Perimenopause and Menopause Essentials

In this guest blog post, Dr Louise Newson explains the essentials of perimenopause and menopause and talks about how exercise and good nutrition can help with the symptoms.

For decades, the menopause has been a taboo and there has been a huge amount of misinformation and misconceptions about treatment options, especially hormone replacement therapy (HRT). This has resulted in women's health being far worse than it could be otherwise. If more women were given the right advice and treatment based on the available evidence, women's health would improve and health costs to the NHS and other healthcare systems globally would also dramatically reduce.

What is the menopause?

The menopause is when the ovaries stop producing eggs and levels of hormones oestrogen, progesterone and testosterone fall.

The definition of menopause is when a woman hasn't had a period for 12 months, and the average age of the menopause in the UK is 51. However, it's really important to state that it doesn't just happen in mid-life: menopause before 45 is known as an early menopause, while menopause before the age of 40 is known as premature ovarian insufficiency (POI).

POI is a lot more common than most people think: it affects about 1 in 100 women under the age of 40, and 1 in 1,000 women under 30. Even girls in their teens can be perimenopausal or menopausal.

For most women with POI, the underlying cause is unknown, but it can be triggered by events such as having your ovaries removed, a hysterectomy, radiotherapy to the pelvic area as a treatment for cancer or if you have received certain types of chemotherapy drugs that treat cancer. In addition, eating disorders can lead to early menopause in some women.

What is the perimenopause?

The perimenopause is the time directly before the menopause, when you still have periods, but the fluctuating and low hormone levels - especially oestrogen - can trigger a whole host of symptoms.

There is no blood test for the perimenopause or menopause - they can often be diagnosed by completing a Menopause Symptom Questionnaire.

What sort of symptoms can women expect?

As women have oestrogen receptors in every cell throughout their bodies, there are literally dozens of symptoms associated with perimenopause and menopause. Often these symptoms will be blamed on other conditions and the stresses and strains of everyday life.

Symptoms can vary each day and are different for each person, so it is important to be aware of potential symptoms so you can speak to a healthcare professional if symptoms start to affect your everyday life.

Often periods become heavier or lighter, last longer or become shorter. If you have had premenstrual syndrome then you might find symptoms like mood swings become more severe.

Other symptoms include:

• Fatigue and insomnia
• Night sweats and hot flushes
• Poor sleep
• Low sex drive
• Brain fog and memory problems
• Low mood and anxiety
• Reduced concentration
• Weight gain - the middle age spread isn't a myth!
• Headaches, and more regular or intense migraines
• Vaignal dryness and soreness
• Recurrent UTIs and urinary incontinence
• Oral symptoms like dry mouth, gum disease and even tooth loss
• Dry, itchy skin and thinning hair
• Joint and muscle pain
• Tinnitus
• Pins and needles
• Heart palpitations

The mental health impact and the impact of other symptoms can be huge and, sadly, suicide rates for women aged 45 to 54 - the most common age for perimenopause and menopause - have risen 6% in 20 years, according to the Office of National Statistics.

Health risks that can arise due to the falling hormones during and after the menopause

Once a woman's periods have stopped, her hormone levels will always be low, regardless of whether or not she experiences symptoms - she will have a female hormone deficiency. There are health risks of the menopause as women have an increased future risk of heart disease, osteoporosis, type 2 diabetes, dementia and clinical depression as a result of low hormone levels that occur.

What sort of treatments are available?

Hormone replacement therapy (HRT) is usually the first-line treatment for women. It does what it says on the tin - it replaces the hormones a woman is deficient in, which in turns relieves symptoms and helps to protect a woman's heart, bones and body.

Only around 14% of menopausal women take HRT but, in some areas in the UK, it is as low as 2%.

Financial status and ethnicity also affect access to HRT and wider menopause care: one study found the overall prescribing rate of HRT was 29% lower in English GP practices from the most deprived areas compared with the most affluent. And there is a shameful lack of dedicated research into the impact of the menopause on women from minority communities.

