Firstly, what is the menopause?
“The menopause is the phase in a woman’s life cycle where her periods stop and she becomes unable to have children,” says Dr Riccardo Di Cuffa, founder and GP at Your Doctor (your-doctor.co.uk). “This starts with the body producing less oestrogen and eggs less regularly. For most women, this occurs between the ages of 45-55. The symptoms can vary from woman to woman, and, while these may seem worrying to some, there are effective ways to combat or reduce them so they don’t have such a significant impact.”
What about perimenopause?
“Perimenopause can begin years before women start to experience the menopause,” explains Dr Kathryn Basford, GP at Zava UK (zavamed.com). “This is the point when the ovaries gradually begin to make less oestrogen – women typically start to experience this from their late 30s to early 40s. There is some overlap in the symptoms of the menopause and perimenopause, with women often experiencing hot flushes, worsened premenstrual symptoms, diminished sex drive and fatigue.”
My memory isn’t as good as it used to be. Is it ageing, or could it be a symptom of the menopause?
“Our memory does change as we age anyway, but menopause can alter your levels of concentration, cognitive sharpness and memory, probably due to falling levels of oestrogen and its effects on the brain,” says Dr Riccardo. “Challenge your mind in new ways to blast through any mental fogginess. Just know that the symptoms will pass.”
I’ve suddenly got really dry eyes. Is this a symptom?
“Dry eye is a common complaint of women going through the menopause, and often this can be exacerbated by using HRT treatments,” says Dr Kathryn. “It’s worth consulting a doctor if you experience this, as they may want to adjust your medication. However, dry eye can be caused by a number of other environmental and health factors as well, so it’s a good idea to speak to a health professional. In the meantime, make sure you keep your eyes clean, use a humidifier and take regular breaks if you spend a lot of time looking at computer screens.”
I thought acne was just for teenagers! What’s going on?
“As levels of female hormones drop before and during menopause, some women develop teenage-like acne,” says registered naturopath Emily Harris (indigo-wellbeing.co.uk). “During perimenopause, there is a reduction of oestrogen, but androgen levels (our male sex hormones) stay fairly constant. Androgens stimulate the skin’s oil glands to produce more sebum, an oily substance that blocks pores. Coupled with the slower regeneration of mature skin cells, the result is skin inflammation and infection. Menopausal acne is most likely to affect the chin, jaw and neck. Once postmenopausal hormone levels settle, the acne usually resolves.”
Now that I’m going through the menopause, do I need to worry about contraception?
“Although pregnancy is less likely during the perimenopause and menopause, women should use contraception as it is still possible to ovulate,” says Dr Kathryn. “Equally, while HRT has a similar make up to the contraceptive pill, the dosage is smaller and less potent, so it’s not impossible to conceive. After the age of 55, women don’t need to use contraception to avoid unplanned pregnancy. Depending on when you had your last period and your age, you may be able to stop using contraception earlier, but, if you’re unsure, you should check with your doctor. It is also a good idea to use barrier contraception, such as condoms, when having unprotected sex to limit the risk of STIs.”
My confidence has hit an all time low, what can I do to help myself?
“You’re not alone, many women feel their confidence levels drop during menopause,” says Julie Robinson, founder of Menohealth (menohealth.co.uk). “Empower yourself, create an action plan to boost your self-esteem to get active, eat well, stay hydrated and create a little me-time every day. Exercise is truly amazing – it releases feel-good hormones to lift your mood and relieve stress, it helps you keep a healthy and toned body and it energises you. Try to make time to do something physically active each day, even if you’re tired or are short on time. This will give you a sense of control and achievement and help you find the real you again.”
What exactly is hrt, and is it safe?
“HRT stands for Hormone Replacement Therapy and there are different types and doses,” explains menopause specialist Dr Louise Newson (menopausedoctor.co.uk). “The most important hormone is oestrogen, and the safest way of having this is through the skin as a patch or gel. If a woman still has her womb then she also needs a type of progestogen, and the best way of having this is either as a capsule of micronised progesterone, or having a Mirena coil. The benefits of taking HRT usually outweigh any risks, and it can lower your future risk of heart disease, osteoporosis and type 2 diabetes. The risk of breast cancer with HRT is very small and studies have not even shown it to be significant. At its worst, the increased risk is similar to an increased risk a woman has if she drinks a couple of glasses of wine or is overweight. It’s very important that women receive the optimal dose and type of HRT for them, so all women should receive individualised consultations.”
Can the menopause cause depression?
“The menopause can cause changes in mood, largely due to the decline in oestrogen and progesterone levels in the body,” says Dr Jo Gee, specialist women’s health psychotherapist at The Luna Hive (thelunahive. com). “Women might notice feeling more anxious, and irritable with periods of feeling down or low. These emotional changes can also come about due to the psychological adaptation we make in this important phase of life, with difficult symptoms, relationship changes and changes to the body. Depression, which is a longer term period of low mood, decreased energy, low appetite, low self-esteem and disturbed mood, can occur in the menopause due to the hormonal and chemical changes in our bodies and brains. If you notice that your low mood persists for more than two weeks, do seek professional advice.”
Sex is painful, what can I do?
“After menopause, up to half of all women have pain before, during or after intercourse,” explains women’s health osteopath Sally Wade (surreyosteopathiccare.co.uk). “There are many reasons, but dwindling oestrogen is the top one for painful sex during this time. Low oestrogen can cause the walls of your vagina to become thinner and drier, leading to friction during sex. Due to the lower oestrogen levels, your vagina also stretches less, which can make it feel tight. Using a lubricant is essential during intercourse, and a vaginal moisturiser can help to ease the dryness. If this isn’t helping, your doctor should be able to prescribe oestrogen in the form of a cream, a tablet or a ring. These make a huge difference to easing painful intercourse, so please don’t be embarrassed to talk to your GP about what treatment may be right for you.”
I’ve put on a lot of weight since the start of the menopause and i’m often bloated, what can I do?
“The hormonal changes of menopause might make you more likely to gain weight around your abdomen than around your hips and thighs, but hormonal changes alone don’t necessarily cause weight gain,” says Dr Riccardo. “Instead, the weight gain is usually related to ageing, as well as lifestyle factors, such as a lack of exercise, unhealthy eating and not getting enough sleep. Genetic factors can also play a part. Muscle mass typically diminishes with age, while fat increases. Loss of muscle mass decreases the rate at which your body uses calories, which can make it challenging to maintain a healthy weight. If you continue to eat as you always have and don’t increase your physical activity, you’re likely to gain weight.”
How will I know when the menopause is over?
“For many women, it’s simply a case of starting to feel better,” says Dr Kathryn. “As the hormonal changes subside, so too do symptoms. If you experience symptoms for a prolonged period, speak with a medical professional, as another condition may be responsible.”