All you need to know about the menopause

Menopause is a natural phase of life that all women go through. Despite this, it is rarely a topic of open discussion, which may contribute to feelings of fear, shame, and uncertainty around the subject.

In our September 2021 Menopause Survey of over 500 women, we found that:

• 93% call for better support
• 46% say menopause has damaged their career
• 70% confess menopause affected their self-worth

We want to break the silence. By educating each other on what to expect, we can prepare in the best possible way. Sharing helpful hints and tips can shape menopause to be a more positive experience.

In this blog, we look at the support available to you before, during and after menopause.

Why do we experience menopause?

It may be puzzling to understand why women experience this phase of life. Menopause is caused by a change in the balance of the sex hormones. The ovaries produce less oestrogen and stop releasing an egg each month, meaning you can no longer get pregnant naturally. The change in hormone levels can trigger various unwanted symptoms. So, what is the purpose of menopause?

There are two potential reasons for menopause. One possibility is that it is the by-product of a dramatic increase in the human lifespan. When life expectancy was much shorter, there was no need for a surplus of eggs. In other words, we’ve outlived our stores [1]. 

Another theory is that menopause has developed to provide an evolutionary advantage: being unable to get pregnant late in life means more energy can be rechannelled into other duties, such as helping existing children and grandchildren. This potentially provided an evolutionary advantage which was then passed on [2].

Regardless of which is true, menopause provides females with an opportunity to invest valuable time and energy into important and exciting areas of life—spending time with family, travelling, or learning a new skill. 

When does menopause start?

All women are unique, so the start of menopause varies. Usually, menopause occurs between 45 and 55 years of age.

Menopause is influenced by many factors, making the age it starts difficult to predict. This includes the age of your first menstrual period, your mother's menopausal age, use of oral contraceptives, number of pregnancies, your lifestyle, and your BMI [3]. Researchers have found that, on average, smokers go through menopause one to two years earlier than those who do not smoke [4].

How common is early menopause?

Early menopause is when a woman’s periods stop before the age of 45. It occurs in around one in 20 women. It can happen at any age, and in many cases, there is no clear cause. Sometimes, treatment or surgery for a health condition may lead to early menopause, for example, breast cancer treatment, or if your ovaries are surgically removed [5].

If you are aged under 45, and you think you are experiencing symptoms of early menopause, a blood test can be performed to investigate whether you are undergoing menopause early. These are available at your GP surgery, or you can start your investigation with an at-home Menopause Blood Test.

Experiencing early menopause can be distressing. There are places you can seek help and support. Daisy Network is a support group for women with premature ovarian failure.

What is perimenopause?

Perimenopause is the transition phase between regular periods and periods stopping altogether; it can last for a few months or even years. During perimenopause, your body undergoes fluctuations in reproductive hormones such as oestrogen, progesterone, and follicle-stimulating hormone (FSH) [6].

What are the first signs (symptoms) of menopause?

The first sign that you are entering menopause will likely be due to perimenopause. The hormonal fluctuations that occur during this stage can change the normal pattern of your menstrual periods [6]. They may become much lighter or heavier. The regularity of your period may be affected; you may begin to have a period every two to three weeks or even every few months.

Eventually, your periods will stop completely. One year without a menstrual period signifies the beginning of menopause.

What symptoms should I expect during menopause?

During menopause, your ovaries no longer release an egg each month and stop producing as much oestrogen and progesterone.

These hormonal changes mean that eight in ten women have additional symptoms before and after their menstrual periods stop. For some women, these symptoms can be undesirable and impact daily life.

Common symptoms of menopause include:

• Hot flushes
• Night sweats
• Difficulty sleeping 
• Reduced sex drive
• Problems with memory and concentration
• Vaginal dryness and pain
• Mood changes such as depression and anxiety [6]

In our September 2021 Menopause Survey, the majority of women reported:

• Brain fog, disturbed sleep and mood changes (70%)
• A loss of sex drive (67%)
• Weight gain (65%)
• Anxiety (62%)

Nearly half of women (47%) experienced itching or discomfort during sex, and over a quarter of women (29%) reported formication – the sensation of insects crawling on the skin.

How long does menopause last?

On average, most symptoms last around four years from your last period. Although, one in every ten women experiences symptoms for up to 12 years [6].

When is it appropriate to see a doctor?

If your symptoms are troublesome and interfere with your daily life, it is worth visiting your GP. Alternatively, if you are experiencing symptoms earlier than expected (under 45) your GP can investigate the underlying reason for your symptoms.

If you are aged over 45 years old, menopause is usually diagnosed by an assessment of symptoms. For women under 45, due to the lower incidence of menopause at this age, a blood test may be used to diagnose menopause.

Our Menopause Blood Test can provide you with more information on your hormone levels. It could also give you the confidence to decide how to move forward.

Is there anything I can do to treat my symptoms of menopause?

Your GP may prescribe certain treatments and therapies to help ease severe menopause symptoms. Many women also find that simple lifestyle changes can be helpful. We take a closer look at some of the options below:

1. Hormone replacement therapy (HRT)

HRT is exactly what it says on the tin. Hormones are reintroduced to your body to replace the ones that are missing. Most HRT is a combination of oestrogen and progesterone. It can be taken by oral tablets, skin patches, gels, or pessaries. It is extremely effective at relieving menopausal symptoms but can slightly increase your risk of breast cancer and blood clots in some women. Your GP can give you more information on HRT and discuss the risks and benefits to help you decide if it’s right for you.

If HRT isn’t suitable for you, your GP may recommend other medicines, such as clonidine, which can reduce hot flushes. Some women may experience side effects with these medications [7].

2. Nutrition

Before and during menopause, particular aspects of the diet are especially important to reduce the risk of developing health conditions and to help manage symptoms.

Nutrition for bone health

Reducing oestrogen levels during menopause increases the rate of calcium loss from our bones, which can make them weaker and lead to osteoporosis where they are more prone to fracture. Getting enough calcium in your diet can protect against this loss.

Calcium-rich foods include dairy products (such as milk and cheese), tofu, fortified food products such as bread and dairy alternatives (such as soya milk) and green leafy vegetables such as broccoli and kale.

It is currently recommended that we have 700 mg of calcium daily [8].

The table below outlines some food sources of calcium and the estimated quantity they provide:

You should be able to get all the calcium you need from your diet, but some people may need additional calcium in the form of a supplement, especially those with brittle bones. Speak to your GP before taking new supplements, as too much supplemental calcium may be harmful. You can find more information on the amount of  calcium in foods.

Vitamin D is also essential to building and maintaining strong bones. We get most of our Vitamin D from sunlight. During the winter, you may not get enough, so a 10ug supplement is recommended. If you have darker skin, spend most of your time indoors, or cover your skin, it’s recommended that you take a 10ug supplement all year round. You may be interested to find out your vitamin D levels using our  Vitamin D (25 OH) Blood Test.

Nutrition for heart health

Menopause and post-menopause can increase your risk of developing heart disease and stroke [9]. Eating heart-healthy foods can reduce your risk. These include high-fibre and whole-grain foods (such as beans, pulses, and brown rice) fruit and vegetables and oily fish. Try to cut down your saturated fat intake and choose healthier fats such as olive and rapeseed oil. The Mediterranean diet is known for its heart health benefits and can also reduce your risk.

Nutrition to maintain a healthy weight

During menopause, the amount of muscle in your body will reduce – this means that you need to eat fewer calories a day to maintain a stable weight. Without being aware of this, it is easy for excess body fat to creep up.

Being overweight is associated with an increased risk of breast cancer. This risk increases with age and in women who have late menopause (after the age of 55). Fat cells secrete the hormone oestrogen, which can encourage the growth of some breast cancers. Therefore, ensuring you maintain healthy body weight is especially important during this time [10].

Be mindful of your portion sizes and try not to eat energy-dense foods regularly (foods high in fat and sugar). Combining healthy eating with regular exercise is a good way to keep your weight in check.

3. Cognitive behavioural therapy (CBT)or antidepressants

Your GP may recommend antidepressants or CBT, a type of talking therapy that can improve low mood and anxiety [7].

4. Exercise

Exercising regularly has huge benefits for everyone, through all stages of life. One simple reason is that it makes you feel good! During menopause, you may find some light to moderate exercises, such as an aerobics class, to improve symptoms such as low mood and sleep disturbances. In addition, weight-bearing exercises, such as playing tennis or running, are particularly good for strengthening your bones and can help reduce the risk of menopause-related health complications such as osteoporosis [11].

Life after menopause – what to expect?

If you have transitioned through menopause, you are now in the postmenopausal life stage. Many women find that this stage of life offers a new sense of freedom away from both monthly periods and menopausal symptoms.

If you experience bleeding after menopause, it is important to get it checked out by a GP. Also, try to attend regular health check-ups and screenings. Women in England aged 50 to 71 years are invited for breast cancer screening every three years [12].

However you choose to spend your menopause and postmenopausal life stage, we say - embrace it! 

References

1. Austad SN. Menopause: an evolutionary perspective. Exp Gerontol. 1994 May-Aug;29(3-4):255-63. doi: 10.1016/0531-5565(94)90005-1. PMID: 7925746.
2. Hawkes, K., O’Connell, J.F., Jones, N.B., Alvarez, H. and Charnov, E.L., 1998. Grandmothering, menopause, and the evolution of human life histories. Proceedings of the National Academy of Sciences, 95(3), pp.1336-1339.
3. Ceylan B, Özerdoğan N. Factors affecting age of onset of menopause and determination of quality of life in menopause. Turk J Obstet Gynecol. 2015 Mar;12(1):43-49. doi: 10.4274/tjod.79836. Epub 2015 Mar 15. PMID: 28913040; PMCID: PMC5558404.
4. Fleming, L., Levis, S., LeBlanc, W., Dietz, N., Arheart, K., Wilkinson, J., Clark, J., Serdar, B., Davila, E. and Lee, D., 2008. Earlier age at menopause, work, and tobacco smoke exposure. Menopause, 15(6), pp.1103-1108.
5. NHS. 2021. Early menopause. [online] Available at: <https://www.nhs.uk/conditions/early-menopause/> [Accessed 28 October 2021].
6. NHS. 2021. Menopause - Symptoms. [online] Available at: <https://www.nhs.uk/conditions/menopause/symptoms/> [Accessed 28 October 2021].
7. NHS. 2021. Menopause - Treatment. [online] Available at: <https://www.nhs.uk/conditions/menopause/treatment/> [Accessed 28 October 2021].
8. NHS. 2021. Food for healthy bones. [online] Available at: <https://www.nhs.uk/live-well/healthy-body/food-for-strong-bones/> [Accessed 28 October 2021].
9. BDA UK. 2021. Menopause and diet. [online] Available at: <https://www.bda.uk.com/resource/menopause-diet.html> [Accessed 28 October 2021].https://www.bhf.org.uk/informationsupport/support/women-with-a-heart-condition/menopause-and-heart-disease
10. Cancer Research UK. 2021. Risk factors for breast cancer | Breast Cancer | Cancer Research UK. [online] Available at: <https://www.cancerresearchuk.org/about-cancer/breast-cancer/risks-causes/risk-factors> [Accessed 28 October 2021].
11. British Nutrition Foundation. 2021. Menopause. [online] Available at: <https://www.nutrition.org.uk/life-stages/women/menopause/> [Accessed 28 October 2021].
12. NHS. 2021. When you'll be invited for breast screening and who should go. [online] Available at: <https://www.nhs.uk/conditions/breast-cancer-screening/when-its-offered/> [Accessed 28 October 2021].