What to expect during menopause

Menopause is a natural part of ageing in women when periods stop and getting pregnant naturally is no longer possible. However, although it is a natural process, it doesn’t mean that it can’t significantly affect your quality of life. Despite the fact that millions of women in the UK go through menopause every year, many of its symptoms and consequences aren’t talked about and are still considered taboo. 

Breaking this taboo can help women going through menopause seek help when they need it. So here we’ll look at the symptoms of menopause, including those ‘hidden’ problems that often go undiscussed. 

When do menopause symptoms start?

Although strictly speaking menopause occurs 12 months after your last period, usually between the ages of 45 and 55, symptoms can begin several years earlier during a time called perimenopause.

Perimenopause usually starts in your 40s but can occur as early as your 30s. During perimenopause, your oestrogen levels start to drop, which causes noticeable symptoms. This means you may still have periods, even if they are irregular, when your symptoms begin.

For most women, periods do not suddenly stop but become increasingly irregular over a period of several years.

Common menopause symptoms

Hot flushes and night sweats

Hot flushes and night sweats are two of the most common symptoms of menopause, affecting three quarters of women and persisting for an average of seven years. The cause is a change in your brain’s thermoregulation ability ie its ability to control your body’s temperature.

Mood changes

Mood changes are also common and include low mood, anxiety, irritability, mood swings and lethargy. Some of these mood changes are similar to what would happen during your normal menstrual cycle. However, for some women, these changes are more pronounced during menopause. Low mood, for example, can lower to the point that it becomes depression.

‘Brain fog’

Menopause can slow your speed of thinking and affect your memory, which is commonly referred to as ‘brain fog’. This may affect your ability at work and lead to a loss of confidence.

Tiredness

Tiredness during menopause is usually due to poor sleep. Although you may not be aware of waking through the night, episodes of hot flushes can mean your sleep is not as deep or restorative. This reduction in high-quality sleep can leave you feeling tired in the daytime.

Weight gain and body shape changes

As your oestrogen levels drop, your metabolism will slow, your muscle mass will reduce and more fat will be deposited around your body. This can all lead to weight gain. However, you may also notice distinct body shape changes due to where fat is laid down. Most often, fat from the breasts and bottom is lost, while fat around the tummy is gained.

Skin and hair changes

Menopause can make your skin drier, coarser, slacker, thinner and less elastic. All of these skin changes can cause more lines and wrinkles to appear all over your body. Your hair may also thin out.

Reduced libido

Reduced libido is a common problem during menopause but is often not discussed, with many women consequently believing that nothing can be done to address their desire for sex. However, with a variety of menopause treatments available, this is not necessarily the case.

It is important to remember that many different factors affect libido. Stress, relationship problems, finances and general health all have a role to play. However, during menopause, additional pressures can develop. As your body changes due to menopause, you may feel less feminine — research shows that feeling less feminine is linked to reduced libido in women.

There are other physical changes during menopause that can also affect libido, specifically changes in your vagina. Reduced oestrogen levels cause your vagina to become less lubricated, less supported and less elastic. This can lead to painful sex, cystitis and in some cases soreness and vaginal bleeding. Unsurprisingly, this can reduce your libido.

Weaker bones

Menopause reduces the density of your bones. This is not something you will notice but it makes your bones more likely to fracture if you have a fall or get in an accident. In women who go through early menopause, this increases the risk of osteoporosis.

Headaches

If you have headaches before menopause that are hormone-related, you may actually find you have fewer headaches or less severe headaches after menopause. However, the opposite can also happen — headaches can worsen and/or become more frequent. This may be particularly pronounced during perimenopause as your oestrogen levels are dropping.

Treating menopause symptoms

There are several successful treatment options to ease the symptoms of menopause. If you think you are going through menopause or perimenopause, it is therefore important to see your GP or a gynaecologist. They can talk you through the different treatment options and recommend which will work best for you based on your lifestyle, general health and personal preferences.

There are three main approaches to relieving menopause symptoms:

Hormone replacement therapy (HRT)

HRT is an effective treatment for many menopause symptoms. However, HRT has attracted considerable controversy in the media due to certain health risks. However, recent studies have shown that using HRT during the early years of menopause has profound health benefits. It is only when HRT use is extended into later post-menopausal life that it can increase the risk of heart disease, breast cancer and stroke.

If you’re considering using HRT, it is important to discuss the risks and benefits with your doctor. If you decide to go ahead with HRT, the type and dose of HRT, as well as the recommended period of time to take it, will be tailored to your particular circumstances. HRT is not suitable for everyone but there are other options.

Non-hormonal medication

If you don’t want to take HRT or due to medical reasons are unable to, there are still other options to explore. Antidepressants can help relieve low mood and hot flushes. However, antidepressants often have side effects, so you may decide that counselling and/or focusing on resolving other factors contributing to your low mood is preferable.

Self-help

You can reduce your menopause symptoms through lifestyle changes, such as quitting smoking, following a healthy diet and exercising regularly. This can help with body shape changes, reduce your risk of osteoporosis and lift your mood.

Life after menopause should be enjoyable, rewarding and fulfilling, so if you’re struggling with symptoms, remember that treatments are available to help you enjoy the next chapter of your life.

Author biography

Mr Tim Duncan is a Consultant Gynaecologist at Spire Norwich Hospital and Norfolk and Norwich NHS University Hospital. He specialises in minimally invasive treatments to common gynaecological conditions, colposcopy, and the investigation and treatment of gynaecological cancer. He also holds a research MD in molecular prognostic markers in ovarian cancer and is a senior lecturer at the University of East Anglia.