menopause

Menopause 101: The Signs, Symptoms and Treatments

October 18, 2021Zoya Ali BSc MSc

Approximately 25 million people go through menopause every year. Despite it directly affecting half of the population, knowledge and understanding around menopause remains incredibly low. In light of World Menopause Day, we are here to help change that. Here’s all you need to know about the inevitable, yet natural transition. 

What is menopause?  

The word ‘menopause’ can be broken up into two segments – ‘Meno’­ refers to your menstrual cycle and ­’pause’ refers to the cycle coming to a halt. It is usually diagnosed when someone experiences no periods for 12 months in a row

This marks the end of one’s reproductive years as after experiencing menopause, it is no longer possible to become pregnant naturally without assistance.

Dealing with the transition to menopause can be challenging because it is accompanied by physical and emotional symptoms, which can be distressing and impact the quality of life.

What causes menopause?

Menopause is caused by a natural decline in the levels of sex hormones, in particular, oestrogen and progesterone as they regulate the menstrual cycle.  With age, the ovaries stop producing as much of these hormones, and as a result, eggs are no longer released from the ovaries, which causes your period to stop. You can read more about the impact of age on fertility here.

Menopause is a natural part of ageing that usually occurs between the mid ’40s-’50s. In the UK, the average age for experiencing menopause is 51.

However, around 1 in 100 people experience menopause before 40 years of age, known as premature menopause.

Premature or early menopause can occur at any age, it may occur naturally or as a result of medical or surgical treatment. Some things that might increase the chances of premature menopause are:

  • Family history of early menopause
  • Being a smoker
  • Having had a hysterectomy (surgical removal of the uterus) or oophorectomy (surgical removal of the ovaries)
  • Having undergone cancer treatments such as chemotherapy or radiotherapy to the pelvic area
  • Surgery that might impact the ovary
  • Injury to the ovaries
  • Premature ovarian insufficiency – the inability of the ovaries to produce adequate levels of reproductive hormones because of genetic factors or underlying autoimmune conditions. You can read more about POI here

It is important to continue to use contraception to reduce the risk of unintended pregnancy for at least a full 12 months after your last period. After this period, it is important to continue using barrier contraception such as condoms to reduce the risk of transmission of sexually transmitted infections (STIs).

Symptoms of menopause

Most of the symptoms of menopause are associated with declining oestrogen levels. The durations and severity of these symptoms can vary for people; however, the most common symptoms include:

  • Changes in  menstrual cycle characteristics :

Often the first sign that people notice is a change in the normal pattern periods, including changes in:

  • Cycle length

Cycles may be shorter or last longer. Someone may experience an increased frequency in periods, while others may not have them for months at a time until they eventually stop altogether.

  • Flow:

Flow may become lighter or heavier than normal, and periods may last longer than normal. 

  • Hot flushes

The sudden feelings of heat, usually in the face, neck and chest, which can make the skin red and flushed. This can be followed by heavy sweating as the body tries to reduce its temperature and cold shivering. They may cause an increase in heart rate (palpitations) and dizziness as a result of it.

  • Night sweats: Hot flushes that occur at night
  • Difficulty sleeping (insomnia) & fatigue
  • Urogenital  atrophy: 

It is the drying and thinning of the tissues of the vagina and urethra. This can lead to pain or discomfort during sex, as well as vaginitis, cystitis, and recurrent urinary tract infections (UTIs).

  • Reduced sex drive (libido) 
  • Frequent urination 
  • Headaches & Migraines
  • Changes in mood, including low mood, anxiety, irritability, etc.
  • Problems with memory, concentration and brain fog
  • Impact on bone &  muscle health :
  • Weak bones
  • Joint stiffness & pain
  • Reduced muscle mass
  • Hair & skin changes:
  • Hair thinning or loss 
  • Decreased skin thickness, elasticity & hydration resulting in fine lines & wrinkling
  • Increased facial hair growth.

The stage when someone may experience none of the symptoms of menopause is sometimes referred to as premenopause (“pre” means “before”). 

Symptoms usually start a few months or years before your periods stop, known as perimenopause (“peri” means “around”) or menopausal transition, and can persist for some time afterwards. Healthcare professionals generally use perimenopause as opposed to premenopause. It is important to remember that people are still having menstrual cycles during this time, and can get pregnant, which is why contraception is important.

Perimenopause can last anywhere from a few months to several years. Many people begin to experience it at some point after their mid-40s; however, some might skip perimenopause and enter menopause suddenly.

