Menopause is the point when a woman’s periods stop completely, and so there is no longer any chance of pregnancy. This is usually 12 months after the last menstrual period, although in some can occur sooner due to surgery or some cancer treatments.

The time from when symptoms start to when periods stop is classed as ‘perimenopause’ and is due to the body’s oestrogen levels starting to drop. Symptoms may continue after our periods have stopped too. Symptoms and timings vary from person to person, where some women may have no symptoms, and others could experience debilitating symptoms. Looking at what your mother or older sisters went through could give an understanding of what you may also experience.

Menopause usually occurs between the ages of 45 and 55, with the UK average age being 51.

Blood tests are not usually required unless you are under the age of 45. Blood tests may also be requested to determine if the symptoms you experience may be due to an alternate cause.

There are a range of symptoms that could be due to the menopause:

• Hot flushes and sweats (75% women)
• Changes to your periods
• Mood changes
• Changes to your sleep pattern
• Lethargy
• Irritability
• Anxiety
• Brain fog
• Vaginal dryness
• Reduced libido
• Joint aches
• Muscle aches
• Palpitations or feeling aware of your heart beat which may be racing
• Skin and hair changes
• Weight gain and changes in body shape
• Headaches
• raised cholesterol
• Urinary symptoms including recurrent urinary tract infections
• Vaginal prolapse symptoms

As you can see there are a huge range of menopausal symptoms, and there is often an overlap with other conditions which may be contributing to them too. It’s important to consider this when thinking about starting any treatment for these symptoms.

It is always useful to make lifestyle changes where possible, as these are also useful changes to optimise your long term health too. This includes things like stopping smoking, reducing alcohol, increasing exercise levels and having a well rounded diet. Further information can be found here:

https://www.selfcareforum.org/menopause/

Non-hormonal treatment options include anti-depressants. Although you may not have any mood changes, these medications can be effective in treating hot flushes and sweats.

Hormonal replacement therapy (HRT) is a big topic in itself, and so it may be worthwhile taking some time to understand it:

HRT works by replacing the oestrogen which is dropping during the perimenopause. The benefits include:

• It can be very effective in treating symptoms
• it can be good for your bone health and cardiovascular health up to the age of 60

Unfortunately there are also risks associated with HRT including:

• an increased risk of breast cancer. If you start HRT it is recommended you self examine your breasts on a regular basis and seek medical advice promptly if you notice any changes (https://thebms.org.uk/wp-content/uploads/2023/01/WHC-Infographics-JANUARY-2023-BreastCancerRisks.pdf)
• an increased risk of blood clots. This is more the case with tablet form oestrogen
• an increased risk of endometrial cancer (this is a cancer of the womb lining. If you have not had a hysterectomy then you will be prescribed a second hormone called progesterone as part of the HRT to protect your endometrium (womb lining). You must seek prompt medical advice if you experience any unusual vaginal bleeding whilst on HRT.

If you or any immediate family members have had breast cancer, blood clots or any oestrogen sensitive cancers, it is important to highlight this during your consultation as it can affect your suitability to have HRT safely.

After the age of 60 the risks outlined above increase, and so this may guide some women in choosing when to stop their HRT.

There are many ways of having HRT, and as above, it would be advisable to start by having oestrogen via the skin (ie with a patch, gel or spray) to minimise the blood clot risk. There are some patches which can have progesterone combined, however it would otherwise need to be given via a separate tablet or the Mirena coil, unless you have had a hysterectomy.

HRT may be given on a continuous or cyclical basis depending on when your last period was. Until you have gone through the menopause, or reached the age of 55, it is advisable to continue any contraception you are taking. If you are unsure you can discuss this with a medical professional before you stop your contraception. Please note HRT and contraception are separate from each and so HRT is not a form of contraception, and having the mini pill will not count as being part of HRT.

If you are experiencing vaginal symptoms such as dryness, discomfort during intercourse or urinary symptoms, then you may be offered vaginal oestrogen. This can be used alongside standard HRT too.

If you wish to discuss your symptoms and any treatment options, you can contact the surgery to book an appointment with a doctor or physician associate. It would be useful to have the following information handy for your appointment so we can guide you in the best way:

• a recent blood pressure reading
• height and weight
• date of your last menstrual period
• history of breast cancer, oestrogen sensitive cancers or blood clots in yourself or any immediate family members

https://www.nhs.uk/conditions/menopause/

https://www.menopausematters.co.uk/

https://www.balance-menopause.com/