Menopause - North Arden Primary Care Network

Menopause

What Is Menopause?

The menopause can be a distressing time for many women. It describes the stage of a woman’s life when her menstrual periods stop for good, and she can no longer get pregnant. This happens because your ovaries stop producing eggs and your hormone levels drop and is diagnosed after 12 months without a menstrual period, vaginal bleeding or spotting.

On the approach your periods can seem to be shorter in length, and then sometimes missing altogether. For most women, length of your menstrual cycle shortens to around 21 to 26 days and missed periods are very common.

Menopause is not a disease or disorder — it is a natural part of ageing that usually happens between 45 and 55 years old, the average age being about 51. Some women can have it much earlier, though. This could be because of surgery on the ovaries or a hysterectomy. It can also be caused by cancer treatments like chemotherapy. Sometimes it is because of your genetics or for an unknown reason.

During the menopausal transition, the body’s production of estrogen and progesterone, two hormones made by the ovaries, declines greatly. This drop in hormones causes menopause symptoms. Some symptoms can be difficult to manage. Make sure you talk to your GP about your menopause symptoms and get the help you need.

For more information on the menopause please click on the following links or watch the video below from the British Menopause Society.

What are the stages of Menopause?

The transition into menopause usually starts with changes in women’s menstrual cycle patterns between the ages of 45 and 55, often accompanied by hot flashes or other symptoms. There are various stages of menopause, and the entire process can take several years. The stages in a woman’s life are as follows: premenopause, perimenopause, menopause, and postmenopause.

The possibility also exists for early menopause. This is when you’re between the ages of 40 and 45. Or premature menopause which is when you’re under the age of 40, but this is rare. Your doctor might also refer to this as ‘premature ovarian insufficiency’.

The four general stages of menopause are as below.

Premenopause – This stage occurs before any menopausal symptoms appear. Women continue to experience menstrual periods, whether they are regular or irregular, and remain in their reproductive years. Although hormonal changes may be taking place in the body, there are typically no noticeable effects at this time. These hormonal changes often begin 8 to 10 years before menopause, usually in a woman’s 40s, but they can also start in the 30s.
Sometimes, blood tests can be useful to detect abnormal hormone levels, and to exclude other causes of symptoms, such as thyroid problems or anaemia. Hormone levels fluctuate from day to day, so blood tests aren’t usually helpful to make a diagnosis of menopause-related problems.
Perimenopause – The time leading up to menopause is known as perimenopause, which means “around menopause.” This phase occurs when the ovaries gradually stop functioning, leading to irregular ovulation and menstrual cycles. Women may experience hormonal changes during this time; some may have mild symptoms or feel relieved by the absence of periods, while others experience more intense symptoms.
Perimenopause typically lasts about four years, though it can range from a few months to longer. Pregnancy is still possible during this stage. Menopause is officially reached after 12 months without a period, and many of the symptoms during perimenopause can resemble those of menopause.
Menopause – Menopause occurs when a woman no longer gets a menstrual period for 12 consecutive months. This is when the ovaries have stopped producing eggs and have also stopped producing most of their estrogen. As noted, the average age of menopause is 51 years old.
PostMenopause – If it has been over a year since a woman’s last menstrual cycle, she is then in the postmenopause stage. She will continue to be in this stage for the remainder of her life.

The Role of Hormones

Hormones significantly impact menopause. Hormones are chemical messengers released into the blood or other extracellular fluids. They convey messages to specific parts of the body, known as target sites, instructing them on their functions. Five hormones that are central to the process of menopause are listed below.

Follicle-stimulating hormone (FSH) – FSH is crucial for regulating the menstrual cycle and stimulating egg growth in the ovaries. Its levels peak just before the egg is released.
Luteinizing hormone (LH) – LH regulates the menstrual cycle and facilitates egg release from the ovary.
(Both FSH and LH stimulate oestrogen production, specifically oestradiol.)
Gonadotrophin-releasing hormone (GnRH) – is released by the hypothalamus in order to stimulate the pituitary release of FSH and LH.
Progesterone – Progesterone prepares the endometrium, the uterine lining, for potential pregnancy by thickening it and preventing contractions that could reject a fertilized egg. If pregnancy occurs, progesterone levels stay high to prevent ovulation; if not, levels drop, allowing menstrual cycles to continue.
Oestrogen – Oestrogen is crucial during puberty and afterward. Primarily produced in the ovaries, it also comes from adrenal glands and fat tissues. This hormone aids in breast development, hair growth, regulates the menstrual cycle, controls cholesterol, and supports bone, brain, heart, skin, and overall tissue health.

