Around 50 per cent of the world’s population will go through the menopause and yet it’s an experience that leaves some women feeling isolated in so many ways. Until recently, it was rarely discussed openly and usually whispered about as ‘the change’ or change of life. Something to be endured in stoic silence.
Of course, it can be a difficult subject to talk about for many women. This is one of the reasons why it can impact relationships. Menopause is an intimate and complicated situation, not least because it means the end of fertility.
There are many women out there who have decided to stop being apologetic about the menopause and instead feel they should ‘own it’ After all, while it marks the end of an important part of life, it can also be a positive and liberating experience.
What causes menopause?
When a woman reaches puberty she will have between 300,000 and 400,000 eggs but will lose around 1,000 immature eggs a month. Scientists aren’t sure what prompts this to happen, but they know that it isn’t influenced by most things we can control.
When you run out of your supply of viable eggs, your ovaries will cease to make oestrogen and you’ll go through menopause. Exactly when this happens depends on the number of eggs that you were born with.
So menopause happens when a woman’s periods stop. Basically it’s the end of the menstrual cycle.
Usually it’s diagnosed after you’ve gone 12 months without a period, however many women start developing symptoms around four years before their last period with a small number developing them a decade before menopause actually happens.
The body will begin to undergo several changes in response to lower levels of:
- Follicle-stimulating hormone (FSH)
- Luteinizing hormone (LH)
The average age for this to occur is 51, although it can be earlier or later depending upon a variety of different factors.
What Is Perimenopause?
Perimenopause is the run-up to the menopause and it happens when your hormones begin to change in preparation for the main event. This stage can last a few months or several years and usually starts when you’re in your mid-40s but it doesn’t happen for everyone and there are those who will enter menopause directly.
During this cycle your menstrual periods will become unpredictable, they may be early, they may be late or not appear at all and they could become very light or very heavy.
How do I know that I’m going through the menopause?
Not every woman experiences the same symptoms. There are some whose periods stop and they notice very little change to themselves and their bodies, while others may experience some overwhelming effects. It’s thought that the latter is more likely if the menopause occurs over a much shorter time for example if you’ve undergone a hysterectomy or cancer treatment.
Symptoms of menopause
1. Menstruation becomes unpredictable
You may notice that your periods are less frequent. They can also be much lighter or much heavier than normal.
2. Hot flushes
Hot flushes and night sweats are a very common symptom and you are not alone if you also experience feelings of anxiety.
Hot flushes are often described as a sudden feeling of heat that seems to come from nowhere and spreads throughout the body and you may also experience sweating and palpitations. Some women can feel like they’ve been drenched with a bucket of water when they wake up at night in a sweat.
These symptoms can be occasional and mild for some, while others can have many a day and find them uncomfortable, disruptive and embarrassing.
Hot flushes can also be part of the perimenopause and they can last years after the menopause.
3. Vaginal dryness
You may have vaginal dryness if you:
- Feel sore or itchy in and around your vagina.
- Experience pain or discomfort during sex.
- Have the urge to wee more often than usual.
- Keep getting urinary tract infections (UTIs).
4. Dry skin
When oestrogen levels drop during menopause, oil glands get smaller and stop secreting oil causing the skin to get more wrinkled and dry and even itchy.
5. Low moods
Declining oestrogen levels can make you feel depressed and anxious.
Symptoms of a general low mood may include feeling:
- Anxious or panicky.
- More tired.
- Angry or frustrated.
- Low on confidence or self-esteem.
- If you are depressed you may feel you’re
- Not getting any enjoyment out of life.
- Feelings of hopelessness.
- Lack of concentration.
- Having thoughts of suicide or self harm
You may find you develop insomnia, which is usually caused by the decline of oestrogen in the body.
Signs of insomnia include:
- Finding it hard to go to sleep
- Waking up several times during the night
- Lying awake at night
- Waking up early and unable to go back to sleep
- Still feeling tired after waking up
- Finding it hard to nap during the day even though you’re tired
- Feeling tired and irritable during the day
- Finding it difficult to concentrate during the day because you’re tired
7. Weight gain
The drop in oestrogen levels that happens at menopause has the effect of redistributing body fat, so excess pounds tend to settle round the waist as the dreaded ‘middle-aged spread’.
8. Your sex drive may disappear
Some women may experience an increase in libido, while others experience a decrease. Not all women go through this libido decrease, though it is very common.
9. You may urinate more frequently
Oestrogen also plays a role in supporting the sides of your bladder. That means if your estrogen levels are low, like during menopause, you may experience more frequent (and more urgent) urination as your bladder feels squeezed.
10. Breasts could feel tender
Because the hormonal changes, breast soreness can strike unpredictably.
11. You may suffer from headaches
Menopause can affect headaches in many ways. The effects can be different for every woman, so you may not experience the same changes as someone else.
12. Bone mass is reduced
With the amount of oestrogen in your body lowering, your bones will become less dense and can increase the chances of developing osteoporosis.
13. You may get urinary tract infections
Menopause causes hormone changes that can cause changes in your vaginal bacteria. This can increase your risk of chronic UTIs
14. Hair gets thinner
Your hair may get thinner, but ironically you find yourself getting hairier in places you don’t want it like the face, neck, chest and back.
This is when women under the age of 40 begin menopause. About five per cent of women undergo menopause between the ages of 40 and 45.
Causes of early menopause
1. The ovaries stop working
Early menopause can happen naturally if a woman’s ovaries stop making normal levels of certain hormones, particularly oestrogen.
This is sometimes called premature ovarian failure, or primary ovarian insufficiency.
