Many women wonder if they are going through menopause, or when it will start. Bear in mind that menopause can occur at any age. In most women the natural menopause – the last menstrual period – occurs at age 51 – but there is a huge range from 45 to 55 years. In fact, premature menopause – premature ovarian failure (POF) affects 1 in 1000 women aged 25-29, and 1 in 100 women aged 30-35. Rarely a woman can still have periods to age 57. Menopause can also be surgical if a woman has her uterus (womb) and ovaries removed.
Medical terms
There is often confusion when talking about menopause. Although the last menstrual period is the marker of the last natural ovarian cycle, ovarian function starts to decline from age 35 and diminishes further from age 40 and beyond. Women may experience menopausal symptoms at any stage as these are fundamentally associated with fluctuating hormone levels and low levels of oestrogen. In the few years before the last period, symptoms may get dramatically worse. This is called the perimenopause. After the menopause has happened a woman is now postmenopausal. Within 1-2 years of perimenopause, most perimenopausal symptoms will settle.
What is ‘going through menopause?’
When we talk about ‘going through menopause,’ we mean those women who are symptomatic as they are going through the menopausal transition. This could last for 5-10 years. During this time women have slowly declining ovarian activity. However, the ovaries stop working in a haphazard fashion, leading to large swings in levels of follicle-stimulating hormone (FSH) and oestrogen. This is thought to underlie the occurrence of hot flushes and night sweats.
Menopausal symptoms
There are over 30 recognised symptoms of menopause. You may have some, all or none. They can come and go, and be mild, moderate or severe. But the good news is, there is something that can be done to help relieve these symptoms, and they generally improve and eventually disappear in the postmenopausal period.
1 in 4 women have a few mild symptoms, 3 out of 4 have significant symptoms and 1 in 4 have debilitating symptoms (Menopause support)
Here’s a list of the most common menopausal symptoms. If you have noticed any of these and are aged 40 or above, they are most likely to be due to perimenopause. They may be mild and are not interfering much with life, but if they are troublesome, severe and/or interfering with your ability to function at home or go to work – see your GP.
If you suspect you might be having a premature menopause – a menopause before the age of 40, you should always seek help from your GP without delay. Premature ovarian failure (POF) is a specific type of menopause that requires specialist management.
Hot flushes
Hot flushes can be extremely unpleasant and debilitating. You suddenly experience a wave of heat, with warmth spreading through her body. Some describe it as an inferno. Women often feel unwell, out of breath and shaky. Some may have 50-60 hot flushes a day or more. 85% of women suffer from hot flushes during the perimenopausal transition.
Night sweats
You may wake up during the night suddenly, feeling hot, and sweating, sometimes so much that your night clothes and bedding are drenched in sweat. As the sweat evaporates you feel chills.
Insomnia
This includes difficulty falling asleep as well as frequent waking at night and having trouble getting back to sleep.
Irregular bleeding
Chaotic ovulation, and long periods of anovulation, result in disordered vaginal bleeding. Keep a record of your bleeding pattern and discuss this with your GP. This is important as although most of the time there will be no serious underlying cause, it can be a sign of polyps, fibroids, endometrial hyperplasia or endometrial cancer.
Mood changes
In one recent government survey, 53% of women experienced mood changes at menopause. Anxiety, anger and mood swings were the most common. Women also suffer from low mood and loss of self-esteem and self-confidence.
Weight gain
In the run-up to menopause there is a gradual change in body shape with more fat being deposited on the abdomen so women become more apple than pear-shaped. As visceral fat increases, lean body mass decreases resulting in a lowered metabolic rate.
Cognitive dysfunction
Women often complain of ‘brain fog.’ Lower oestrogen levels reduce brain performance, meaning it’s harder to focus on a task or think straight. They may also have short-term memory problems.
Anxiety
Anxiety is common in perimenopausal women. Women often feel tense and stressed. Your heart can be racing, and you may feel sweaty, dizzy or sick.
Panic disorder
In severe cases, panic attacks can occur – sometimes for the first time. A woman suddenly becomes terrified, out of breath, fearful and overbreathing. Panic attacks can be very severe and upsetting.
Depression
This is also more common in perimenopausal women. Falling levels of oestrogen also mean lower levels of the happy hormone, serotonin and the neurotransmitter gamma-aminobutyric acid (GABA). Women can then find stress harder to cope with. Low mood is common. Severe depression can occur for the first time during perimenopause.
Breast tenderness
Hormonal changes during perimenopause can cause breast tenderness, as well as connective tissue loosening meaning the breasts are less well supported.
Vaginal dryness
Lack of oestrogen makes the cells lining the vagina become thinner, drier, and the tissue becomes less elastic. This can mean sex is painful and increases the risk of episodes of thrush and bacterial vaginosis (BV).
Loss of libido
Around one-third of women notice a loss of sexual interest. They often experience difficulty with arousal and orgasm.
Headaches
These may be triggered by lack of sleep, tiredness and hormonal fluctuations. Migraine can be worse in the perimenopausal period.
UTIs
Urine infections are more common during perimenopause. This may be due to the effects of lack of oestrogen on the pelvic floor.
Stress incontinence
Oestrogen deficiency weakens the connective tissue and muscles of the pelvic floor. Prolapse is more likely. Commonly women notice the pass urine when they laugh, cough or sneeze.
Joint and muscle pain
Oestrogen plays a role in joint health and lowers inflammation. When oestrogen levels are low, this protection is less efficient.
Fatigue
Women often feel drained and exhausted. Insomnia, hot flushes and night sweats take their toll. But even if these are not a particular issue, the hormonal changes of perimenopause can cause extreme tiredness.
Itchy, dry skin
As oestrogen levels decline the skin produces less sebum – which is the oily substance that keeps skin soft and supple. Plus less collagen results in skin wrinkling.
Dry eye
In the eye, the tear and natural oil production reduces with age but this is exacerbated by the fall in oestrogen as menopause approaches. Dry eyes cause itchy, irritated eyes and can affect your vision.
Formication
An altered sensation in the skin can result in the feeling of ants crawling over the skin. This is called formication.
Hair loss
Changes in estrogen and progesterone levels make the hair grow more slowly. There is a relative increase in androgens (testosterone) which causes hair to thin at the front and sides.
Brittle nails
Low oestrogen leads to a reduction in collagen which is the main component of hair nails. Women may notice their nails grow slowly and are more brittle.
Final thoughts
Menopause is a natural event that we can’t prevent. But we can stay healthy and there is a lot that can be done to help cope with these unpleasant perimenopausal symptoms. If you are suffering, my advice is to get help and discuss how you are feeling with your GP. There should be no embarrassment about menopause – it happens to every woman. Don’t suffer in silence.
Have you got any perimenopausal symptoms? Are they interfering with daily life? What could you do today to start to feel better?
Dr Deborah Lee, Dr Fox Online Pharmacy
