July 04 2021
Dr. Rebecca Lewis, GP with a special interest in menopause.
Rebecca qualified from Guy’s Medical School in London in 1991. She continues to practise as a GP and has developed an interest in the menopause. Rebecca is determined to improve the understanding of the menopause through education and access to accurate, evidence-based medical information.
All ages are affected:
A natural menopause occurs when the ovary has run out of eggs and fails to produce the ovarian hormones oestrogen, progesterone and testosterone. It is defined as a year and one day after your last natural period. The average age in the UK for this to happen is 51. However, 1 in a 100 women experience menopause under the age of 40 (called Premature Ovarian Insufficiency), and 1 in a 1000 experience menopause under the age of 30. Also, many women are put into a menopause straight away by having their ovaries surgically removed or their ovaries damaged by medications such as some chemotherapy treatments.
The perimenopause is the time leading up to the menopause when the ovarian function begins to decline and the hormone levels start to drop and fluctuate, causing symptoms. This can be 10 years before the actual menopause when your periods have finally stopped. It is common for the perimenopause to start in women in their 40s.
Symptoms of the Menopause:
Women experience symptoms of the perimenopause and the menopause due to fluctuating and low levels of oestrogen. All cells around the body and in organs have oestrogen receptors and need oestrogen to function properly. Once the ovary starts to slow down, it does not produce the hormones oestrogen, progesterone and testosterone and symptoms can then occur due to these hormone deficiencies.
It is known that 80% of women will experience symptoms and, for 25% of women, these will be severe.
The symptoms are many and varied, and can come and go and fluctuate in intensity and will vary from individual to individual; for example, 20% of women never experience a hot flush or night sweat.
Symptoms can be classified as follows:
Psychological and Brain Symptoms
Poor sleep, increasing anxiety and a low, flat mood are very common and are the symptoms that most women find the most difficult. Some people are even housebound by their anxiety and have to give up work in severe cases. Poor memory and concentration are also very common and worrying, as many women think they are beginning to have early dementia as their memory is so poor and they struggle to find the right words in sentences. Fatigue is an incredibly common symptom as well.
In addition, libido often suffers and declines for many women.
Hot flushes and night sweats are experienced by many, but not all, women. Sometimes the sweats can be drenching at night so that bed sheets and nightwear have to be changed. Migraines and headaches are common; these often get worse or increase in frequency in the perimenopause. Muscle and joint pains occur and women feel very stiff and achy all over and some can have severe joint pains. Heart palpitations and tinnitus are other common physical symptoms of the menopause.
Vaginal and Bladder Symptoms
Oestrogen is vital for bladder and vaginal health; without it symptoms can arise such as vaginal dryness and burning, making sex very uncomfortable and painful. Some women have severe vaginal symptoms making it painful even to sit down for prolonged periods or wear jeans or underwear due to discomfort. Bladder symptoms from low oestrogen levels cause urinary frequency, incontinence and recurrent urine infections. If these symptoms are present and are not treated with local oestrogen treatment, they get worse with time.
Silent Symptoms affecting future health
Losing oestrogen as a result of the menopause causes a hormone deficiency which will last for the rest of a woman’s life. Studies have shown this deficiency can be harmful for a woman’s future health, resulting in increased risk of heart disease, osteoporosis (thin, brittle bones), obesity, depression, type 2 diabetes and even dementia.
How long do Symptoms last for?
Studies have shown that symptoms can settle for some women after 7-8 years and others find that the symptoms become less severe, but many will continue to have symptoms for decades. The long-term hormone deficiency will last forever as the ovaries have stopped functioning, so women will never regain their hormones after the menopause, so the long-term health risks will remain unless the hormones are replaced.
How can they be treated?
The most effective way of treating every one of these symptoms is by replacing the lost hormones with HRT, which is a very safe treatment for the majority of women and can really make a huge improvement to women’s symptoms. HRT can also improve a woman’s future health as it reduces the risk of heart disease, osteoporosis and type 2 diabetes
Alternative treatments can be used such as diet, talking therapy and exercise. Some medications such as antidepressants can improve hot flushes and night sweats, but not the other symptoms. However, alternative treatments are not as effective as HRT.
The free Balance app has a menopause symptoms questionnaire form, which documents menopausal symptoms and tracks them over time. This can then generate a health report that can be taken to a woman’s health care professional. It also has free, evidence-based information about the menopause and perimenopause and the treatments available. The app and the information and content within it is not funded by any pharmacological company. There is an opportunity to be part of a community on the app to interact with others and read about other people’s experiences, There is also an option to take part in different experiments or challenges to improve an individual’s future health.