Symptoms of the menopause

What is the menopause?

Menopause is a natural stage in every woman's life that occurs when your hormone levels drop, your ovaries stop making eggs and your periods stop permanently.

The most common age for menopause in the UK is 51, and most women go through the menopause between the ages of 45 and 55.

Some women go through menopause at a younger age. Menopause that occurs before the age of 45 is called early menopause, and before the age of 40 is known as premature menopause, or sometimes as primary ovarian insufficiency.

What are the stages of menopause?

When we talk about menopause, we are usually describing the time in a woman's life when her periods stop. In reality, menopause is not a single event, but a transition that normally lasts several months or years. Menopause is defined medically as not having had a menstrual period for the last twelve months.

The transition through menopause is made up of 3 stages:

• Perimenopause
• Menopause
• Post-menopause

Perimenopause

This is the first stage of the menopause. On average, perimenopause starts around 4 years before your last menstrual period, but it can last anywhere from a few months to around 10 years.

During perimenopause, your hormone levels drop, causing your periods to become less regular. This is often one of the first symptoms of perimenopause. Even if your periods are irregular, or infrequent, there is still a chance you could get pregnant during perimenopause. Make sure you continue to use a reliable method of birth control if you want to avoid an unwanted pregnancy during this time.

Menopause

Menopause is medically diagnosed when you haven't had a period for one year. When you are in menopause, your ovaries are no longer releasing eggs, and your periods have stopped permanently.

Post-menopause

Post-menopause describes the years after menopause has occurred and is the last stage of the menopausal transition. The symptoms of perimenopause and menopause should gradually start to improve during post-menopause, though some symptoms may continue until your hormone levels stabilise. Reduced levels of oestrogen in post-menopause increase your risk of certain health conditions including osteoporosis (brittle bones), heart disease, and urinary tract infections (UTIs).

What are the symptoms of menopause?

The symptoms of the menopause can be different for everyone. For some women, menopause causes mild or no symptoms, while for others, symptoms can have a significant impact on many areas of life, including self-esteem, psychological health, relationships, work, and social life.

You may have none, all, or some of the symptoms described below, and your symptoms may be mild or severe. It's also common for your symptoms to change as you progress through the menopause transition.

Some common symptoms of menopause include:

Changes to your periods

This is usually one of the first signs of perimenopause. A decrease in the female hormones oestrogen and progesterone means your periods may become less regular, lighter, heavier, or your cycle may be longer or shorter than before.

Hot flashes

Hot flashes (or hot flushes) affect over 80% of women and are one of the most common symptoms of the menopause.

During a hot flash, a feeling of heat spreads across your chest, neck, and face accompanied by reddening of the skin. You may also sweat, have a fast heartbeat, and feel anxious or dizzy.

Hot flashes normally last between 2 and 5 minutes and may be followed by a period of chills and shivering. Though unpleasant, hot flashes are not harmful and are thought to be due to a drop in oestrogen that affects the body's ability to regulate its own temperature.

Night sweats

Night sweats are hot flashes that happen during the night. They are a common cause of disturbed sleep during the menopause.

Difficulty sleeping

Problems sleeping are common during the menopause and may include difficulty falling asleep, staying asleep, and poor quality sleep. Difficulty sleeping is often a result of other menopause symptoms, including hot flashes, night sweats, anxiety, and depression.

Tiredness

It's normal to feel tired from time to time, especially after strenuous physical or mental activity, but menopause fatigue is a severe form of tiredness that impacts your quality of life, prevents you from carrying out day-to-day activities, and doesn't improve with rest.

Menopause fatigue may be caused by:

• Hormonal fluctuations
• Depression
• Stress
• Night sweats
• Difficulty sleeping

Mood changes

It's common to feel moodier or more irritable than usual as you go through the menopause. This may be due to a combination of hormonal fluctuations, and life changes such as children leaving home, caring for elderly parents, changes in your body shape, difficulty sleeping and fatigue.

The menopause can also affect the production of serotonin, a neurotransmitter responsible for regulating our moods. Mood swings, anxiety and depression are common during this time, as are difficulty concentrating and memory problems.

Brain fog

'Brain fog' is a term used to describe problems with concentration, difficulty focusing, and forgetfulness. It is common during the menopause and may be related to hormonal fluctuations as well as difficulty sleeping during this time. Brain fog appears to be temporary, and symptoms usually resolve over time.

Vaginal dryness

Lower levels of the female hormone oestrogen during the menopause can cause the vagina to become drier and less lubricated. It can also make the walls of the vagina thinner and less elastic. This can make sex painful and lead to tearing and infections.

Low libido (sex drive)

Less interest in sex is common during the menopause and may be due both to changes in hormone levels and vaginal dryness, which can make sex painful and lead to urinary tract infections (UTIs).

Thinning hair and dry skin

Oestrogen helps keep the skin plump and hydrated by helping the skin retain water. It is also important for hair growth. When oestrogen levels fall during the menopause, you may find that your skin becomes drier and your hair thinner.