As women enter perimenopause and menopause, their hormone levels may still appear relatively normal. However, in the later stages of menopause, levels of oestrogen and progesterone drop significantly, while levels of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) increase in an attempt to stimulate oestrogen production. Once menopause is fully underway, both FSH and LH will remain elevated for the rest of a woman’s life.

What are the symptoms of Menopause?

Hot flashes and night sweats are the most common symptoms of menopause, affecting about 75% of women. These sudden and brief increases in body temperature typically begin before a woman’s final menstrual period. For approximately 80% of women, hot flashes last for two years or less.

During the menopause, your periods are likely to be irregular and it’s normal to miss a few periods. However, it’s important to note that menopausal symptoms can still occur whilst your periods are regular (as in the perimenopause).

As well as changes to your period you may also lots of other, less talked about symptoms that women sometimes dismiss. Symptoms of the menopause can have a huge impact on your life. They may also affect your confidence.

Some of the other more common symptoms are:

Anxiety, Low mood and depression – Anxiety can vary with hormonal fluctuations and may worsen at night. Menopause can significantly impact mood and mental health, and sleep disturbances from symptoms can contribute to low mood. Click HERE to read a leaflet from Women’s Health Concern regarding Emotional wellness in menopause.
‘Brain fog’ and poor concentration – When oestrogen levels drop in midlife, the body, including the brain, enters a deprivation state. Oestrogen helps brain cells burn more glucose, their primary fuel.
Joint and muscle pain – Oestrogen has anti-inflammatory qualities, and as levels of this hormone drop after menopause, it can lead to increased inflammation and joint discomfort.
Vaginal dryness – Female sex hormones ensure that there is a good circulation of blood flow around the vagina, so a lack of these hormones can impact natural lubrication and cause dryness. This can be uncomfortable and make penetrative sex difficult.
Low sex drive – Menopause may lower your libido due to reduced testosterone and oestrogen levels, making physical arousal more difficult. Other symptoms like mood changes or medication side effects can also contribute.

Everyone’s experience of menopause is different. Some other people may have other symptoms such as:

Tingling in extremities – During the menopause you might experience tingling in your hands, feet, arms and legs. This symptom is the result of hormone fluctuations affecting the central nervous system and usually lasts for a few minutes at a time.
Problems sleeping – This is often due to hot flashes, especially night sweats, and changes in mood. Depression in particular can contribute to poor sleep. Please click HERE to read a leaflet from Women’s Health Concern regarding Menopause and insomnia.
Burning mouth – Menopause can cause lesser-known symptoms like burning, tenderness, tingling, heat, or numbness in the mouth due to hormonal changes.
Dry skin and eyes – It turns out that oestrogen, the same hormone behind so many of your body’s changes may be responsible for dry skin problems at menopause, too
Low Energy – You may have noticed that you feel more tired than usual; this could be due to lack of sleep from night sweats or hormonal fluctuations.
Thinning hair – Hormonal fluctuations during the menopause can cause your hair follicles to shrink, causing hair to grow slower and shed easier. Please click HERE to read a leaflet from Women’s Health Concern regarding Menopausal hair loss.
Brittle nails – During or after the menopause, your body might not produce enough keratin, the substance that nails need to stay strong. This can lead to brittle, weak nails that crack or break easily.
Breast tenderness – Your breasts might feel more sore or tender than usual as oestrogen and progesterone levels change. This symptom tends to ease as the menopause progresses.
Headaches – A headache can be triggered any time there is a fluctuation in oestrogen levels.
Palpitations – Changing hormone levels, such as oestrogen, may cause your heart to pound and flutter. Palpitations typically start when you’re experiencing a hot flash and feel like your heart is beating much faster than usual, almost as if you’ve been running very hard.
Urinary symptoms – This is a result of thinning of the lining of the urethra due to reduced oestrogen levels. weakened pelvic floor muscles, which can lead to a more frequent need to urinate and decreased ability to hold in urine and faeces. Also, vaginal dryness which can put you at more risk of a UTI.
Cold Flushes – You may be familiar with hot flushes during menopause, but cold flushes can also occur. These can happen after a hot flush or on their own and are due to the brain’s changing ability to regulate body temperature. Wearing damp clothes from sweating can aggravate the issue.
Dizziness or vertigo – You might experience dizzy spells during the perimenopause and menopause. This is because the hormonal changes which take place affect the production of insulin, which can make it difficult for your body to maintain blood sugar stability.
Changes in spatial awareness – During the menopause, changes in the perception of depth of vision can occur, which can affect your awareness of surroundings. Your concentration can sometimes dip during this time, and your eyes can become drier. This can lead to clumsiness or being more accident prone.
Tinnitus – The menopause can cause your hearing to alter slightly, or for you to start experiencing tinnitus (ringing in your ears). There are oestrogen receptors in the ear cells and it’s thought that a change in production of oestrogen can impact your ear function.
Changes in taste – You may find that some foods taste differently or that your sense of taste becomes stronger. Fluctuation in oestrogen levels might also cause a metallic taste in your mouth.
Change in body odour – Hot flushes and night sweats can result in an increase or change in body odour during the menopause. If the menopause is also making you feel more stressed or anxious than normal, this can also make you sweat more.