On average, most symptoms last around four years from your last period, although some people may experience them for much longer. This phase after not having a period for 12 consecutive months is referred to as postmenopause.

Menopause has an increased risk of long term health conditions, including:

  • Osteoporosis:

Oestrogen is very important in providing lubrication for your joints and preventing inflammation, so low levels can leave the joints sore and aching. It  can also negatively impact bone density. This can cause bones to become brittle and weak, leading to an increased risk of bone loss (osteopenia) and osteoporosis which can lead to an increased risk of fractures

  • Urinary incontinence:

Declining oestrogen levels can impact the elasticity of the tissue of urethra, causing a frequent, sudden, strong urges to urinate, followed by an involuntary loss of urine (urge incontinence), or the loss of urine with coughing, laughing or lifting (stress incontinence). There is also an increased risk of urinary tract infections.

  • Vaginal health issues:

Declining oestrogen levels can result in atrophic vaginitis or vaginal atrophy, i.e. the thinning of the walls of the vagina. It causes vaginal dryness, which might cause discomfort and pain during sexual intercourse (dyspareunia). There may also be a reduction in desire for sexual activity (libido).

  • Cardiovascular conditions:

Declining oestrogen levels can increase cholesterol levels and the risk of cardiovascular diseases such as coronary heart disease, stroke, and vascular dementia.

  • Weight issues:

Many people notice weight gain during the menopausal transition and after menopause because of slower metabolism.

Do you think you might be experiencing any of these symptoms? Our at-home tests can give you a better insight into your hormones. At Hertility, we don’t believe in giving you results without the rest, we give you the what’s up and the what’s next. Our team of experts include menopause specialists that can help you to manage your symptoms and create an actionable plan for the future.

Treatments plans for menopausal symptoms:

There are various treatment options for the different symptoms one might experience, including lifestyle modifications, medication and counselling.

Some people may find that symptoms go away by themselves, while others might need intervention to help manage them. 

  • Hormone replacement therapy (HRT):

HRT is a treatment that aims at replacing the hormones which have naturally declined. Most menopause symptoms are caused by low oestrogen levels, which needs to be supplemented.  HRT usually contains oestrogen, progesterone if it’s needed, and in some cases, testosterone.

HRT has been found to be effective at relieving menopausal symptoms for those under the age of 60, or within 10 years of menopause onset, including:

  • Hot flashes
  • Night sweats
  • Vaginal atrophy
  • Osteoporosis
  • Studies have also shown it lowers the risk of cardiovascular diseases, type 2 diabetes, osteoarthritis, bowel cancer, depression and dementia.

It is available as tablets, skin patches, a gel to rub into the skin, implants, injections or sprays.

HRT is not suitable for everyone, especially for those who may have a history of stroke, heart attack, or high blood pressure. For those with a history of breast cancer, oestrogen based HRT may not be suitable as it is an oestrogen sensitive cancer. 

It is essential for those considering HRT to consult a doctor about the risks and  benefits before making your decision.

  • Vagina atrophy can result in dryness, pain or itching, which is why looking after your vaginal health is so important. Over-the-counter lubricants  and vaginal moisturisers can be used to treat it. If these are not effective enough, prescription oestrogen treatment such as a pessary, cream, or vaginal ring may also be recommended. 
  • Some ways of reducing the chances of developing osteoporosis and maintaining bone health are:

If you have osteoporosis or fragile bones, regular physical activity can help keep your bones healthy and reduce the risk of a fracture in the future. 

Eating a healthy blanced diet is very important to maintain bone health. Your diet should be able to sufficiently meet the daily recommendations for calcium to keep your bones healthy and vitamin D to help your body absorb calcium.

If you have or suspect you might have a calcium deficiency, consider increasing intake of foods rich in it, including:

  • Milk;
  • Cheese and other dairy foods;
  • Green leafy vegetables – such as curly kale, okra
  • Soya products with added calcium such as tofu or fortified soya milk or yoghurts
  • Bread and anything made with fortified flour

Getting some sunlight – sunlight triggers the production of vitamin D, which can help to keep your bones strong. On average, we need 10 minutes of direct sunlight or 30 minutes outdoors on a cloudy day to meet our vitamin D requirements. 

If you have or suspect you might have a Vitamin D deficiency, consider increasing intake of foods rich in it, including:

  • Oily fish such as salmon, sardines, herring and mackerel;
  • Red meat;
  • Liver;
  • Egg yolks;
  • Fortified foods such as breakfast cereals.