Weight gain and slowed metabolism

Reduced levels of oestrogen changes the way your body stores fat, and you may gain weight, especially around your abdomen (tummy). Your metabolic rate also slows down during the menopause, meaning you may gain weight even if you eat the same amount as you did before the menopause.

Breast changes

Reduced oestrogen levels during the menopause cause breast tissue to become fattier and less dense, which may affect the size and shape of your breasts. You may also experience breast pain or tenderness and find lumps in your breasts. While it's likely that these changes are due to hormonal fluctuations, if you find a lump in your breast, or are worried about changes to your breasts, see a doctor as soon as possible.

When should I see a doctor?

Seek medical advice if your menopause symptoms are making it difficult to carry out normal activities, negatively impacting your relationships or affecting your quality of life. Getting help as soon as possible can reduce the impact of menopause symptoms on your mental and physical health as well as your relationships, social and work life.

How are the symptoms of menopause treated?

Menopause symptoms can be treated in a variety of ways, including lifestyle changes, cognitive behavioural therapy (CBT), hormone replacement therapy (HRT), and non-hormonal medications.

Lifestyle changes

Some changes to your lifestyle that can ease symptoms of menopause include:

• Take regular exercise
• Eat a healthy, balanced diet such as the Mediterranean diet
• Stop smoking
• Reduce your alcohol intake
• Get into a good sleep routine and sleep in a cool, well-ventilated room
• Avoid alcohol, caffeine, and spicy food, especially before bed
• Wear light, loose-fitting clothes
• Carry a portable fan with you to make you more comfortable during hot flashes
• Use a good quality moisturiser to help combat dry skin
• Practise relaxation techniques to reduce stress and anxiety
• Ask for support from friends, family, or join a local or online support group to connect with other women going through the menopause

Read our guide on self-care during the menopause.

Cognitive behavioural therapy (CBT)

If you experience low mood and anxiety during the menopause, cognitive behavioural therapy may help. CBT is a talking therapy that aims to change the way you think about problems and break negative patterns of behaviour.

Hormone replacement therapy (HRT)

HRT is the most common treatment for menopause symptoms. It works by replacing the hormones that naturally decrease during this time. HRT normally resolves most menopause symptoms when taken correctly and can lower your risk of developing conditions like osteoporosis and heart disease. It is normally prescribed for between 2 and 5 years. There are 2 main types of HRT, oestrogen-only HRT, and combined HRT.

Oestrogen-only HRT

This type of HRT only contains the female hormone oestrogen. It is prescribed if you have had an operation to remove your womb (a hysterectomy). Oestrogen-only HRT is available as a tablet, skin patch, gel, spray, or implant.

Combined HRT

This type of HRT contains both oestrogen and a synthetic form of progesterone called progestogen. It is prescribed if you still have a uterus (womb), as the progestogen protects against endometrial (womb cancer). You may be prescribed oestrogen and progestogen separately, or in a combined form. Oestrogen is available as tablets, skin patches, spray, or gel. Progestogen comes as tablets or an intrauterine system (IUS) such as the Mirena coil.

Vaginal oestrogen

Vaginal oestrogen is sometimes prescribed to treat vaginal dryness and painful sex during menopause. It is available as a cream, pessary, or a ring that you place inside your vagina. Vaginal oestrogen doesn't treat other menopause symptoms and is often used in combination with HRT.

Testosterone

During the menopause, levels of the hormone testosterone also start to fall. This can cause symptoms such as fatigue, mood swings, and low libido (sex drive). Testosterone isn't licenced to treat menopause symptoms, but some doctors can prescribe small doses of testosterone 'off label' when regular HRT hasn't improved symptoms. Testosterone comes as a gel that you apply to your skin and is normally used in combination with HRT.

Non-hormonal medications

If you can't, or don't want to, take hormonal treatments for menopause symptoms, your doctor may recommend another medication such as clonidine, gabapentin, or an antidepressant.

Clonidine

Clonidine is normally prescribed to treat high blood pressure but can also help with hot flashes and night sweats.

Gabapentin

Gabapentin is a medication normally prescribed for epilepsy, seizure disorders, or nerve pain. It has also been shown to be effective in reducing hot flashes and night sweats.

Both Clonidine and Gabapentin can cause side effects and may not be suitable for everyone. Talk to your GP or consultant about whether these treatments could be right for you.

Antidepressants

Your doctor may prescribe antidepressants if your menopause symptoms include depression, low mood, or anxiety. Some low dose antidepressants can also help with hot flashes and night sweats.

Do herbs and supplements treat menopause symptoms?

There are many herbs and supplements on the market that claim to relieve symptoms of the menopause. While some may be effective for some women, they are often unregulated and there is little-to-no scientific evidence that they work. Talk to your healthcare provider before taking any herbs or supplements to treat symptoms of the menopause.

A final note

Menopause is a natural part of life, but that doesn't mean you should put up with distressing symptoms. Talk to your GP or to one of our specialist consultants, reach out to friends and family, and find a support group to ensure your transition through the menopause goes as smoothly as possible.