Perimenopause is the period before the menopause. Perimenopause starts when the amount of oestrogen made by the ovaries begins to decline. It usually begins in your 40s, although it can start earlier.

Menopause is when you have not had your monthly period for at least 12 months. Menopause is only one day in your life.

Postmenopause is the day after the menopause and continues for the rest of a woman’s life.

• The average age of a person, in the UK, going through a natural menopause is 51-years old, but it can happen at any time.
• If you’re younger than 45, it is called an early menopause.
• Before the age of 40, it is known as a premature menopause, or Premature Ovarian Insufficiency (POI).
• By the age of 54, 80% of women will have stopped having periods.

What do these hormones do?

Oestrogen plays an important role in maintaining bone and heart health as well as brain function during the reproductive years. It also regulates your mood and keeps your joints, eyes and vagina well lubricated.

Progesterone helps regulate periods and plays an important role in pregnancy.

Testosterone, despite being known as a male hormone, is also produced by the ovaries and helps build muscle, improve memory and concentration, and helps libido.

Symptoms of the menopause are the same as those of the perimenopause and can include:

• Hot flushes and night sweats
• Low libido
• Memory fog
• Word finding difficulties
• Concentration difficulties
• Fatigue
• Sleep disturbances
• Mood swings
• Irritability
• Weight gain
• Hair loss
• Joint pains
• Headaches
• Dry skin
• Itchy skin
• Bladder weakness
• Vaginal dryness
• And more

Whilst not all women will experience menopausal symptoms when they go through the menopause, up to 80-90% will have some symptoms, with 25% describing them as severe and debilitating. Clearly this has significant implications for women at work and in relationships.

How do you diagnose the menopause?

The diagnosis of the menopause should be made by assessing the clinical picture and based on a combination of menopausal symptoms and change in menstrual cycle pattern in women beyond the age of 45. Hormonal testing is not helpful in diagnosing the menopause as the level of the hormone can fluctuate from one month to another and may not give an accurate assessment.

Long term health

When the ovaries have stopped producing oestrogen, this fall in hormone levels may influence long-term health. Most commonly these changes affect the strength and density of bones, increasing the risk of the bone-thinning disease osteoporosis. In addition, oestrogen deficiency after the menopause has also been shown to result in an increase in the risk of heart disease, diabetes, dementia and clinical depression and other diseases.

What interventions are available to women going through the menopause?

All women should be able to access advice on how they can optimise their menopause transition with advice from lifestyle and diet modification through to Hormone Replacement Therapy (HRT).

Diet and lifestyle changes

Lifestyle changes to help perimenopause and menopause:

• A healthy balanced diet is good for general health.
• Spicy foods, alcohol, caffeine can make hot flushes worse so avoiding these may help.
• Up your intake of vitamins B, C, D and E.
• Drink lots of water, this could be infused with fruit, or sugar free squash, anything which helps you to remain hydrated.
• Take up regular exercise that you enjoy. This may improve hot flushes and night sweats and improve sleep as well as helping you maintain or lose weight. Weight bearing exercise such as walking, running and dancing can improve bone strength.
• Get a good night’s sleep of approximately 8 hours.

Hormone Replacement Therapy (HRT)

HRT is the most used treatment for managing menopausal symptoms and HRT has been shown to be the most effective intervention for managing menopausal symptoms and has been shown to result in a significant improvement in menopausal symptom control and quality of life. The main component of HRT is the hormone oestrogen which aims to replace your own body’s levels around the time of the perimenopause/menopause.

Oestrogen can be given in the form of:

• Oral tablets
• Patches, gel or spray aka transdermal oestrogen i.e. through the skin

Progesterone can be given in the form of:

• Patches (as part of a combined patch with oestrogen)
• IUS (Hormonal coil)
• Tablets

Progesterone needs to be given to women (who have not had a hysterectomy) to protect the lining of the womb from the effect of oestrogen.

If you have low libido and HRT does not help with it you could be prescribed testosterone. This may also help with improving low mood and energy levels. At present there are no testosterone preparations available that are licensed for female use in the UK.

Risks of HRT

The risks of HRT are small and the decision whether to take HRT should be made on an individualised basis after discussing the benefits and risks with each woman. For most women, the benefits in quality of life improvement, reduction in osteoporosis risk and reduction in risk of heart disease would outweigh the small increase in the risk of breast cancer. Women who take HRT have a reduced mortality compared to women who do not take HRT.

Alternative treatments

• Herbal Remedies – there is no strong evidence that these work
• Medications – there are some medications that help with night sweats and hot flushes. These can be discussed further with your clinician
• Complementary and alternative therapies – such as acupuncture, aromatherapy, homeopathy, yoga and reflexology may sometimes help with troublesome menopausal symptoms
• Cognitive Behavioural Therapy (CBT) – also an effective option in improving hot flushes, nights sweats and other menopausal symptoms

Useful links

• Balance Menopause
• Menopause Matters
• Rock My Menopause
• Menopause Symptom Questionnaire (PDF)

Dr Heather Craigie is our menopause clinical lead but all our regular GPs are confident in managing the menopause.