There are lots of different ways to take HRT, including a skin patch, gel or spray. This means HRT can be changed according to the individual and can be adjusted if needed. It's so important that women speak to their healthcare professional to talk through the individual benefits and risks of HRT based on their age, symptoms, medical history and personal preference.

There are numerous potential benefits to be gained by women taking HRT. Symptoms of the menopause such as hot flushes, mood swings, night sweats and reduced libido improve. Numerous studies have shown that shown that when women take HRT they have a lower future risk of osteoporosis, type 2 diabetes, osteoarthritis and also death from all causes.

The majority of women taking HRT will take oestrogen and will take progesterone to protect the lining of their womb if they still have one. Testosterone can also be prescribed if the benefits of HRT are not being felt after several months, it can help with low sex drive but also mood, energy and concentration often improve.

Busting some HRT myths

HRT as a treatment has been around for half a century, but in the early 2000s a study was published that linked it to an increased risk of breast cancer in women who took combined HRT, which contains both oestrogen and a synthetic version of the hormone progesterone called progestogen. This led to scores of worrying headlines and the number of women taking HRT plummeted. However, the risks are still very small and the types of HRT we prescribe now are body identical rather than synthetic and have not been shown to be associated with any risk of breast cancer. For the majority of women who take body identical HRT, the benefits outweigh any risks.

Studies have shown that women who take oestrogen-only HRT actually have a lower risk of developing breast cancer than women who don't take HRT.

Any risk of breast cancer even with lower types of HRT is very low; to put this in perspective, the risk of breast cancer is greater in women who are overweight or drink moderate amounts of alcohol compared to taking any types of HRT.

If a woman has a history of blood clots, liver disease or migraine, they are still able take some types of HRT. Having an oestrogen patch, gel or spray with micronised progesterone are not associated with a risk of blood clots.

What about other treatment options?

There is more to good menopause care than just taking HRT - having a good and healthy menopause is all about holistic care. It's never too late - or too early - to start making some simple but effective changes to make the perimenopause as smooth and symptom free as possible.

Food and nutrition

A great place to start is by eating a balanced diet with lots of fresh fruit and veg. Try to cut back on processed foods and also reduce your sugar intake. Healthy fats, such as olive oil, avocados and nuts, are really beneficial. Spicy foods and caffeine can trigger hot flushes, so steer clear if you suffer from them. Likewise so can smoking, so yet another reason to quit.

Many women drink more alcohol to try and numb their symptoms or to help them sleep but it actually worsens the quality of sleep and can lead to early waking. It can also lower mood, which is not ideal.

Exercise

Exercise is hugely beneficial too - not only can it release endorphins, the feel-good hormones, but it can protect against the long-term effects of hormone deficiency. Lack of oestrogen increases the risk of osteoporosis and cardiovascular disease, so regular exercise will help strengthen bones and help keep a woman's heart healthy.

Unless you have been told to avoid a particular exercise by a health professional, all exercise will be beneficial to your general health and wellbeing before, during and after your menopause.

In addition, there are two types of exercise that are particularly good for bone health. The first is weight-bearing exercises, where our bones support our weight. Variety is good for bones, which you can achieve by varying movements, direction and speed. Examples of good weight-bearing exercise includes brisk walking, dancing or aerobics.

The second type is strength exercises, when you use your muscles to pull on your bones. Your bones will respond to this by renewing themselves or maintaining or improving their strength. Examples of strength activity include yoga, Pilates or exercises involving weights or resistance bands.

The main thing is to find an exercise that you enjoy so you will be more likely to stick to it - exercise is such an important investment in your health and wellbeing.

Dr Louise Newson is a GP and Menopause Specialist who works to increase awareness and knowledge of the perimenopause and menopause, and campaigns for better menopause care for all women.

She is founder of the free balance app and also The Menopause Charity. You can find her on Instagram here.