Feeling in the dark about what to expect with the menopause? Find out what it's all about here.

The menopause has long been seen as a time to dread, linked to ageing and loss of attractiveness. Now that’s all changing, with UK celebrities like Mariella Frostrup, Davina McCall, Gillian Anderson, and supermodel Yasmin Le Bon openly discussing this natural phase in every woman’s life as an empowering rite of passage.

That attitude is slowly starting to filter through to the rest of us, but many women are still unsure about what to expect. Sound familiar? This guide has everything you need to know about the menopause – and beyond.

What does ‘menopause’ mean?

Technically, ‘menopause’ is simply the end of your periods when you’ve gone at least a year with no menstrual bleeding¹. But the word ‘menopause’ is often used to describe what is – strictly speaking – the perimenopause. This is the period leading up to the menopause when levels of the main female hormones (oestrogen and progesterone) start to rise and fall erratically². On average, perimenopause lasts for around four years, although for some women, it can go on for up to 12 years³. It’s likely you’ll notice signs of perimenopause in your forties, or even your thirties – only 10% of women report their periods stop suddenly, with no noticeable changes in their cycles beforehand⁴. The menopause usually happens between the ages of 45 and 55.

Why does the menopause happen?

It’s because your ovaries’ supply of follicles – needed to make eggs – starts running out. This has a cascade of effects: your ovaries become less able to respond to reproductive hormones, like follicle-stimulating hormone, which means they then stop making oestrogen and progesterone – the hormones that regulate menstruation and are needed for fertility – causing those classic menopause symptoms⁵. OK, that’s the physical reasons that trigger menopause but why do women go through it? One theory is that it’s an evolutionary throwback, giving women the chance to care for their grandchildren, passing on their knowledge and to safeguard the next generation of their genes⁶.

What are the most common menopause symptoms?

Not every woman has significant symptoms, and you may find you barely notice the transition⁷. But here are the most common menopause symptoms and how to tackle them:

Menstrual changes

A persistent change of seven days or more in the length of your cycle – making it shorter or longer – can indicate you’re in early perimenopause. A stretch of 60 days or more between periods usually happens later in perimenopause. Menstrual changes are caused by ovulation becoming unpredictable as your supply of eggs dwindles⁸.

What you can do: this is a normal part of menopause transition, but see your doctor if periods are troublesome – if they’re particularly heavy, for example.

Hot flushes

Hot flushes and night sweats are collectively known as ‘vasomotor symptoms’ and affect between 60 and 85% of women, varying in severity and frequency. They usually last around two years but for 10% of women, hot flushes can last if 15 years⁹. Experts still don’t know exactly what causes them, but it’s thought hormone fluctuations affect the way the brain controls body temperature¹⁰.

What you can do:

• Ask your doctor about hormone replacement therapy (HRT) – HRT replaces your missing hormones and is the most effective way of stopping vasomotor symptoms, as it treats the underlying cause. Taking HRT can also lower your risk of conditions such as heart disease and osteoporosis that increase post-menopause

• Some menopausal women may prefer to use alternative remedies to tackle their symptoms, such as agnus castus, red clover or soy isoflavones

• Simple lifestyle measures – like wearing natural fibres and reducing stress – can also make a difference to hot flushes¹¹

• Reducing (or cutting out) alcohol and spicy foods – these can often make hot flushes worse

• Consider a course of CBT (cognitive behavioural therapy) – it has been shown to reduce the frequency and duration of hot flushes.

Mood problems

Anxiety and depression are more likely to affect women during perimenopause; if you have a history of depression, you’re likely to experience it now. Changes in hormone levels may affect the neurotransmitters, such as serotonin, that control mood¹². Of course, your mood can also be affected by other factors at this time, such as loss of fertility and negative social stereotypes around menopause, along with worries about children, work, and elderly parents¹³.

What you can do: self-help measures can ease depression and anxiety, including yoga, meditation, and regular exercise. Speak to your doctor about a course of CBT too. HRT may be useful¹⁴, but antidepressants are not recommended as there’s no evidence that they work for low mood associated with menopause. Some women find herbal remedies, such as St John’s wort or valerian, may be helpful for low mood or anxiety during the menopause.

Sexual issues

Falling oestrogen levels can thin and dry vaginal walls, leaving you prone to infections and having sex uncomfortable. You may also experience irritation and soreness, even if you’re not sexually active. On top of this, you may find you have a reduced libido. Stress and relationship problems can contribute to lower sex drive and loss of lubrication too.

What you can do: vaginal dryness can be treated very simply with topical oestrogen, used either as a cream, pessary, or vaginal ring. It can be used on its own or with HRT. Or you could try over-the-counter vaginal moisturisers and lubricants.

And what about post-menopause?

After menopause, a lack of oestrogen means you’re more susceptible to developing osteoporosis and heart disease. You may also find you gain weight, and your skin starts to become dryer. You can support your bone health by upping your intake of calcium and vitamin D – the government recommends all post-menopausal women take 10mcg a day – while omega-3 can help reduce your risk cardiovascular disease and combat dry skin.

It may sound like a lot to deal with, but every woman’s experience of the menopause is different. Some sail through it, while others are floored by their symptoms – either way, it’s a sign that an exciting new chapter in your life has started. And don’t forget that you’re in good company; finally, we’ve all got something in common with a supermodel!

Advice is for information only and should not replace medical care. Please check with your doctor before trying any remedies.

Sources