Although some women ‘sail through’ their menopause years, for others the years leading up to and including the menopause can be an extremely difficult time.

Many women find their lives turned upside down by the symptoms of menopause and I often see women who have relationship breakdowns at home, at work and with friends largely due to symptoms of menopause.

I suppose we should start by clarifying what we mean by ‘the menopause.’

the menopause is when a woman stops having periods and is no longer able to get pregnant.

For most women, their periods become irregular for a varying length of time before stopping all together, but for some their periods can stop suddenly.

The ‘perimenopause’, or menopause transition, refers to the period of time when the ovaries gradually begin to make less estrogen.

Perimenopause usually starts when a woman is in her 40’s but can start in her 30’s or even earlier. Menopause is considered ‘early’ in women who stop having their periods before the age of 40. this is also know as ‘premature ovarian insufficiency.’ The majority of women will reach menopause between the ages of 45 and 55, with 51 being the average age in the UK.

Most women experience menopausal symptoms. For some, these may be mild and short lived, but for others, the menopause can bring severe symptoms which can have a significant impact on their quality of life. The average length of perimenopause is 4 years, so you can appreciate the impact the symptoms of menopause can have on your physical and mental wellbeing.

Most people are aware of the fact that during the menopause a womans ovaries stop producing oestrogen. What we also need to bear in mind is that other hormone changes are taking place as we age too, including falling levels of progesterone and testosterone.

Reduction in oestrogen levels increases your risk of:

  • bone thinning (women can lose up to 20% of their bone density in the 5-7 years after menopause)
  • heart disease and stroke (oestrogen has a protective effect on the lining or your blood vessels, including the ones that supply your heart.

And can cause other symptoms including:

  • vaginal dryness (making sexual intercourse uncomfortable and increasing the risk of urinary tract infections)
  • Night sweats
  • Breast tenderness
  • Headaches, including migraine
  • Palpitations
  • Anxiety
  • Insomnia/broken sleep
  • Fatigue
  • Weight gain around the abdomen
  • Loss of muscle mass (sarcopaenia)
  • Brain fog
  • Incontinence

Falling progesterone levels can cause periods to become very irregular and heavy during the perimenopause.

Reduction in testosterone has been implicated in reduction in libido during the perimenopause but I suspect the reduction in libido experienced by many women is multi factorial.

It is no surprise that, as a GP, I see many women every week who come in looking for advice on how to improve their menopausal symptoms so that they can get back to enjoying what should be some of the best years of their lives.

I would encourage all women who are experiencing, or think they may be experiencing symptoms of menopause that are having a detrimental effect on their wellbeing to go and see their GP.

In Scotland, if you are over 45 and have symptoms of menopause, your GP should be happy to discuss medical and lifestyle management with you without checking your hormone levels. If you have few symptoms they may check your level of Follicle Stimulating Hormone (FSH) as well as other bloods to make sure there isn’t another cause for your symptoms.

If you are under 45, even if you have a full house of symptoms, your GP will check your FSH levels (and other bloods as above as dictated by your symptoms).

They can then discuss the risks and benefits of HRT and alternatives to HRT with you if this is something you are keen to consider.

There are several good online resources that have lots of evidence based information about the risks and benefits of HRT including, and, for those with premature menopause

There are some benefits to taking HRT in terms of your risk of various diseases quite apart from the reduction in menopausal symptoms but, as noted above, you need personalised advice from your GP to work out if this could be a good treatment options for you.

Many women worry about the risk of blood clots when taking HRT but evidence has shown no increased risk if you are using HRT patches.

Others are concerned that HRT may increase their risk of heart disease and stroke. In fact, the risk of heart disease and stroke remains the same or is reduced with oestrogen only HRT (for those without a uterus) and combined HRT (for those with) has been shown to have no or little increased risk.

HRT does not increase your risk of Type 2 diabetes.

Oestrogen only HRT does not increase your risk of breast cancer. Combined HRT can be associated with an increased risk of breast cancer. This increase in risk is related to length of time on treatment and reduces after stopping HRT.

HRT reduces your risk of bone fractures while taking HRT but this benefit reduces when treatment is discontinued, It also helps maintain muscle mass and strength.

