of each to help you find the best treatment method.
Based on your age and how regular your period is, your GP should be able to determine whether you’re perimenopausal or menopausal, so further tests aren’t often needed. But if you’re taking hormonal treatments, this can be trickier to establish, meaning a test may be necessary.
In some instances, you may be required to do a blood test – but this should only be necessary if you’re under the age of 45 and are experiencing the symptoms associated with menopause. This test will measure how much of the FSH hormone (follicle-stimulating hormone) you have, as higher levels are found during menopause. If you’re taking a contraceptive that contains oestrogen and progestogen, you won’t have a blood test as they alter your natural FSH levels.
Treating and managing menopause symptoms
As highlighted in our article on menopause treatment and support, there are various ways to help make living with menopause easier. Ultimately, everyone will have a different experience with menopause, but your GP is there to help walk you through treatment options if symptoms are affecting your daily life.
Prescribed medications
Hormone replacement therapy
One of the main treatment methods for perimenopause and menopause symptoms is hormone replacement therapy (HRT). This involves replacing the hormones that are at low levels with oestrogen, which can be taken at different doses through skin patches, a gel or spray that’s put on the skin, implants, and tablets. If you have a womb, it’s also necessary to take progesterone whilst taking oestrogen in order to protect the womb lining. This treatment method is known as combined HRT.
There are pros and cons – which you can read more about in our guide to hormone replacement therapy – that should be taken into consideration before opting for this treatment method, however your doctor will walk you through these. If you’re unable to have HRT, or you choose not to, there are a number of non-hormone treatment options available to help manage your menopause symptoms. There are probably some advantages in being prescribed bioidentical HRT, which means a medication very similar to the natural hormones.
Testosterone supplements
Testosterone supplements can help to increase libido and arousal, as a lack of interest in sex can be experienced during menopause – although reducing stress may also help with this. Not only this, they can help with muscle and bone strength, mood and thinking, along with urogenital health. Although not licensed for use in women, your GP may prescribe them to you if all other treatment alternatives have been discussed, and if there are clear reasons for taking them.
Vaginal oestrogen
If you’re experiencing vaginal dryness, you can take vaginal oestrogen – either as a pessary, cream or vaginal ring. This treatment method allows the vagina to lubricate itself by replacing the hormones that are reduced during menopause. Although it’s rare for vaginal oestrogen to cause any problems, it’s important that you consult your GP if you experience any vaginal bleeding. Also, it’s possible for your symptoms to return once you stop using vaginal oestrogen, so further treatment may be required.
Over the counter therapies
Research suggests that certain over the counter therapies can improve menopause symptoms, however your GP should advise you that their effectiveness is largely unknown. These include:
- St John’s wort: There is some evidence that this can reduce hot flushes and night sweats during menopause. However, the ingredients used in products containing St John’s wort aren’t consistent, so their effectiveness may vary. Not only this, they can interfere with and cause side effects when taken alongside other medications, so it’s important to speak to your doctor before consuming these products.
- Black Cohosh: Some evidence suggests that taking Black Cohosh can help with hot flushes and night sweats. However, the evidence out there is contradictory, making its effectiveness inconclusive. The ingredients of the products can vary and may interfere with other medications.
- Red clover and isoflavones: Limited evidence suggests that isoflavones (which are plant based chemicals that are believed to produce oestrogen-like effects in the body) may reduce hot flushes and night sweats. However, more research is needed in this area to confirm this. Plus, the ingredients and amounts of isoflavones can vary between products.
- Sea buckthorn oil: Sea buckthorn oil may relieve the symptoms of menopause, such as vaginal dryness, and can be an effective alternative to oestrogen treatment.
- Bioidentical hormones: Deemed as the “natural” alternative to HRT, these are unregulated hormone preparations made from plant sources that can be purchased online or from certain pharmacies. However, The British Menopause Society recommends that hormone therapies should only be provided by a professional with the relevant training.
Lifestyle changes
There are various lifestyle changes you can make that can help alleviate some of the symptoms associated with perimenopause and menopause. These include:
- Reducing or avoiding alcohol
- Limiting caffeine intake
- Stopping smoking
- Exercising regularly, including weight-bearing and resistance exercises
- Consuming a healthy diet that’s rich in calcium
- Practising mindfulness through yoga, tai chi, or meditation
- Sticking to a regular sleep schedule
- Using moisturisers and lubricants for vaginal dryness
- Talking to friends or family members who are also experiencing menopause
Cognitive behavioural therapy (CBT)
Perimenopause and menopause can cause you to experience emotional changes, such as low mood and anxiety, alongside distress as a result of the associated physical symptoms. The menopause can coincide with other stressful times: children leaving home, grandchildren appearing, or a change in career path. In these instances, it’s important to remember that mental health treatment is readily available, and you can access NHS talking therapies without having to consult your GP first. Cognitive behavioural therapy (CBT) is a well-recognised talking therapy that can help with managing these emotional fluctuations. Your doctor can help with recommending the best treatment method for you.
Additional treatments
Other natural changes that you experience as you age – such as osteoporosis and heart disease – can be intensified by menopause, so it is worth keeping track of any additional symptoms you’re experiencing as they may lead to further tests. For example, a bone density scan (DEXA scan) may reveal that you are at risk osteoporosis, so you may be referred for additional treatments, such as medications or supplements.
Good things about the menopause
The menopause is often talked about with dread, but it’s worth thinking about some of the positives it brings. You won’t have to have a period every month. For some women that might mean less disruption, pain, or premenstrual syndrome. You can also have sex without worrying about pregnancy.
Many women (as many as 70-80%) suffer from uterine fibroids at some point. These are small benign growths that can develop in the wall of your womb and cause some women to have heavy periods or experience pain. The hormone changes in menopause stop these tumours growing and of course the heavy bleeding linked with fibroids also stops.
Advice and support for menopause
Communication during menopause is important, which is why there are various resources available that aim to both educate and support. Ultimately, knowledge is power, and speaking with support groups and medical professionals can make it easier to discover the right treatment method for you.
You may find the following resources helpful if you’d like to understand more about menopause:
- Menopause Support UK
- Menopause Matters
- The Daisy Network
- Women’s Health Concern
- The Menopause Exchange
- Fertility Friends
Not got the app yet? Download the Evergreen Life app and look out for a notification about your Menopause questionnaire*. Start taking more control of your health and wellbeing.
* Must be 30 or over and have a uterus to receive the Menopause Check. If you haven’t told us your age and sex, please first take the GP Check in your Records section.
Reviewed by:
Anna Keeble – Head of Content
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