The cause of premature ovarian failure is often unknown, but in some women it may be caused by:
- Chromosome abnormalities – such as in women with a female-only genetic disorder called Turner Syndrome.
- An autoimmune disease where the immune system starts attacking body tissues
- On rare occasions caused by certain infections, such as tuberculosis, malaria and mumps.
- Premature ovarian failure can sometimes run in families. This might be the case if any of your relatives went through the menopause at a very young age (20s or early 30s).
2. Cancer treatments
Radiotherapy and chemotherapy can have an impact on your fertility which could lead to early menopause.
3. Surgery to remove the ovaries
Having an operation to remove both ovaries will also bring on premature or early menopause.
Symptoms of early menopause
The main symptom of early menopause is periods becoming infrequent or stopping altogether without any other reason (such as pregnancy).
The menopause is as individual as the person experiencing it and there are different ways of coping with symptoms. While some women will opt to go down the conventional route, others will control symptoms with natural remedies and diet. It’s all about what works for you.
Hormone replacement therapy (HRT)
If your symptoms are severe and distressing your GP may prescribe HRT, a cocktail of hormones that replaces those women no longer produce because they’ve gone through the menopause. There are different types of HRT available so if you find one type doesn’t work, then you can go back to your doctor to discuss other options.
The two main hormones used in HRT are:
- Oestrogen – types used include estradiol, estrone and estriol
- Progestogen – a synthetic version of the hormone progesterone, such as dydrogesterone, medroxyprogesterone, norethisterone and levonorgestrel
When taking HRT you can opt for a combination of both hormones or oestrogen (oestrogen-only HRT). With oestrogen alone there is an increased risk of developing womb cancer but progestogen alongside oestrogen minimises this risk.
Oestrogen-only HRT is usually only recommended for women who have had their womb removed during a hysterectomy.
You can take HRT in tablet form, usually once a day but there is a small risk of developing blood clots with this method. You can also opt for skin patches, which are a good option for those who might forget to take their tablets every day and unlike tablets, they do not increase your risk of blood clots. You can also use oestrogen gel, which is an increasingly popular form of HRT that is rubbed onto your skin once a day.
Like skin patches, the gel can be a convenient way of taking HRT and does not increase your risk of blood clots.
But if you still have your womb, you’ll need to take some form of progestogen separately too, to reduce your risk of womb cancer.
HRT also comes as small pellet-like implants that are inserted under your skin (usually in the tummy area) The implant releases oestrogen gradually and lasts for several months before needing to be replaced. Again if you still have your womb you’ll also need to take progesterone.
Another HRT option is vaginal oestrogen which is available as a cream, pessary or ring that is placed inside your vagina. It’s especially effective for vaginal dryness but not so helpful if you’re experiencing hot flushes.
You can also administer testosterone as a gel rubbed into the skin if your low sex drive doesn’t improve after using HRT.
Lifestyle changes and natural remedies can be effective in helping you to manage moderate menopausal symptoms and even if you’re on HRT, doing more exercise, or learning how to meditate can just make you feel more relaxed and positive.
1. Dress in loose natural fabrics, especially at night to help with those hot flushes and night sweats.
2. Reduce calories by 400 to 600 to help stave off the excess kilos.
3. Exercise in moderation for 20 to 30 minutes a day as this can
- Increase energy.
- Help improve sleep.
- Improve mood.
4. Join a menopause support group
Supplementing your diet
Take calcium for vitamin D and magnesium supplements to help reduce your risk for osteoporosis and improve energy levels and sleep. Talk to your doctor about supplements that can help you for your individual health needs.
Using herbal remedies
There are studies that suggest herbal remedies can be effective in treating symptoms of the menopause caused by a lack of oestrogen. These include:
- vitamin E
- flax seed
There are also claims that Black Cohosh, red clover and Dong quai are good to take for hot flushes and night sweats. Ginseng may help with some menopausal symptoms, such as mood symptoms and sleep disturbances and Kava may decrease anxiety. It must be stressed that herbal supplements are not as closely regulated as standard prescription drugs so there are risks involved and you may wish to consult your GP before you take any supplementary medicines.
Practicing relaxation techniques
Yoga for menopause will help you stay cool, calm, and collected. Certain types of yoga help with balancing the mind and body so you can build up your strength as well as learning how to calm the mind.
This is a technique used when taking slow, deep breaths. It can heighten performance and concentration while also being a powerful stress reliever. It’s also called four-square breathing.
You don’t have to belong to a religion to practice meditation, which is less about faith and more about altering consciousness, finding awareness, and achieving peace.
With today’s greater need to reduce stress in our busy and uncertain lives, meditation is increasing in popularity. You might not know there are actually nine types of popular meditation so it should be possible to find the right one for you.
Acupuncture is one way to help with those troublesome menopausal symptoms, suggests a study published in the online research journal BMJ Open.
Among women dealing with moderate to severe symptoms, acupuncture was associated with reductions in hot flushes, excess sweating, mood swings, sleep disturbances, and skin and hair problems.
The findings prompt the researchers to conclude that acupuncture offers “a realistic” treatment option for women who can’t or don’t want to, use hormone replacement therapy (HRT).
Menopause can be a liberating experience. Being a woman free of period pains and headaches, not having to use contraception and not being a slave to monthly mood swings are all positives that can be embraced at this vital time of your life.
If you want advice, support or to join a community that can share their advice and knowledge about the menopause then don’t hesitate to get in touch.
Emma is a multi-entrepreneur. She founded The Menopausal Godmother and Acupuncture That Works. She specialises in acupuncture for menopause & fertility and has delivered acupuncture to over 1000 women going through the menopause.