Menopause: Your no-nonsense guide

It’s a natural stage of ageing, with challenges and cycles of its own. But the right advice and treatments make managing the menopause much easier.

Menopause is a time in a person’s life when their periods have stopped for 12 months, something that usually happens between the ages of 45 and 55 – the average age is 51. Although we say we’re “going through” menopause, the time when we’re having symptoms is actually known as perimenopause, which usually begins in our forties.  

Just as puberty is the beginning of a woman’s reproductive years, menopause signals the ending of those reproductive years.

Smiling womanCredit: Shutterstock / Monkey Business Images

Although both sexes produce oestrogen, females make (and need) much more. It is this crucial hormone that aids our reproductive system, enabling the uterus lining to thicken as part of the menstrual cycle.  

As our oestrogen levels decline during perimenopause, periods become irregular, eventually stopping altogether. It is the lack of oestrogen that causes many of the symptoms experienced during perimenopause. 

Perimenopause symptoms

Symptoms vary by person

Speaking to Saga Exceptional, Newson Health menopause expert and GP Rebecca Lewis tells us: There are receptors to oestrogen on every single cell in the body, and it underpins the function of all our organs.  

It’s important in our brain, and our limbic system, and lack of oestrogen affects our mood, concentration, memory, fatigue, libido.”   

Perimenopause symptoms form a long and varied list, because oestrogen is used throughout the body. You might have physical symptoms such as irregular periods or sore breasts, or psychological symptoms, such as anxiety or depression. In fact, although some researchers have suggested there are 34 symptoms of menopause, it’s thought there could be many more.  

Lack of oestrogen affects our internal thermostat,” Lewis explains. This can lead to hot flushes and night sweats. We can become fatigued and experience aching muscles. Women can also experience urinary problems – recurrent infections, incontinence or an increase in urgency due to a lack of oestrogen in the bladder.”   

That can all sound overwhelming, but its important to stress that we wont all experience every symptom during menopause.  

We know that 75% of women will have symptoms that will affect them in some way, but 25% of those won’t really be affected too significantly. It’s unique to each person,” Lewis says.  

For most, dealing with perimenopause symptoms is relatively straightforward. There are a variety of options or paths to take (which you’ll read about later) to keep everything under control.  

However, it’s worth noting that some women experience more extreme symptoms, and these can really affect day-to-day life.

Menopause support is critical. If you’re finding it hard to manage symptoms, be sure to talk to your doctor, loved ones, and workplace colleagues (if applicable). Accessing the help and support you need is crucial to maintain positivity during this transition.  

Woman taking HRTCredit: Shutterstock / Image Point FR

Treatment options

Medical or holistic?

If menopause symptoms are affecting your day-to-day life, treatments to investigate include hormone replacement therapy (HRT), cognitive behavioural therapy (CBT), and complementary and alternative therapies, among others.  

There are also treatment options for specific menopause symptoms, such as testosterone gel for reduced sex drive or oestrogen cream for vaginal dryness. Of course, you might decide you don’t want to treat the symptoms at all, and that’s perfectly fine. You can deal with menopause in your own way. 

HRT

Hormone replacement therapy (HRT) replaces hormones that are at a lower level due to perimenopause. This can help eliminate issues for some women, such as hot flushes, mood swings or anxiety. HRT can also protect against health issues that arise due to lack of oestrogen.  

“The principle of HRT is restoring hormone levels – physiologically replacing like with like, and that’s restoring your hormone levels to where they were before you went through the menopause,” Lewis says.  

“If you do that within 10 years of a woman’s last period, you will reduce their risk of heart disease. Osteoporotic fractures are reduced by up to 40%, it will help your glucose handling, which can help decrease obesity. And if you’re under the age of 45, studies have shown that HRT can decrease your risk of dementia.    