Symptoms related to menopause can last anywhere from two to eight years; however, the timing and specific symptoms can vary widely among women. These differences are likely influenced by factors such as genetics, race and ethnicity, cultural background, lifestyle choices, and environmental conditions. For instance, smoking is linked to an earlier onset of menopause and more severe symptoms.

Research indicates that Black women are more likely than White women to experience menopause earlier, to face more intense symptoms, and to endure these symptoms for a longer duration. In contrast, Asian women tend to report fewer menopausal symptoms.

Additionally, during the menopausal transition, the body begins to use energy differently. This shift can lead to changes in fat distribution, making weight gain easier. Women may also experience alterations in bone density, heart health, body shape, composition, and physical function.

Women who are concerned by menopausal symptoms should talk with a doctor about lifestyle changes or medications that might help.

Can you test for menopause at home?

Pharmacies sell over-the-counter test kits that claim to assess hormones in the urine or blood tests to determine whether a woman has entered menopause. But don’t expect an at-home test to provide a definitive answer as they are often unreliable. It isn’t possible to verify the presence of menopause with a blood or urine test.

Menopause is diagnosed based on your menstrual history and symptoms. For a definitive diagnosis, you will need to visit your doctor’s surgery for them to assess the issue.

What treatment is available and how can I lessen the symptoms?

Menopause comes with many changes in a woman’s body, and it can often feel overwhelming. However, help and support are available. Because there are various potential symptoms, it’s important to rule out other conditions. Your GP or gynaecologist can help determine if you are experiencing menopause or perimenopause and discuss the best ways to manage your symptoms.

Not all women need treatment. But for those that do the primary treatment for menopausal symptoms is hormone replacement therapy (HRT). This therapy can alleviate some of the symptoms commonly associated with menopause and help rebalance the body’s oestrogen levels. It’s essential because prolonged deprivation of oestrogen can have significant health effects.

There are different types of hormone replacement therapy (HRT) available.

They can:

Contain different hormones – oestrogen, progestogen or both (a specialist doctor may also sometimes prescribe testosterone)
Be taken or used in different ways – tablets, patches, gel, spray or vaginal rings, pessaries or cream
Be taken or used at different times – routines can be cyclical (sequential) or continuous

If you are considering hormone replacement therapy (HRT), it is important to discuss the associated risks and benefits with your general practitioner (GP) or gynaecologist. Should you choose to proceed with HRT, the type and dosage, as well as the recommended duration for which you will take it, will be customized to fit your specific circumstances. The most suitable type of HRT for you depends on various factors, such as whether you have had a hysterectomy, your stage of menopause, and your personal preferences. Please note that HRT is not suitable for everyone, and there are alternative options available.

Your GP, nurse or pharmacist can give you advice and help with your menopause or perimenopause symptoms, including information about Hormone Replacement Therapy (HRT) and available alternative options.

For more information about hormone replacement therapy please click on the following links from Women’s Health Concern or watch the below video from the British Menopause Society.

Is it better to go through menopause without HRT?

Whilst the most common and effective treatment options for menopausal symptoms is hormone replacement therapy (HRT) and oestrogen, this isn’t the best option for everyone. Some people cannot take oestrogen; for example, those with breast cancer and previous hormone-dependent cancer.

Other people may simply prefer to move through menopause without using hormone treatments.

Non-hormonal medication such as antidepressants can also be prescribed to relieve low mood and hot flushes. However, antidepressants often have side effects, so again talking this through with your GP or specialist is essential.

One of the best ways to help with the symptoms of menopause without HRT and medication is to lead a healthy lifestyle. Following a healthy lifestyle can help with many other symptoms of menopause, not just hot flushes. Eat a healthy diet, exercise regularly, drink sensibly and don’t smoke. This will also help to reduce your risk of developing heart disease and osteoporosis, as the risk of these is higher after menopause.

What are the best ways to manage menopausal symptoms without HRT?

