Before, During & After

Menopause is the normal, natural transition in life that begins between the ages of 35-55. During this time, your ovaries get smaller and stop producing the hormones estrogen and progesterone that control the menstrual cycle, your eggs are depleted and fertility declines. Eventually, you are no longer able to become pregnant.

Peri menopause

The 3-5 year period before menopause when your estrogen and hormone levels begin to drop is called perimenopause. You typically enter into perimenopause in your late 40’s and could begin to experience irregular menstrual cycles and symptoms such as:

• Hot flashes
• Sleep disturbances-insomnia
• Night sweats
• Elevated heart rate

• Mood changes—irritability, depression, anxiety
• Vaginal dryness or discomfort during sexual intercourse
• Urinary issues

There is still a chance that you could get pregnant during this time and if you want to avoid this, a form of birth control is recommended until one year after your last period. A form of progestin therapy may also be an option to control menstrual bleeding and address vasomotor symptoms. Lifestyle changes are often recommended to help relieve other unpleasant symptoms.

Early menopause

Certain events other than natural aging can result in an earlier menopause:

• Hysterectomy (uterus removed)—symptoms appear gradually
• Oophorectomy (ovaries removed)—symptoms appear immediately
• Premature Ovarian Failure (POF)—underactive or inactive ovaries due to genetics, surgery, or cancer treatments, such as radiation therapy or chemotherapy. POF can also be due to ovarian dysfunction or insufficient follicles, which mature into eggs.

Menopause

On average, most women are about 46 to 52 when they enter menopause. Technically, you are in menopause after you’ve missed your period for 12 straight months without experiencing other causes, such as illness, medication, pregnancy or breastfeeding. The transition from perimenopause through menopause to postmenopause can take 1-3 years. It’s important to remember every woman is unique and will experience menopause differently. Some women experience few, if any symptoms, and for those who do, the symptoms can vary widely.

Post menopause

Postmenopause starts after one year has passed since your last menstrual cycle. Other symptoms that might have started in perimenopause can continue through menopause and postmenopause. It’s not unusual to experience:

• Hot flashes
• Night sweats
• Elevated heart rate
• Sleep disturbances-insomnia
• Mood changes—irritability, depression, anxiety
• Urinary issues
• Vaginal dryness—which can lead to discomfort during sexual intercourse

Additionally, due to the decrease in estrogen, there’s an increased risk of heart disease, osteopenia and osteoporosis.

SYMPTOMS OF MENOPAUSE

Every woman will experience menopause differently. You might have symptoms that are barely noticeable, while your friends could experience almost all of them. Listed below are the most common symptoms women have—from perimenopause through postmenopause:

Irregular Periods

Especially during perimenopause, your menstruation may become irregular. You can start to experience missed periods, unusually heavy flow during some months and atypical spotting or bleeding. Once you are in full menopause, your menstruation stops completely and any bleeding you experience after that point should be evaluated by your OB/GYN or health professional. You could still be fertile during perimenopause.

Hot flushes

A hot flush is a sudden, intense surge of heat that spreads over your body, concentrating in the head, neck and chest areas. This sensation of heat can be accompanied by flushing (turning red in the face and chest), an elevated heart rate and perspiration. Hot flushes last from 30 seconds to several minutes and can occur several times a day or only a few times a week. They can happen at any time, but are often triggered by a warm environment, physical exertion or stress. When hot flashes wake you during sleep, they are called “night sweats.” Although the exact cause of hot flushes and night sweats are not completely understood, most research suggests they are due to a woman’s fluctuating hormone levels.

Palpitations/anxiety

Some women experience a sudden elevation in their heart rate that feels like their heart is racing or pounding or having palpitations. You might even notice a slight shortness of breath. While this is usually in conjunction with hot flushes or night sweats, you may notice an increase of perspiration with an elevated heart rate that is independent of the hot flushes and feeling of panic or anxiety. This combination of perspiration, and an increased heart rate can happen day or night, unfortunately disturbing your sleep as well

Mood changes

Your hormone fluctuations can cause all kinds of mood changes, such as irritability, anxiety, fatigue, difficulty concentrating, forgetfulness and depression. Depression is already more common in women than men, and if you have been previously diagnosed with depression, you are more likely to experience depressive symptoms–especially during perimenopause. These symptoms can include a loss of interest in your normal activities, weight loss or gain, sadness, hopeless feelings, irritability and tiredness.

Sleep issues

Insomnia is something many women encounter when they enter menopause. Your core body temperature needs to cool off at night in order to sleep, and hot flashes and night sweats suddenly raise your temperature in the middle of the night, causing your sleep to be disturbed. Other symptoms such as stress, anxiety and depression can also interrupt a good night’s sleep.

Vaginal discomfort

Uncomfortable vaginal symptoms may occur when the lining and tissues of the vagina become drier, thinner and less elastic due to the decline of estrogen. The loss of natural lubrication can cause itching, irritation and vaginal discomfort. Some women feel this affects their sexual desire, arousal and can even cause pain during sexual intercourse and other sexual activity.

Urinary issues

Similar to the changes in the vagina, the lining of your urinary tract can become drier, thinner, and less elastic. This could lead to an increased need to urinate and a loss of muscle control (leakage of urine)—especially when coughing or laughing. The risk for urinary tract infections (UTIs) is greater as well.