Most women take HRT as a combination of oestrogen and progestogen. However, if you don’t have a womb, you can take oestrogen-only HRT. It comes in many forms: tablets, patches, gels, pessaries, creams and rings. Your GP can help advise you on which will be best. You might need to try more than one form until you find the right one for you.

There is very little increased risk of breast cancer if taking oestrogen-only HRT, but a slightly higher risk for combined HRT. There can also be an increase in the risk of stroke or blood clots when taking HRT tablets, but again, this is small. 

It’s important to weigh up the benefits and risks of taking HRT. The NHS says that the risks are relatively small, and are usually outweighed by the benefits, but that still doesn’t mean it’ll be the right option for everyone, and it really is a personal choice.  

Dr Paula Briggs, chair of the British Menopause Society, points out that there’s a lot of misinformation around menopause and HRT, particularly on social media:  

“It should be an active choice that people make in relation to how they manage that life stage,” she explains. “HRT is an important treatment option, but not everybody can take it for one reason or another and not everybody wants to. 

She adds: “What’s happening currently is there’s a lot of anxiety in relation to menopausal symptoms. We’re seeing women in their thirties asking for HRT because they’re so frightened about how their menopause is going to be, and then much older women also asking for HRT because they think it might reverse things, which it’s not going to do either.” 

It’s important to have a full discussion with your doctor or menopause specialist to make an informed decision about taking HRT. 

Woman talking in therapy sessionCredit: Shutterstock / wavebreakmedia

Alternative treatments

Several alternative treatment options to HRT exist. Again, it’s down to your personal choice. Some women opt for a different form of medical treatment, such as taking antidepressants. Tibolone is an alternative to combined HRT and can reduce symptoms such as hot flushes and low libido, but it is only suitable for postmenopausal women (those who’ve had their last period more than a year previously). Tibolone is classed as a synthetic hormone: it is not a direct hormone replacement for oestrogen and progesterone, but instead mimics their activity in the body. 

CBT

Cognitive behavioural therapy (CBT) is a talking therapy often used to treat anxiety and depression – two symptoms that can arise in some perimenopausal women. While CBT can’t treat physical symptoms, being able to talk to a professional about how you’re feeling can help you deal with psychological symptoms by building up your coping mechanisms. You can refer yourself for CBT via NHS talking therapies if you live in England. For those in other parts of the UK, your GP should be able to direct you toward CBT help.  

Myra Hunter has looked into the effects of CBT with the British Menopause Society. She has also written a book based around CBT, which may be useful for those wanting a non-medical approach to dealing with menopause symptoms. Findings show that it can be effective in reducing the impact of some menopause symptoms and improving sleep and quality of life.  

Briggs offers further explanation on how CBT works: “The basis of it is about not flying off the deep end, for example when you have a hot flush. It’s about managing that moment and not letting it escalate. So, the patient still has the hot flush, but it’s the reaction to it that changes.” 

Complementary therapies

Many health food stores sell products that can help during menopause. There is some evidence to suggest that St John’s wort and black cohosh might help with hot flushes (evening primrose oil wasn’t thought as effective, though some women found it helpful). It’s worth noting that the studies into these herbal remedies were small in scale, which makes them harder to rely on.  

When looking into herbal medicine, it’s important to remember that it may interact with other medications you’re taking, so always seek advice from a professional before trying something new. 

Group of female friends laughingCredit: Shutterstock / Monkey Business Images

Exercise

It can be hard to find the motivation to exercise if your joints are aching or you’re struggling to sleep at night. However, exercise in menopause will really help. Not only can exercise prevent osteoporosis, osteoarthritis and more, but it can also help your mood and sleep. Gentle, restorative yoga for the menopause can help you to reconnect with your body and take time out from busy lives to focus on yourself.  

“It doesn’t have to be anything extreme,” Briggs says. “You can just get out and walk briskly for half an hour a day, five days a week. Maybe combine that with something like Pilates for the effect that has on the core, including the pelvic floor.” 