Avoid triggers – Although hot flushes can be unpredictable, you might find they’re worse after drinking alcohol or caffeine, smoking, or after eating spicy food. Try keeping a diary for a few weeks to see whether you notice a link or trigger.
Exercise – Exercising regularly can reduce your risk of weight gain, as well as symptoms of hot flashes and disrupted sleep. Losing weight if you’re overweight can also help. And weight-bearing exercises can reduce your risk of menopause-related osteoporosis. Please click HERE to read a leaflet from Women’s Health Concern about exercise in menopause.
Wear loose light clothing – Wearing lighter clothing made of natural, breathable fabrics, such as cotton, silk, or soft wool, might help you to keep cool. Go for looser styles rather than tighter ones. During the colder months, wear a few light layers so you can easily take clothes off when you feel a hot flush coming on.
Keep it cool at night – Increase ventilation in your sleeping area to keep it cool at night and minimize the disruption of night sweats. Rather than using one heavy duvet, try layering a few light blankets and sheets made from natural fabrics. Sheets made with 100% cotton are usually cool and comfortable.
Stress relief – Managing stress can relieve mood swings, and practices like tai chi and yoga can help you maintain calm and relaxation.
Lubricants and moisturizers – Can help with vaginal dryness.
Minimally invasive procedures and physical therapy can help with menopause-related urinary incontinence.
Take cool or lukewarm showers – The use of a fan or cold drinks can also help reduce the effect of hot flashes.
Vitamins and minerals can help – As a woman’s natural oestrogen level falls, her risk of bone loss increases. This can be helped by getting more calcium, vitamin D and magnesium. However, it’s best to get these nutrients through food instead of relying on supplements.
Carry a cooling spray – Keep a small spray bottle in your bag, on your desk or close to hand when you’re at home. Fill it with water and give yourself a little spritz to cool down during a hot flush.

To read a leaflet from Women’s Health Concern regarding Complementary and alternative therapies and Non-hormonal treatments for menopause symptoms please click HERE.

What are the best things to eat in menopause?

Paying close attention to diet, nutrition and exercise can also be helpful in dealing with menopausal symptoms, for example following a Mediterranean diet which involves good-quality protein, lots of fruit and vegetables and a reduction on carbohydrates can be beneficial.

Look to increase your intake of foods rich in calcium, magnesium and vitamins D and K, these nutrients help maintain the integrity of our bones.

Cut back on high-fat, high sugar, high salt foods and spicy meals. Limit cholesterol to 300 milligrams or less per day. And watch out for trans fats, found in vegetable oils, many baked goods, and some margarine. Trans fat also raises cholesterol and increases your risk for heart disease. Caffeine should also be avoided.

Eat and drink two to four servings of dairy products and calcium-rich foods a day, although maybe switch to lower fat options. Calcium can be found in dairy products, fish with bones (such as sardines and canned salmon), broccoli, and legumes. Aim to consume 1,200 milligrams per day. Additionally, eat at least three servings of iron-rich foods daily.

Some other useful foods include:

Lots of different coloured fruit and vegetables, especially leaf greens.
Choose wholegrains (bulgur wheat, millet, sweet potatoes, brown rice, brown bread).
Eat a handful of nuts a day and add seeds to your food.
Choose lean or plant-based protein at every meal.
Regularly enjoy beans, lentils and chickpeas.

For more information about dietary changes that can help with the symptoms of menopause please visit some of the websites or read some of the leaflets below.

What are the best drinks for menopause?

Medications can help balance the hormonal changes that occur during perimenopause, but they may not be suitable for everyone. If you prefer more natural remedies, herbal teas can be a healthy and cost-effective option.

As your levels of oestrogen, progesterone, and testosterone decline during menopause, drinking tea may help alleviate some of these symptoms. Be sure to follow the package instructions for the best results.

Some of the best teas are:

Black cohosh root
Ginseng
Chasteberry tree
Red raspberry leaf
Red clover
Dong quai
Valerian root
Licorice
Green tea
Ginkgo biloba

Are there risks in drinking these teas?

There are pros and cons to drinking teas to treat the symptoms of menopause. Some have caffeine which isn’t recommended, can cause allergic reactions in some people or other adverse effects. Some teas are natural blood thinners or have adverse effects on prescription medications.

Always consult with your doctor before using tea to treat your symptoms.

You can find more information on the pros and cons of these teas by clicking HERE for the Healthline website.

Drinking tea occasionally poses little risk and can be a gentle way to address the symptoms of perimenopause. If you decide to use tea to help manage these symptoms, it’s best to choose organic herbal teas and caffeine-free options, as caffeine may exacerbate menopausal symptoms.

Be cautious with hot teas, particularly if hot flashes are a significant concern, as they can increase the frequency of hot flashes and night sweats. This effect may be more pronounced if you consume hot tea before bedtime. To enjoy tea without the heat, consider brewing it in advance and drinking it cold as a refreshing alternative.

Other Useful Information

For more useful information and help regarding the menopause please visit the websites or read the Leaflets below: