This post was written by London-based GP, broadcaster, author, journalist and mother of three kids – Dr Philippa Kaye.
What is the menopause and when will it happen to me are questions that I am often asked during surgery. The menopause means your last period, and menarche meant your first period, but just as the process of puberty took quite a few years, it also takes a few years for the changes related to the menopause to occur. As the menopause means the last period, doctors cannot say you have ‘gone through’ until you have not had a period for a year. The period of time before this happens, when you may have symptoms, irrespective of what your period is doing is known as the climacteric, or peri-menopause. The good news is that you can get treatment, if needed, during the peri-menopause, so you can have menopause treatments even if you still have periods!
When will it happen?
The average age of the menopause in the UK is about 51 years old, though you can have symptoms for many years before, and for many years afterwards!
The menopause occurs due to the ovaries stopping working, so ovulation stops and all the hormones of the menstrual cycle are affected. It leads to a drop in the hormones, oestrogen, progesterone and testosterone, which in turn lead to the symptoms of the peri-menopause and menopause.
What are the symptoms?
4 out of 5 women will experience symptoms related to the menopause, with varying severities, so your friends may well experience different symptoms to your own, just like some of us have heavy or painful periods and others do not.
Physical symptoms include:
- hot flushes and sweats (these are probably the most known about)
- joint pain
Psychological symptoms can include:
- low mood
While some women find that their periods get lighter and further apart, others find that during the peri-menopause, their periods actually become heavier and more frequent! Add into that hair loss, skin changes and unwanted hair growth on the face and it isn’t a wonder that many women dread the ‘change’.
The symptoms described above tend to occur during the peri-menopause or for a few years after the menopause. However there are other symptoms and conditions which occur which are also related to the longer term effects of deficiency of these hormones.
Approximately 70-80% of women will experience vaginal dryness, which can lead to painful sex, or urinary symptoms, but only 7% of women will ask for help with regards to these symptoms. No person needs to experience incontinence, it is not a routine part of growing older and there are lots of treatments available. Nor should we be tolerating, or enduring, painful sex, when again, there are easily available treatments.
Longer term health conditions relating to the long term deficiency of these hormones after the menopause includes osteoporosis (a condition where the bones become thinner and more brittle), an increased of heart disease and even dementia.
If you are over the age of 45 and experiencing symptoms which could be related to the peri-menopause your doctor is able to offer you treatment without investigations such as blood tests. This is because the blood tests around the time of the menopause are not particularly helpful in that they fluctuate. The levels of the hormones in the brain which stimulate the menstrual cycle, FSH and LH, can be extremely high one month, indicating the menopause, and then normal the next, as ovulation can still occur, be it sporadically or not, during the peri-menopause. So the blood tests aren’t helpful after the age of 45, which is why they aren’t taken. It also means that you will need to continue using contraception for 2 years after your last period if it occurred before the age of 50, or for one year if your last period occurred after the age of 50, though by 55 it is generally safe to stop using contraception even if you were still having periods.
If you are under the age of 40 or so and are experiencing symptoms of the peri-menopause your doctor will test the levels of the hormones FSH and LH, on two occasions at least 6 weeks apart. If the levels are high on both occasions you would be considered menopausal. Premature menopause (or premature ovarian insufficiency) affects 1 in 100 women under the age of 40 and 1 in 1000 women under the age of 30.
Why does any of this matter, if the menopause is a natural process which all women will go through?
It matters because we aren’t talking about it and because of that women are not coming for help for symptoms which can be extremely distressing and debilitating, affecting relationships and ability to work and function.
We all learnt about sex and puberty at school, but the menopause was not mentioned at all. This is due to change as from the Summer of 2019, legislation was passed which stated that everyone should be taught about the menopause as part of the PHSE (personal, health and social education) curriculum in secondary school. But this still leaves generations of women without the knowledge of what symptoms could be related to the menopause, which treatments are available and safe and how to get help. So we need to keep talking about it, raising the issue as women will spend 1/3 of their lives being post menopausal, there is no need to spend that 1/3 suffering with symptoms!
There are lots of treatments out there available for the symptoms of the peri-menopause and menopause, from lifestyle changes to medication including HRT, which will be discussed in the next article – is HRT a big bad baddie or a panacea for all?
Philippa’s latest book “The M Word; Everything you need to know about the menopause” is available to purchase on Amazon now.