Menopause can be a challenging time, with many women experiencing a sleuth of uncomfortable symptoms. Here we get into everything you need to know about menopausal symptoms, the stages and the treatment options available. 

Quick facts:

• Menopause is a natural part of ageing and usually occurs between 45-55.
• Menopause can also occur as a result of surgical removal or damage to the ovaries.
• Perimenopause refers to the time before menopause when symptoms start due to declining hormone levels.
• There are various treatment options for the different symptoms, including lifestyle changes, HRT and CBT.

What is menopause?

Menopause is when your periods stop due to low hormone levels. It will happen to anyone who has periods, usually at around 45-50 years of age and is a natural part of ageing. 

Menopause marks the end of your reproductive years. After you’ve experienced menopause, it’s no longer possible to become pregnant naturally without assistance. In the UK, the average age for experiencing menopause is 51.

Approximately 25 million people go through menopause every year. Despite it directly affecting half of the population, knowledge and understanding of menopause remains incredibly low.

For many people, menopause can be an incredibly difficult time as it is often accompanied by a series of both physical and psychological symptoms—in addition to a lack of public understanding as to what experiencing menopause can entail. 

How is menopause diagnosed?

Menopause is usually diagnosed when:

• You haven’t experienced a period for 12 months in a row
• You’re not using hormonal contraception
• You’re over 45 years old

If you are experiencing symptoms associated with menopause but don’t meet all of this criteria, it is possible you could be experiencing a different health condition, or premature menopause if you are under the age of 40.

What is early menopause?

Around 5% of people may experience menopause before 45 years of age, known as early menopause. This can happen naturally or due to side effects of some treatments, like cancer treatments or surgeries to remove the ovaries.

What is premature menopause?

If you experience menopause before 40 years of age, it is known as premature menopause, which may also be described as Premature Ovarian Insufficiency (POI), depending on your circumstances. 

Again, premature menopause may occur naturally, due to genetics or lifestyle factors, 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
• Any other surgery or injury to the ovaries
• Autoimmune conditions such as Hashimoto’s disease, type 1 diabetes, Addison’s disease
• Genetic conditions such as Turner syndrome or fragile X syndrome
• In extremely rare cases, due to infections such as mumps, tuberculosis, or malaria

POI affects 1 in 100 people under the age of 40, one in 1,000 people under 30 and one in 10,000 people under 20. It occurs because the ovaries do not function properly and are unable to make sufficient levels of hormones like oestrogen and progesterone, which have important roles in overall health and well-being. 

POI can occur because of many reasons. Unfortunately, in the majority of cases, no underlying cause can be found.

What are the 3 stages of menopause?

The stages of menopause include premenopause, perimenopause and post menopause. The menopause actually only references the time when it has been 12 months since your last period. Let’s take a look at these stages one by one…

What is premenopause?

Premenopause refers to the period of your life before the transition into menopause has started, also sometimes referred to as your reproductive years. This is when you shouldn’t be experiencing any (peri)menopausal symptoms and have a healthy and regular menstrual cycle.

What is perimenopause?

The transition to menopause is known as perimenopause. This is when your body starts preparing you for menopause. During the perimenopausal phase, your ovaries will begin producing less oestrogen and progesterone and your periods can become irregular or erratic.

Perimenopause can be challenging because it is often accompanied by lots of physical and emotional symptoms, which can be distressing and impact your quality of life. 

Perimenopause can last anywhere from a few months to several years, with the average length being four years. However, this will depend on the individual, your lifestyle and hormonal make-up.

Most people start perimenopause at some point after their mid-40s, but some as early as their mid-thirties (although this is quite uncommon). Sometimes people even skip perimenopause all together and enter menopause suddenly.

Although chances of pregnancy are low during perimenopause, it is still possible as ovulation may still be occurring and an increased risk of sexually transmitted infections if you aren’t using barrier contraception methods.

If you are sexually active and in the perimenopausal stage, it is important to speak to your doctor about appropriate contraception for you.