If you think you are not getting enough sunlight or your diet is not enough to meet your daily requirements, you can ask your doctor about calcium or vitamin D supplements.

Cutting down or stopping smoking and drinking alcohol.

Considering prescription medication such as HRT.

  • Some ways of managing hot flashes & night sweats include:
  • Avoiding triggers, such as spicy foods, hot drinks, and overheated rooms
  • Reducing stress levels
  • Wearing loose-fitting clothes or dressing in layers that are easy to remove when the hot flash starts
  • Use cotton sheets, lingerie, and clothing that allow your skin to breathe
  • Keeping a fan nearby, especially at night
  • Keep a thermos of ice water or ice pack next to your bed at night
  • Drinking cold liquids when a hot flash occurs
  • Pelvic floor muscle strengthening exercises such as Kegels may help relieve symptoms of urinary incontinence

Try drinking adequate water to keep urine diluted, and avoiding foods or beverages with a high acid or caffeine content, which may irritate the bladder lining, can also help.

Additionally, there are surgical interventions that can help improve symptoms.

Maintaining a healthy weight and staying fit and strong can improve some menopausal symptoms, improve energy levels, joints and bone health, stress levels, better sleep, and reduce the risk of developing long term health complications such as cardiovascular conditions. 

NHS guidelines state suggest walking, lifting weights or using resistance bands, some impact activities like running, jumping or skipping if someone is active. If someone is not very active, they could consider walking, climbing stairs and strength exercises at home. To reduce the chance of falls, one might also consider activities that help with balance at least 2 days a week such as dancing. 

  • Mental health support:

It is normal to feel like you’re struggling or not coping. You’re certainly not alone, many people have mood swings, low mood and anxiety. It is important to acknowledge whatever you feel and process them rather than ignore, dismiss, or deny them. 

Self-help measures such as getting plenty of rest, taking regular exercise and doing relaxing activities such as meditation & yoga may help. 

Connect with your loved ones to talk about how you feel and how they can support you through this journey. 

Talking to a therapist or psychologist about your emotional wellbeing, including feelings of depression, anxiety, sadness, isolation, as well as concerns surrounding your sex life,  might be a good option to consider.

Here are some organisations that work to support mental health:

Samaritans website: www.samaritans.org 

www.mentalhealth.org.uk/your-mental-health/getting-help 

Here are some applications that can help you work on your breathing & sleep :

Calm: www.calm.com 

Headspace: www.headspace.com 

If you think you might be struggling with handling your emotions and stress, our counsellor care pathway is here to allow you to express your emotions freely, help you make the right choices, and support you throughout your journey.

Take away:

Menopause is confirmed after someone experiences no periods for 12 months at a stretch. 

Menopause is a natural phenomenon; however, it can also result in case of surgical removal of the uterus or ovaries. 

The average age of menopause is between mid ’40s-’50s; however, a small number of people may experience it before this age, this is called premature menopause.

Perimenopause refers to the time before menopause when hormone changes start to occur, but menstruation is also still occurring. When perimenopause ends, menopause occurs, and postmenopause follows.

There are various treatment options for the different symptoms one might experience, including lifestyle modifications, medication and counselling.

References:

Menopause basics. Office on Women’s Health. https://www.womenshealth.gov/menopause/menopause-basics Accessed August. 25th, 2021.

Menopause overview. NHS.

https://www.nhs.uk/conditions/menopause/ Accessed August. 25th, 2021.

What are the signs & symptoms of menopause? NIH

https://www.nia.nih.gov/health/what-are-signs-and-symptoms-menopause Accessed August 26th, 2021.

Menopause Quality Standard (QS143, published Feb 2017) nice.org.uk/guidance/qs143  

American College of Obstetricians and Gynecologists. Practice Bulletin No. 141: Management of menopausal symptoms. Obstetrics & Gynecology. 2014; doi:10.1097/01.AOG.0000441353.20693.78. 

Monteleone, P., Mascagni, G., Giannini, A. et al. Symptoms of menopause — global prevalence, physiology and implications. Nat Rev Endocrinol 14, 199–215 (2018). https://doi.org/10.1038/nrendo.2017.180 

https://www.nhs.uk/live-well/healthy-body/food-for-strong-bones/
https://theros.org.uk/information-and-support/osteoporosis/living-with-osteoporosis/exercise-and-physical-activity-for-osteoporosis/

Written by – Zoya

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