The menopause is not far away

I think being post menopause is a wonderful thing. No more periods, no more premenstrual syndrome (PMS), no more mood swings, no more contraception. But since we do not teach women about the menopause, I feel that some fear it, get anxious about it and do not understand what will happen. In Chapter 11 of Your Fertile Years, I will explain what the menopause is, the symptoms, and how we can reduce the symptoms.

The menopause has three stages: perimenopause; menopause; and post menopause.

Perimenopause is the time when a woman may start to experience menopausal symptoms because of fluctuations in the level of oestrogen, such as hot flushes, mood swings, vaginal dryness and a change in her periods. If you are in your 40s, and are experiencing any of the menopause symptoms, you are probably in the perimenopause. Please ignore people when they tell you – but you are too young to be going through the menopause!

The menopause is defined as the last period and is complete in a woman under 50 years if she goes for 24 months without a period. For a woman over 50 it is when if she goes for 12 months without a period. The woman is then postmenopausal.

The menopause typically happens between your mid-40s to mid-50s, with an average age of 51 years. 1% of women go through the menopause before the age of 40 (premature menopause) and 10% before the age of 45. The hormones involved in the menstrual cycle stop being produced and the ovaries run out of eggs. The menopause marks the end of a woman’s fertile years. Unfortunately the symptoms can start up to 10 years before you have your final period.

The list of possible perimenopausal symptoms is long.

The main short term symptoms include:

mood changes
menstrual cycle changes
hot flushes
night sweats
genital and urinary problems
sexual difficulties
joint and muscle pain
headaches
palpitations
tiredness
weight gain

Long term symptoms include:

osteoporosis
cardiovascular disease
urinary incontinence
pelvic organ prolapse

In this blog I will concentrate on two of the key short term symptoms.

Menstrual cycle changes

The first change that a woman normally notices in the perimenopause is a change in her menstrual cycle. Up to this point, most women will have had a menstrual cycle between 21-35 days with her period being of a similar number of days and volume each month. But from around the age of 40 onwards, chances are there will be a change in the length of the menstrual cycle, often initially becoming shorter but then longer, and periods may become lighter, heavier, more painful or less painful and there may be bleeding mid-cycle. These changes occur as the levels of oestrogen and progesterone fluctuate. There may be an increase in premenstrual syndrome, which may correspond with other mood changes.

It is totally normal for these changes to occur and women need to be prepared for, rather than be stressed about them. It would be advisable to always carry period protection because the period can be unpredictable.

Problems may arise if the period becomes really heavy and more painful. Generally, women lose no more than 80 ml of blood during their period. A heavy period is where a woman loses more than 80ml.  With a heavy period, the woman may need to change her period pad or tampon every few hours. The use of a menstrual cup might help. Non-steroidal anti-inflammatories, such as Ibuprofen every four-six hours during heavy flow will decrease the blood loss by 25–45% and can help with pain relief. If heavy periods persist, women should see their doctor because there is a chance they could become anaemic.

Mood changes

Mood swings are defined as an emotional response that is inappropriate to its trigger and they can be extreme.

Mood changes are one of the first symptoms to start and need to be understood because women will often be in denial that they are going through the menopause. These mood changes can be upsetting to the woman, her partner, family and friends so it is important for everyone to understand if a woman is suffering, so everyone can be tolerant and sympathetic. Mood swings are unpredictable and effect every woman differently.

The symptoms are similar to the issues seen with PMS, including: mood swings; inexplicable emotions; irritability; depression; sadness; anger; anxiety; increased stress; lack of energy; lack of motivation; decreased patience; concentration problems, brain fog; a decrease in memory affecting the recall of words and numbers; disruptions to everyday behaviour, for example losing household items, needing to use memory aids and forgetting appointments.

Dealing with the perimenopausal symptoms

I get asked all the time – how can I cope with the menopause symptoms?

Every woman’s experience of the peri menopause will be different. A healthy lifestyle should help with many of the symptoms. But different solutions will work for different women. If you are suffering from perimenopausal symptoms, it is a good idea to try various options and see what works for you.

Although the menopause is a natural condition, it has been medicalised and portrayed as an illness by the media and sometimes the medical establishment. But it does not need to be like this and many women will not require any medical treatment for the menopause. As they enter their forties women should prepare for the menopause and ensure they have a healthy lifestyle. We often spend decades of our lives looking after other people, but at this time we need to ensure that we find the time to look after ourselves.

As described in Chapter 3, we have to maintain the four pillars of wellbeing, which include: optimum nutrition (especially cutting down on alcohol, caffeine and processed foods); an active exercise regime; sufficient sleep and good mental health. This is especially important as we age.  In Chapter 11, I will explain in detail how our 4 pillars of wellbeing can affect the menopause symptoms.

But if you are balancing all of these, and are still suffering, you should not suffer in silence. Ask your doctor if you can be referred to a healthcare professional with expertise in the menopause.  I see a growing number of women seeking private menopause help, but please try to convince your doctor to refer you to a specialist on the NHS.

The main treatment will be HRT – hormone replacement therapy. In chapter 11 I will discuss in detail this controversial topic and explain the key studies on HRT and bioidentical and body identical hormones. Some health professionals believe that all women should be on HRT for the rest of their lives, but I do not agree with this. Some will benefit from it, but I do not think all women need it.

I hope that as women learn more about the menopause, they can transition through it more easily and without fear. I truly believe that life after the menopause can be a wonderful new stage of a woman’s life, released from the ups and downs of the menstrual cycle.

In spring 2021 I will be running a survey on how women are learning about the menopause. We would love perimenopausal and menopausal women to complete this. Please keep an eye out on social media for the link.

The menopause poster shown here is produced by https://www.pausitivity.co.uk/

Read more
Your Fertile Years is available to pre-order on Amazon now. Contact joyce.harper@ucl.ac.uk if you would like Joyce to give a talk to any group or at any event.

Blogs
Chapter 1: Knowing Your Body; Understanding Your Menstrual Cycle And Fertile Window
Chapter 2: The biological clock, female fertility decline
Chapter 3: Optimising your reproductive health
Chapter 4: Everything you should know about sex
Chapter 5: If you do not want to become pregnant, how do you prevent it?
Chapter 6: How Can Sexually Transmitted Infections Affect Fertility?
Chapter 7: What you should know about pregnancy and childbirth
Chapter 8: Is egg freezing the answer to female fertility decline?
Chapter 9: What causes infertility and how we test for it
Chapter 10: Debunking the myths of fertility treatment

And videos to accompany the blogs on my YouTube Channel
Why I wrote Your Fertile Years
Chapter 1
Chapter 2
Chapter 3
Chapter 4
Chapter 5
Chapter 6
Chapter 7
Chapter 8
Chapter 9
Chapter 10

9 things you should know if you want kids in the future