The menopause

The menopause actually refers to the time when it has been 12 months since your last period. This is technically when you have experienced menopause. 

What is post menopause?

Post menopause refers to the time after you have experienced menopause—the rest of your life after menopause. During this time your sex and cycling hormones will be at different levels to where they were before menopause and you will no longer have periods. 

At what stage of menopause are symptoms worse?

Symptoms and their severity will depend on the individual, but for most, perimenopause is the time when you will experience the most symptoms. This is because of the huge hormonal fluctuations happening during this stage and your body adjusting to lowering hormonal levels.

What are the symptoms of menopause?

Most of the symptoms of menopause are associated with declining oestrogen levels. The duration and severity of these symptoms can vary depending on the individual. 

Symptoms usually start a few months or years before your periods stop (in the perimenopausal stage) and can persist for some time post menopause. 

On average, most symptoms will last for around four years after your last period, although some people may experience them for much longer. 

Let’s take a look at some of the most common symptoms…

Changes in menstrual cycle characteristics

Often the first sign is a change in the normal pattern of your periods—cycles may be shorter or last longer, become erratic or increase in frequency. 

You may find that you begin to experience fewer periods and go for months at a time between periods until they eventually stop altogether. Your menstrual flow may also become lighter or heavier than normal and last longer than normal.

Hot flushes and night sweats

Hot flushes are sudden feelings of heat, usually in the face, neck and chest, which can make your skin red and flushed. These can happen at any time and often erratically with seemingly no external trigger. 

Flushes can be followed by heavy sweating as the body tries to reduce its temperature and cold shivering. They may also cause an increase in heart rate resulting in palpitations and dizziness too. Flushes at night are often called night sweats.

Urogenital atrophy

This 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).

Other menopausal symptoms can include:

• Difficulty sleeping (insomnia) and fatigue
• Reduced sex drive (libido) 
• Frequent urination 
• Headaches and migraines
• Changes in mood, including low mood, anxiety and irritability 
• Problems with memory, concentration and brain fog
• Impact on bone health, including weak bones, joint stiffness and pain 
• Reduced muscle mass
• Hair changes, including hair thinning or loss, decreased skin thickness 
• Skin changes, including elasticity and hydration, fine lines, wrinkling and increased facial hair growth

Are there any long-term effects of menopause?

Menopause has an increased risk of a number of long-term health conditions. These can include the following.

Osteoporosis

Oestrogen is very important for cell renewal and providing lubrication for your joints as well as 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 bone fractures.

Urinary incontinence

Declining oestrogen levels can impact the elasticity of the tissue of the urethra, causing 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 recurrent urinary tract infections due to the thinning of the walls of the urinary tract.

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 the desire for sexual activity (libido).

Cardiovascular conditions

Oestrogen has a crucial role in maintaining your heart and blood vessel health.  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, particularly around their middle, during the menopausal transition and after menopause because of slower metabolism.

How to treat menopause?

There are lots of different options when it comes to treatments for menopause. Before considering treatment, it’s important to speak to a healthcare professional and understand what stage of menopause you are experiencing. 

Hormone replacement therapy for menopause 

The main medical treatment for menopause is hormone replacement therapy (HRT). Hormone therapy for menopause involves replacing your hormones which are at naturally low levels with small doses of either synthetic or bioidentical oestrogen and/or progesterone. 

There are lots of different types and doses of HRT and choosing the right type and dose should be personalised to you based on your medical history and current hormone levels. 

One of our at-home Hormone & Fertility Tests will be able to give you valuable information on your hormone levels and indicate which stage of menopause you are at. 

HRT when taken and prescribed correctly should improve menopausal symptoms. 

Oestrogen can be taken in the form of skin patches, skin gels or sprays, implants or tablets. Progesterone can be taken in the form of patches (combined with oestrogen), intrauterine system (IUS) or a coil, or tablets. Testosterone gel can also be prescribed for low sex drive.

