Everything you need to know about the menopause

What's the difference between the menopause and the perimenopause? Here's what to expect including symptoms, treatments and lifestyle tips.

Menopause signs, symptoms and treatment
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The menopause is a natural part of the ageing process when a woman's oestrogen levels start to decline. But when does it happen, what are the signs and what can you do to ease the symptoms?

The menopause can be a worrying and stressful time but knowledge is power – and the more you know, the better you can deal with it. Dr Stephanie Goodwin, Menopause Specialist GP at Chiswick Medical Centre, explains:

What is the menopause?

Menopause is a definition referring to when women have stopped having periods for a year and can no longer become pregnant naturally. This happens when the body stops producing oestrogen, which controls periods, and an egg is no longer released each month. The menopause can be expected to occur between the ages of 45-55 years old.

How is it different from perimenopause?

We often say women are ‘going through the menopause’ when talking about the period of symptoms, such as irregular menstruation and hot flushes, leading up to periods ceasing completely; however, this process is in fact the perimenopause.

Simply put, the perimenopause is the transition to menopause. It can last months or years, but varies a lot from woman to woman.



What happens during the perimenopause?

Perimenopause indicates a significant hormonal change going on in the body, so naturally it can take a toll. It can affect the brain, the skin, muscles and emotional behaviour, and because of the gradual nature of the decline in oestrogen, women can experience changes in their behaviour a long time before their periods stop happening.



Menopause signs and symptoms

Many women will experience perimenopausal symptoms, but maybe not all of them – and they can start a long time before the final period (menopause). They can be light, or conversely, they can be detrimental in a woman’s day-to-day life.

Common perimenopausal symptoms include:

    As well as starting in advance of the last period, these symptoms can last up to four years after you reach menopause.



    Menopause treatment options

    If you are struggling with the symptoms of perimenopause and menopause, it’s best to see your GP to discuss your symptoms and what treatments and therapies may help alleviate them, as no two women are the same.

    Depending on whether you’re experiencing physical symptoms, emotional symptoms, or both, your doctor may prescribe you with any of the following options:

    • Hormone Replacement Therapy

    Your doctor may prescribe you hormone replacement therapy (HRT), which aims to relieve common menopausal symptoms by replacing oestrogen. HRT can be taken through tablets, or by using patches or gels. HRT is effective in treating not only physical symptoms such as hot flushes and vaginal dryness, but also in alleviating mood symptoms such as increased anxiety and low mood.

    • Cognitive Behavioural Therapy

    Your doctor may refer you for a course of Cognitive Behavioural Therapy (CBT). A talking therapy often used to treat depression and anxiety, this is used to help tackle the low mood and increased anxiety symptoms.

    • Medications to treat specific symptoms

    Your doctor may prescribe medication to treat specific symptoms you’re experiencing as a result of the perimenopause or menopause:

    ✔️ This could include oestrogen creams to help with vaginal dryness.

    ✔️ Sometimes women who cannot take HRT for medical reasons may be offered antidepressant medications which can be very helpful for hot flushes and sweats as well as depressive symptoms.

    ✔️ Your doctor may also give you advice on how you can adapt your lifestyle to minimise or alleviate perimenopause and menopause symptoms. This may include diet advice or exercise suggestions.



    Lifestyle tips to make the menopause easier

    A healthy and balanced lifestyle is effective in helping reduce the severity of menopause symptoms. It’s important to keep exercising regularly and maintain a healthy diet.

    Cutting down on certain foods and habits is also helpful – this includes limiting coffee, alcohol and spicy foods, and stopping smoking.



    References

    • Writing group for the WHI study. Risks and benefits of oestrogen progestin in healthy postmenopausal women. Principal results from the women's health initiative randomised controlled trial. Journal of the American Medical Association 2002;288:321-333
    • Dixon JM. Hormone replacement therapy and the breast. British Medical Journal 2001; 323: 1381-1382
    • Hickey M, Elliot J, Denison SL. Hormone replacement therapy. British Medical Journal 2012; Feb 16 344 Panay N, Hamoda H, Arya R et al. The 2013 British Menopause Society and Women's Health Concern recommendations on hormone replacement therapy. Menopause Int, 2013; June 19(2); 59-68.

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