HOW HORMONE DEPLETION AFFECTS YOU

What causes menopausal symptoms? Hormonal changes.

Hormones are the messengers in the body that travel through the blood stream to start, stop, speed up or slow down your physical and chemical functions and processes across all body systems. Your ovaries are the source of estrogen and progesterone, the two key hormones that control the reproductive system, including the menstrual cycle and fertility in women. You are born with all the eggs you will ever have. The eggs are in the follicles, which are found in the ovaries. During menopause, the number of ovarian follicles declines and the ovaries become less responsive to the two other hormones involved in reproduction—Luteinizing Hormone (LH) and Follicle-Stimulating Hormone (FSH). As your ovaries age and release fewer hormones, FSH and LH can no longer perform their usual functions to regulate your estrogen, progesterone and testosterone. These inevitable changes in your hormones and natural decline of estrogen levels during menopause can significantly affect your health for years to come. Click on the bars next to diagram to discover how estrogen depletion can affect each part of your body.

See How Hormone Depletion Affects You

BRAIN AND NERVOUS SYSTEM

Estrogen depletion can bring on a combination of hormonal and biochemical fluctuations that can lead to changes in your brain and nervous system. You may experience mood swings, memory loss, problems focusing, irritability, fatigue, hot flashes, night sweats, stress, anxiety and depression. Physical symptoms, such as hot flashes, mixed with cognitive changes, such as irritability and memory loss, can create more opportunities for emotional changes and mood swings, although no research to date shows a direct link to depression due to menopause. Some researchers believe that estrogen depletion can affect your memory and may impact one’s risk for the development of Alzheimer’s disease, but more research is needed.

HEART

Due to estrogen depletion, women are put at an increased risk for cardiovascular issues, such as heart attacks, strokes, or other heart-related problems. If you have undergone a hysterectomy (removal of uterus) and/or oophorectomy (removal of ovaries) and have experienced early menopause, you are at an even greater risk for heart problems. In addition to menopause-related estrogen depletion, your age, family history, diet, and lifestyle also play a key role in your heart health.

REPRODUCTIVE SYSTEM

Your reproductive ability decreases with age due to the loss of ovarian function and estrogen depletion. The monthly menstrual cycle that you’ve had since puberty ends with menopause and you’re no longer able to conceive.

BONES

After the age of 30, the creation of new bone cannot keep up with the rate of bone loss in your body. The estrogen depletion that comes with menopause results in an increased risk for low bone mineral density, osteopenia and osteoporosis. For 5-10 years after menopause, this bone density loss accelerates into a gradual weakening of your bones and can lead to an increase in the risk for fractures and other injuries.

SKIN

The body’s largest and most visible organ, your skin, undergoes changes during menopause. The reduction of estrogen at menopause decreases the water-holding ability and elasticity in the skin, leading to dryness, itching, and an increase in wrinkling and sagging. Your skin becomes more susceptible to injury, such as bruising. Estrogen appears to help your skin heal faster when wounded and researchers are beginning to study its possible connection to melanoma, a serious type of skin cancer.

URINARY SYSTEM

As with the vagina, estrogen depletion can cause the lining of your urethra to become drier, thinner and less elastic. This can lead to feeling the need to urinate more often, an increased risk of urinary tract infections (UTIs) and involuntary leaking of urine (incontinence) when coughing, laughing or lifting heavy objects.

VAGINA

Low estrogen levels can lead to vaginal dryness, irritation or discomfort. This lack of estrogen can cause vaginal atrophy—an inflammation of the vagina as a result of the thinning and shrinking of the tissues, along with a decrease in lubrication. Sometimes this thinning and dryness can lead to discomfort during sexual activity and make your vagina more vulnerable to infection.

The main treatment for menopausal symptoms is hormone replacement therapy (HRT), although other treatments are also available for some of the symptoms.

Hormone replacement therapy (HRT)

HRT involves taking oestrogen to replace the decline in your body’s own levels around the time of the menopause. This can relieve many of the associated symptoms.

Guidelines from the National Institute for Health and Care Excellence (NICE) say that HRT is effective and should be offered to women with menopausal symptoms, after discussing the risks and benefits.

There are two main types of HRT:

• combined HRT (oestrogen and progestogen) – for women with menopausal symptoms who still have their womb (oestrogen taken on its own can otherwise increase your risk of womb cancer)
• oestrogen-only HRT – for women who have had their womb removed in a hysterectomy

HRT is available as tablets, skin patches, a gel to rub into the skin or implants.

HRT is extremely effective at relieving menopausal symptoms, especially hot flushes and night sweats, but there are a number of side effects, including breast tenderness, headaches and vaginal bleeding. It’s also associated with an increased risk of blood clots and breast cancer in some women.

HRT is not advisable for some women, such as those who have had certain types of breast cancer or are at high risk of getting breast cancer.

Your GP can give you more information about the risks and benefits of HRT to help you decide whether or not you want to take it.

Read more about HRT.

There are also natural alternatives to HRT to manage symptoms and both methods are available here at the clinic where you can book a consultation.