Non-hormone medicines for menopause

If you choose to not pursue HRT there are a number of other non-hormonal medicines available to help with symptoms. These include:

• Clonidine: a blood pressure medicine that can reduce the instance of hot flushes 
• Gabapentin: an epilepsy medicine that can reduce the instance of hot flushes 
• Antidepressants: to help with mood changes 
• Cognitive behavioural therapy: to help with mood changes and hot flushes 
• Vaginal moisturisers and lubricants: to help with vaginal dryness

Can I treat menopause naturally?

It is possible to ease menopausal symptoms naturally with lifestyle and diet changes, some of which we’ve detailed below. There are some herbal supplements that claim to support symptoms but there is currently limited clinical research into their effectiveness. 

How to manage menopause with lifestyle changes?

It is possible to reduce and manage menopausal symptoms with lifestyle changes, some of which can have a significant impact on certain symptoms. 

Regular exercise, prioritising a healthy sleep cycle and reducing stress can improve a number of different symptoms including, mental health related symptoms, hot flushes, and protecting against weak bones. Wearing loose clothing, taking regular cool showers and cold drinks can further help to ease hot flushes—in addition to avoiding spicy food, caffeine, smoking and alcohol. 

Diet and nutrition can play a significant role in helping symptoms of hormonal fluctuations and supporting lower levels of hormones post menopause. Book a consultation with one of our Registered Nutritionists if you’d like to explore a personalised diet plan to support your menopausal symptoms. 

Think you might be experiencing menopausal symptoms? 

Our at-home Hormone and Fertility Test can give you a better insight into your hormones and any symptoms you might be experiencing. 

Our team of experts will be able to analyse your results and give you insights into whether you are about to undergo or are currently undergoing menopause—plus, give you a bespoke treatment plan and actionable insights to manage your symptoms.

If you’ve already been diagnosed with menopause you can speak to one of our Menopause Specialists. They can help you manage symptoms and optimise any HRT or treatments.

Menopause FAQs

Do you feel better after menopause?

In postmenopause, symptoms may ease or stop entirely. Some people do continue to still have symptoms for some time after menopause and this will vary from person to person. The majority of people do report feeling better after menopause and it’s important to remember that you will feel ‘normal’ again once your symptoms stop.

Does your personality change during menopause?

The menopausal transition can cause physiological symptoms like anxiety, depression and mood fluctuations. You may also experience emotions like anger, feel easily irritable and socially reclusive. This is completely normal and is due to the hormonal fluctuations happening within your body. It’s important to remember to be kind to yourself and seek out professional support if you are struggling.

How long does menopause last?

The menopausal transition, from the first instance of symptoms, usually lasts about seven years, but can last as long as 14 years. This begins with perimenopause, usually between the ages of 45-55, with most symptoms clearing up around 4 years post your last period.

Can you have a period after menopause?

No, once you’ve experienced menopause, you will no longer have periods. This is because your ovaries are no longer able to ovulate naturally. You can experience postmenopausal bleeding, which is any bleeding from the vagina. This needs to be checked by a medical professional in every instance as it could be a symptom of an underlying condition, like cancer.

Does the menopause make you tired?

Hormonal fluctuations of the menopause can cause tiredness and fatigue, as well as night sweats making sleeping more difficult. You may also feel more tired if you have increased levels of worry or anxiety.

Resources:

• Menopause basics. Office on Women’s Health
• Menopause overview. NHS
• What are the signs & symptoms of menopause? NIH
• Menopause Quality Standard 
• 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 
• Food for Healthy Bones. NHS
• Exercise and Physical Activity for Bone Health. Theros
• Osteoporosis. Theros
• Knowlton, A A, and A R Lee. “Estrogen and the cardiovascular system.” Pharmacology & therapeutics vol. 135,1 (2012): 54-70. doi:10.1016/j.pharmthera.2012.03.007
• National Institute of Ageing. What is Menopause?