Menopause, it’s a hot topic at the moment. It’s being talked about by politicians, GPs and women’s health advocates. However, it’s amazing to me that I am still speaking to women in my practice every day who haven’t associated the symptoms they are experiencing, with the menopause.
I frequently ask myself why that might be…
Is it a lack of awareness? Perhaps, but considering the numerous articles, TV documentaries, celebrities recounting tales of their symptom journey, their missed or delayed diagnosis, their treatments (risks, benefits etc.), we would expect there to be more awareness.
Is it denial? Yes, that could be a factor; menopause and its surrounding phases have historically been associated with ageing, getting older and later life, and women may not necessarily want to face up to this fact. I think we are, however, being ‘ageist’ to ourselves when thinking this way…Surely it’s important to give ourselves the best chance of a healthy life at whatever stage of life we’re at?
And there is no doubt that there are some people who think ‘what’s the point of discussing it? I don’t want HRT!’ My response to this question is two-fold… ‘Why not?’ and ‘Did you know menopause is not just all about HRT?’
World Menopause Day on the 18 October is fast approaching and here at HCML, we are committed to continuing the conversation.
In the next 6 weeks we’re going to be posting regular blogs and information on different aspects of the menopause, tackling topics including what it actually is, the various treatments available and associated conditions, and how it might affect women at work. Furthermore, we look forward to dispelling some myths and pointing people in the right direction towards getting a diagnosis and support.
And we mustn’t forget that menopause doesn’t just affect women directly, so we will be discussing the wider issues as well.
What is the menopause?
The word ‘menopause’ literally means the ‘end of monthly cycles’ (the end of monthly periods or menstruation) and comes from the Greek word pausis (‘pause’) and mēn (‘month’). It is a completely normal part of a woman’s life and happens to every woman at some point.
There are different phases of the menopause that happen because of natural hormonal shifts, signalling a move towards the end of fertility.
The menopause itself is a single day in time. It occurs exactly one year after the last period. Because of this, a diagnosis is often made in retrospect. Some women have years of symptoms, ranging from the most subtle and sometimes unexplained, to raging hot flushes and mood swings. Others sail through this phase in their lives.
Often my patients understand this phase of their life better when I talk about the ‘journey through the menopause.’ It’s an interesting transition through different phases, sometimes with uncertain starting or end points, and diversions along the way, which happen because of natural hormone shifts and fluctuations, but together signal a move towards the end of fertility.
A quick biology lesson
To understand what happens around the time of the menopause, it’s often useful to think a little about what happens with the monthly cycle, before the menopause transition begins.
During the time between the ‘menarche’ (when the menstrual periods start) and the ‘menopause,’ an egg is released from a woman’s ovaries every month. For this to happen, a cyclical pattern of hormonal changes happens in the body. The hormones (chemical messengers) often talked about are oestrogen, progesterone and testosterone. The levels of these chemicals go up and down at different times in the month. This cycle of changing hormone levels is controlled by an area of the brain called the pituitary gland, and there is a ‘feedback’ mechanism to keep it finely balanced.
So, why is it important to understand this?
Menopause is all about ‘hormones. During the ‘perimenopause,’ – the time leading up to the menopause – the ovaries naturally start to work less well. This leads to greater fluctuation in the hormone levels and the feedback mechanism doesn’t necessarily work as effectively. In many cases it’s this imbalance that leads to the varied symptoms of menopause, rather than an absolute lack of hormones.
Which hormone causes the symptoms?
That’s an easy question…oestrogen, isn’t it? Well yes, and no. It’s true to say that oestrogen plays a particularly significant role in the menstrual cycle and therefore the menopause. Oestrogen is important in every system of your body. There are oestrogen receptors in your brain, skin, bones, heart, urinary system and genital area. So, it’s not hard to see why low levels of oestrogen can affect all these parts of your body and why women experience the symptoms they do, for example, period changes, brain fog, vaginal dryness and skin irritation to name a few. However, oestrogen is definitely not the only player in this mid-life adventure.
Focus on Progesterone
Progesterone is also an incredibly important hormone produced once a woman has ovulated in the second half of their monthly cycle. During menopause, the ovaries tend to prioritise the production of oestrogen, which can lead to other symptoms related to the drop in progesterone. These symptoms can be similar to premenstrual syndrome (PMS) and include anxiety, restlessness, trouble sleeping and reduced libido. This will probably seem familiar to many women, and I would argue that sometimes these are the symptoms which they struggle with the most. At a time in life when women must be ‘on it’ and juggle various work, family and social responsibilities, the lack of progesterone can be quite debilitating.
And let’s not forget about testosterone
While oestrogen and progesterone decrease significantly at menopause, testosterone levels gradually decrease with age. Some women won’t notice any symptoms as levels fall. Others may be more sensitive to the changes and experience a lack of sexual desire, low mood, low energy and impaired focus and concentration.
What can’t the biology tell you?
Unfortunately, it’s not a case of ‘one size fits all’ with the menopause journey. Population research shows that the perimenopause typically starts in mid-to-late 40s.
The average age of the menopause in the UK is 51, with most women having stopped their periods by age 55.
It is common for women to continue to experience symptoms after the menopause (remember the menopause is just a single day in time) in that postmenopausal ‘home straight.’ This stage commonly lasts for a further five to seven years, though many experience symptoms for longer than this.
So why does this all matter?
Women who experience these symptoms will be able to tell you that it can have a dramatic impact on their lives. Even where symptoms are subtle, women may spend years wondering why they feel like they do.
This is also often the time in a woman’s life to have a bit of a mid-life reset and take stock to ensure they thrive going forwards.
I am aware that there is a common misconception that if a woman doesn’t want HRT, or doesn’t have symptoms that bother them, that menopause isn’t an important consideration. It’s time to address this.
In the next episode I will be talking about the various considerations that we need to have with regards to treatment and a woman’s future health.