What is Menopause?

The menopause is when a woman stops having periods. It is a natural part of ageing and usually happens between the ages of 45 and 55 years of age.

It occurs due to loss of function of the ovaries leading to a decline in female hormones, mainly oestrogen.

Menopause, however, can be caused by surgery. This includes a hysterectomy (removal of the uterus/womb) even if the ovaries are not removed at the same time. Treatments such as radiotherapy and chemotherapy can also bring on the menopause.

Menopause is deemed to have occurred after 12 consecutive months without menstruation (periods)

Premature Menopause

Some women experience the menopause under the age of 40, this is called a premature menopause.

This can happen for the reasons described above, genetic susceptibility, other health conditions or for unknown causes.

If periods stop naturally under the age of 40 years, please consult with a GP.

A premature menopause should be investigated with blood tests. In most cases treatment in the form of HRT is recommended to protect the bones against thinning early (osteoporosis) and the early development of cardiovascular/ heart disease).

What is Perimenopause?

This is the transitional period leading up to menopause. It can start several years before menopause. During this time, the ovaries start to produce less oestrogen. Perimenopause can last anywhere from a few months to several years.

Not everyone has symptoms of perimenopause, but these can be debilitating and for most people HRT is safe.

Symptoms of Menopause and Perimenopause:

Symptoms may include:

Irregular periods: Changes in menstrual cycle length, flow, or frequency. Cycle length might lengthen or shorten, and periods may get heavier.
Hot flushes: Sudden feelings of heat that can spread throughout the body.
Night sweats: Sweating / feeling hot during the night.
Mood changes: Anxiety, depression, and mood swings.
Sleep problems: Difficulty falling or staying asleep.
Weight redistribution: A propensity to gain fat, particularly around the abdomen. A reduction in muscle mass.
Thinning hair and dry skin: Changes in hair texture and skin moisture.
Vaginal dryness and discomfort during sex.
An increase in urinary tract infection symptoms, needing to pass urine urgently or frequently, especially at night.
Brain fog / forgetfulness
An increase in migraines and headaches
An increase in joint and body pains
Fatigue / energy changes

Not all symptoms need to be present to make a diagnosis and blood tests are not that helpful for women over 45.

Contraception

Pregnancy is still possible during the perimenopause so contraception should be continued.

When periods stop under the age of 50, please continue contraception for 2 years.

When periods stop over 50, please continue contraception for 12 months.

The combined pill is not recommended over the age of 50 years. Hormone coils, the progesterone only pill and barrier methods are suitable for most women.

Managing Symptoms

There are several ways to manage the symptoms of menopause and perimenopause, including:

Lifestyle Adjustments:

Regular exercise (particularly walking and gym work), a healthy diet, and maintaining a healthy weight.

Hormone Replacement Therapy (HRT):

HRT is effective for many women in relieving menopausal and perimenopausal symptoms. Discuss with your GP if this is a suitable option for you.

The preparations available on prescription have been shown to be safe in trials and there now exists a wide variety of options for women. Tablets, patches, sprays and gels are available.

The Mirena coil can be used as part of HRT and has the added benefit of giving good contraception.

If the womb has been removed only oestrogen is required, unless a woman has a history of endometriosis, in which case oestrogen and progesterone is advised.

Testosterone

This is an “off-license” product that can help women with low sex drive / low libido.

It is not recommended for any other indications in the perimenopause / menopause.

It is important that HRT treatment is maximised first before this is started. In other words, flushes etc are controlled before considering this.

Non-Hormonal Treatments:

Options like cognitive behavioural therapy (CBT) and certain antidepressants can help manage symptoms.

Alternative Therapies:

Some women find relief through acupuncture, herbal supplements, and yoga. It’s important to discuss options with your GP to ensure they are safe and appropriate.

Herbal methods do not go through the same rigorous drug trials as conventional medications so a GP cannot fully endorse these preparations.

Body identical HRT is not prescribed on the NHS and there are concerns it may increase the risk of endometrium cancer (lining of the womb).

Managing vaginal dryness and vulval health

Some women benefit from just local oestrogen to help with dryness, urinary symptoms and discomfort during sex.

Most women can start using this, even if the menopause happened many years ago.

Localised lubricants such as ‘YES’ can also help and are available without prescription.

Please avoid all perfumes in the vulval area, soaps, and wet wipes.

Wash in a soap substitute such as Aveeno cream or E45 to maintain good vulval health.

When to See a GP

You should consult your GP if:

Your symptoms are severe and impacting your daily life.
You experience symptoms of menopause or perimenopause before the age of 40. (Known as early or premature menopause).
You have any concerns about managing your symptoms.

Your GP can provide advice, support, and treatment options tailored to your needs. They may also refer you to a specialist if necessary.

Questions to ask the doctor

Before you see a GP, it’s a good idea to prepare so you get exactly what you need from the appointment.

If your periods have changed in recent months, make a note of it so you can tell the GP. Also tell them about any medicines or herbal remedies you are taking.

Please ensure you have available, if possible, details of your family history. The GP is particularly interested in a family history of cancers, especially breast and ovarian.

Your questions could include:

How will HRT help me?
How soon will I feel better?
What are the benefits and what are the risks?
Is HRT the only treatment I can have for my symptoms?
How long will I have to take it for?
How will I know what type will work best for me?

A GP should be able to answer your questions and help you choose the type of HRT that is suitable for you.

Please note, in most cases, there is no maximum time limit for taking HRT.

HRT Prescription Support

A HRT Prescription Prepayment Certificate (PPC) could save you money.

Each item on an NHS prescription usually costs £9.65. You can buy an HRT PPC for a one-off payment of £19.30 (the cost of two single items). This covers an unlimited number of certain HRT medicines for 12 months.

You can find more information here: https://www.nhsbsa.nhs.uk/help-nhs-prescription-costs/nhs-hormone-replacement-therapy-prescription-prepayment-certificate-hrt-ppc