There are also some non hormonal options that can be used to treat some of the symptoms of HRT. Again, your GP can go through the options with you. Some of these options include the use of certain anti depressants for treatment of hot flushes (off license use) and mood disturbance and refer for Cognitive Behavioural Therapy for sleep/mood disturbance.

Whether or not you decide to try medication to help you with your menopausal symptoms it’s definitely worth looking at your lifestyle as making some small changes here can have a big impact on how you feel.

Stay active:

  • It’s recommended that adults aged 19-64 do at least 150 minutes of moderate intensity activity each week. This includes brisk walking. increasing your activity can help combat many of the symptoms of menopause (poor sleep, fatigue, weight gain, anxiety) as well as increase your muscle mass and strengthen your bones.
  • It’s also recommended that we do resistance training 203 times per week. Adding in some weight bearing or resistance exercises (either body weight or with added weights), will help maintian or even increase your muscle mass, aid bone remodelling and improve your mood.
  • Adding in activities such as yoga, pilates and core strengthening can help reduce your risk of chronic disease, aid sleep, reduce stress and help avoid problems with urinary incontinence due to a weak pelvic floor.

Staying active, moving more and sitting less, also reduces your risk of various cancer, heart disease, stroke disease, type 2 diabetes, depression, anxiety and whole host of other chronic diseases. Lots more info of this in previous blogs.

Prioritise sleep:

  • Make a concerted effort to ensure you get enough good quality sleep. Check that your room is cool, dark and quiet and that your bed and bedding and comfortable. Prioritise your bed time routine practice some techniques to help you relax into sleep if this is becoming a problem for you. There are apps such as calm and headspace and lots of good websites for night time meditation, journalling and yoga that are worth having a look at.
  • Avoid taking too much caffeine in general and consider avoiding caffeine after lunch as it has a long half life and stays in your system for many hours.
  • Avoid alcohol before bed as it can reduce both the length and quality of your sleep. Lots more on this in previous blogs too.
  • Avoid blue light from screens in the hour before bed.

Make time to manage stress:

  • You find time in the week to do the shopping and cooking and to take the bins out. You need to make sure you prioritise managing your stress in the same way. This is important for everyone at all stages of life, but if you are struggling with mood changes, poor sleep and faltering self confidence that can accompany the menopause then you would do well to identify 10-20 minutes each day to do something for yourself to help you relax and de stress. For me, this is often going for a walk or taking ten minutes to do some stretches or sit on my own with a cup of tea and no phone/TV/kids. Sounds simple but if you don’t plan it in, it often doesn’t happen.
  • Managing stress also helps to keep cortisol levels under control. When we are stressed our cortisol levels go up. This can cause, among other things, fat gain and muscle loss. You can’t eliminate stress but you can do things to handle it better.
  • Make time to see friends. We need social support to help us get through the changes we experience during menopause. Why not meet up for a walk and a chat?

Eat a balanced diet:

  • While I am all for enjoying food and trying to find a good balance of eating what you love when you want it there is definitely a lot to be gained by looking at your diet during the menopause. Make sure you are well hydrated, especially if you are feeling tired or plagued by headaches. Aim to eat a wide variety of fruit, veg, beans, pulses, nuts and grains to ensure you are feeding all your good gut bugs well and keeping your nutrients topped up and try to avoid drinknig too much alcohol as it can make symptoms such as hot flushes, insomnia, anxiety, palpitations and mood swings worse.
  • Try to include food rich in calcium (those above, dairy)and vitamin D (oily fish, eggs). It’s hard to get enough vitamin D from food so you oculd consider a supplement, especially in winter months.

Get outdoors:

  • Spending time outdoors will not only help you top up your vitamin D but it’s also been proven to be good for your mood. Walking outdoors and surrounding yourself in nature can help reduce anxiety, increase muscle mass and helps ensure a good night’s sleep.

So you see, there are lots of things you can try to help ease your journey through menopause.

I would encourage all women to seek support from their GP with regards to treatment options and it is definitely worth exploring whether HRT may be suitable for you.

If you feel you need more support or advice, or if whatever you have tried to date hasn’t work you should ask your GP if there is a local menopause clinic that you could be referred to. Menopause shouldn’t be something you have to suffer.

Laura ??

©AYOSC 2019

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