No, you don’t suddenly wake up to find that the menopause has happened. It’s a gradual process. You may start to have symptoms while you are still having periods (this is known as the perimenopause)
The age when a woman starts having her menstrual period does not relate to the age of menopause onset. So if you experienced your first period early, it does not mean your menopause will start early and vice versa. There is a family link, in that having an early menopause is more likely if your mum or other female relatives had their menopause early.
Most women reach menopause between the ages of 45 and 55, with the average in the UK being around the age of 51, although it can sometimes occur as earlier as your 30s and very rarely as a teenager.
The scientific reason is that menopause is due to ovarian ageing, and ageing of the part of the brain that controls the ovaries. The end result, which takes several years, is that the ovaries cease to produce eggs and also the hormone oestrogen.
Oestrogen affects many parts of the body, including the blood vessels, heart, bone, breasts, uterus, urinary system, skin, and brain. It is this loss of oestrogen which causes many of the symptoms we associate with menopause. The reason HRT is so successful in combating menopause symptoms is because it tops up the levels of oestrogen.
One of the reasons why more women tend to experience menopause symptoms is, quite simply, because we are, on average, all living longer. Our female ancestors often didn’t live beyond middle-age so they died before the menopause.
This is simply the lead up to the menopause, which itself is defined as having had no menstrual periods for a year, but symptoms very often start some time before your periods finally stop.
These are the symptoms that we all tend to read about – and in many cases worry about. Not every woman will experience all these symptoms. Some may experience just one or two and these may be very mild or, at the other end of the scale, they may be quite debilitating and affect your ability to get on with your daily life.
Symptoms can include:
- Irregular periods
- Hot flushes
- Night sweats
- Vaginal dryness and discomfort during sex
- Difficulty sleeping
- Low mood or anxiety, or mood swings
- Reduced sex drive (libido)
- Problems with memory and concentration – often referred to as ‘brain fog’
- Joint pain
- Weight gain
- Hair loss or conversely increased hair, particularly on the face
- Urine leakage when coughing or sneezing or increased need to pass water, particularly during the night
- Recurrent urinary infections such as cystitis
- Hair and skin changes
Every woman is different but, on average, hot flush symptoms last around seven years although it’s not unusual for symptoms to last up to 12 years. And a few women continue to have flushes for the rest of their lives, my oldest patient is 93.
It’s important to know that these symptoms can be controlled – you don’t have to suffer in silence.
There are a number of available treatments available, which I can discuss with you during an initial consultation at the London Menopause Clinic.
Once you are in the menopause – meaning you haven't had a period for 12 months, your symptoms, may gradually decrease in frequency and intensity.
The short answer is, yes you can. Certainly during the perimenopause - (the time when you are experiencing symptoms and your periods may be more irregular but have not yet stopped) – you should continue to use contraception because your ovaries will still be producing the occasional egg.
When you reach the menopause – (that is to say, your periods have stopped) – you should continue to use some form of contraception until you have gone a full 12 months without having a period if you are over 50, and for longer if your menopause is before 50
Hormone Replacement Therapy – or ‘HRT’ – is, as the name suggests, a treatment which replaces the hormones that are lost during the perimenopause and menopause.
There are many different types of HRT and finding the right one for you may take a little time, so it’s important to understand that if the treatment doesn’t work, don’t give up – we will just need to try other combinations until we find the perfect HRT treatment for you.
Most women take a combination of the hormones oestrogen and progestogen, although women who have had a hysterectomy will take oestrogen on its own.
HRT comes in a number of forms including tablets, skin patches, gels and vaginal creams, pessaries or rings.
I follow NICE guidance (the organisation that guides and recommends the best assessed and validated treatments) and will pick non-oral therapies as a first choice.
HRT helps to strengthen your bones and reduces the risk of osteoporosis, which is very common in women as they get older. Taking HRT reduces your risk of a heart attack or stroke and has many other associated health benefits; every cell in our body has oestrogen receptors!
Many women find that taking HRT reduces unpleasant symptoms such as night sweats and improves their mood, sleep and general quality of life.
HRT may not be suitable if you have a personal or family history of breast, ovarian cancer or womb cancer. Women who have had blood clots cannot be prescribed oral oestrogen but may be suitable for patches and gels.
If you have untreated high blood pressure, this will need to be controlled before you can start HRT.
There are a number of alternatives to HRT, which I can discuss with you during an initial consultation.
The important thing to know is that there will, almost certainly, be a form of treatment which will suit your individual circumstances and which will help you to successfully manage your menopause symptoms.
Remember, you don’t need to suffer in silence – help is available.