At the other end of the spectrum, you might like to sweat it out in the gym, taking out your frustration with some strength training or by hitting a punch bag. Whatever you choose to do, keeping fit and active through menopause is one of the kindest things you can do for yourself.

Diet

Diet and exercise go hand in hand, and nourishing your body throughout perimenopause is important. As our oestrogen levels decline, we can begin to gain weight, especially around the middle. Our muscle mass decreases, meaning our metabolism slows and we store more fat.  

There is evidence that a Mediterranean-style diet (which has plenty of vegetables, fruit, pulses, nuts and wholegrains, as well as fish and lean meat) can help maintain a healthy weight. Fats are essential to wellbeing, so don’t try to cut them out. Instead, choose healthy options such as olive oil, avocado and nuts.  

There is also evidence that a Mediterranean-style diet can help reduce the risk of heart disease and prevent or even reverse type 2 diabetes. Many factors of menopause can put us at greater risk of developing these conditions, so it’s worth eating well and exercising regularly to combat them.  

Addressing obesity can not only help ease menopause symptoms but it will also vastly improve overall health, wellbeing and longevity. Briggs says that “just adding hormones is not enough” – other issues need to be dealt with in order to see an improvement in symptoms. 

“My approach would be everything in moderation,” she says. “Have a good mix of food types on the plate, more protein, fresh fruits and vegetables and less carbohydrates. As you get older you need less calories, so try using a smaller plate or just having smaller portions.” 

Briggs also recommends stopping smoking and minimising alcohol consumption to promote better sleep, manage weight, lessen anxiety and reduce the risk of type 2 diabetes.  

Woman in field, arms held wideCredit: Shutterstock / KOTOIMAGES

Ask for support

Talking helps

Menopause has long been a taboo subject, but the tides are turning. As well as hearing more about it in the media (and Parliament), people are becoming more open and honest about their own menopause experiences. This openness helps others understand what we’re going through and how best they can support us.  

If you can, ask female family members about their menopause and try to learn more about when your mother or other female relatives experienced the menopause. This will help you make a rough guess at what age you can expect to go through it, as well as perhaps boosting familial backing. Loved ones can be a great source of support – whether it’s going with you to appointments or helping you talk through possible treatment options.  

If you’re working and find symptoms are affecting your ability to do your job, talk to your HR manager, line manager or similar. Many work places have menopause policies and will be able to offer you support.  

“Communicate openly with employers,” Briggs says. “Ask for help rather than hiding things.”  

Useful resources

Your GP, sexual health clinic or menopause clinic should be able to talk to you about how you’re feeling, any symptoms you’re having and treatment options.  

Women’s Health Concern, The Menopause Charity and Menopause Matters are just three of the excellent resources online, while apps such as HerCare, Balance and MBody allow you to track menopausal symptoms and share data with your healthcare provider. Queer Menopause has a great resource of support for LGBTQIA+ people dealing with menopause.

What comes next?

Embrace the change

Post-menopause, many women find their lives opening up and becoming richer. Let’s be honest, no more periods is something many of us have been waiting for, and there’s a definite freedom associated with that. But also, our mindset changes.

We can step into our power as women and redefine our boundaries. With age comes wisdom and experience; we know what we will and won’t tolerate. We know what we’re worthy of and how we deserve to be treated.   

“Menopause should be a great time,” Lewis states. “It’s a time to take stock of your future health, because we still have 30-40% of our lives to live after menopause, so we really want to make sure that it’s our best life.” 

Becky Fuller

Written by Becky Fuller she/her

Updated:

Becky Fuller is a fully qualified Personal Trainer, specialising in strength and conditioning for over 50s. Becky’s focus is helping people to become stronger both in body and mind, and to move well without pain. Becky also has many years’ experience working as a freelance journalist, writing for a wide variety of publications such as Screen Rant, Geek Feed, and Daily Actor. She also regularly reviews theatre productions for UKTW.

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