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All you need to know about the menopause

A detailed guide to support you before, during and after transitioning through the menopause.

The menopause is a natural and healthy phase of life that all women will go through. Despite this, it is rarely a topic of open discussion, which may contribute to feelings of fear, shame, and uncertainty around the subject.

We want to break the silence - by informing one another with reliable information on what to expect, we can prepare in the best possible way. Also, by sharing helpful hints and tips, we can shape the menopause to be a more positive experience.

In this blog, we provide a guide to support you before, during and after the menopause. 

First of all, why do we experience menopause? 

Upon a quick reflection, it may be puzzling to understand why women experience this phase of life. The menopause is commonly characterised by a decline in fertility and ability to reproduce, along with a range of unpleasant symptoms. So, how is the menopause useful? What advantages does menopause give?

If we dig a little deeper, there are some very logical (and scientifically supported) explanations for the menopause. Scientists have revealed that it comes down to something called natural selection - a biological process where humans adapt and change over time. 

Throughout evolution, females who lived a little longer than childbearing age experienced a ‘postmenopausal life stage’. This new life stage offered extra time for other important tasks, such as caring for family offspring (such as grandchildren), increasing the chance of offspring surviving…

If the offspring did survive, this valuable ‘postmenopausal life stage’ could be passed on (through family genes) to their own offspring. So, they too were able to dedicate extra time to important tasks… and so on and so on. 

In short, women have evolved to have the menopause, and live almost a third of their lives in a postmenopausal life stage, because it gives us an evolutionary advantage [9, 17].

So, there we have it. The menopause, and postmenopausal life stage, should not be superficially characterised as simply a decline in fertility. The menopause is empowering. It provides females with an opportunity to invest valuable time and energy into important areas of life – family time, travelling, starting a business, learning that new skill, whatever they may be.

When does the menopause start?

All women are unique, so the age when the menopause starts can differ. On average, it usually occurs between 45 and 55 years of age. 

The age at which your menopause will start is difficult to predict because it is influenced by many factors. This includes the age of your first menstrual period, your mother's menopausal age, use of oral contraceptives, number of pregnancies, your lifestyle, and your BMI [2]. Researchers have found that, on average, smokers go through the menopause 1 - 2 years earlier than those who do not smoke [8].

What is perimenopause?

Perimenopause is also known as the ‘menopausal transition’. It is a stage which receives little attention but is important, as it commonly lasts for a few months or even years [4].

Biologically, during perimenopause, your body undergoes fluctuations (rises and falls) in reproductive hormones such as oestrogen, progesterone and follicle stimulating hormone (FSH) [3].

What are the first signs (symptoms) of the menopause? 

The first sign that you are entering the menopause will likely be due to the perimenopause (the menopausal transition, see above). The hormonal fluctuations which occur during this stage can change the normal pattern of your menstrual periods [4]. Your menstrual periods may become uncharacteristically lighter or exceptionally heavier. The regularity of your period may be affected; you may begin to have a period every 2 to 3 weeks, or even every few months.

Eventually your periods will stop completely. One year without a menstrual period signifies the beginning of the menopause.

How common is an early menopause?

Early menopause happens when a woman’s periods stop before the age of 45. It is known to occur in 1 in 100 women [5]. It is surprising to know that premature or early menopause can occur at any age, and in many cases, there is no clear cause [10]. Sometimes, a treatment or surgery for a health condition may lead to an early menopause, for example breast cancer treatment, or if your ovaries are surgically removed [4]. 

If you are aged under 45 years, and think you are experiencing symptoms of an early menopause, a blood test can be performed to investigate whether you are undergoing menopause early. These are available at your GP surgery, or alternatively you can start your investigation with an at-home Menopause Blood Test.

Experiencing an early menopause can be distressing. There are places you can seek help and support. Daisy network is a support group for women with premature ovarian failure.

What happens during the menopause, what symptoms should I expect? 

During the menopause, your ovaries no longer release an egg each month and stop producing as much of the hormones oestrogen and progesterone. 

These hormonal changes mean that 8 in 10 women have additional symptoms before and after their menstrual periods stop. For some women, these symptoms can be undesirable and impact daily life.

Common symptoms include:

•    Hot flushes (a sudden feeling of warmth in the body)
•    Night sweats
•    Difficulty sleeping
•    Reduced sex drive (libido)
•    Problems with memory and concentration
•    Vaginal dryness and pain
•    Mood changes such as depression and anxiety

How long does the menopause last?

On average, most symptoms last around 4 years from your last period. Although, 1 in every 10 women experience symptoms for up to 12 years [4].

When is it appropriate to see a doctor? 

If you find that your symptoms are troublesome, and interfering with your daily life, it is worth visiting your GP. Alternatively, if you are experiencing symptoms earlier than expected (under the age of 45) your GP can investigate the underlying reason for your symptoms. 

•    If you are aged over 45 years old, menopause is usually diagnosed by an assessment of symptoms. 
•    In women aged 45 years old or under, due to the lower incidence of menopause at this age, a blood test may be used to diagnose menopause.

A private blood test, such as the Medichecks’ Menopause Blood Test, can help you to get the answers you’ve been looking for and provide peace of mind. It could also give you the confidence to decide how to move forward.

Is there anything I can do to treat my symptoms of the menopause?  

Your GP may prescribe certain treatments and therapies to help ease severe menopause symptoms. Many women also find that simple lifestyle changes can be helpful. We take a closer look at some of the options below: 

1. Hormone replacement therapy (HRT)

HRT is exactly what it says on the tin. Hormones are reintroduced to your body to replace those which your body has reduced the production of. Most HRT is a combination of oestrogen and progesterone. It can be taken by oral tablets, skin patches, gels or pessaries. Your GP can give you more information on HRT, and discuss the risks and benefits, to help you decide if it’s right for you.

2. Nutrition

Before and during the menopause, particular aspects of the diet are especially important, to reduce the risk of developing health conditions and to help manage symptoms. 

Nutrition for bone health

Reducing oestrogen levels during menopause increases the rate of calcium loss from our bones, which can make them weaker (also known as osteoporosis) and more prone to fracture. Getting enough calcium in your diet can protect against this loss. 

Calcium rich foods include dairy products (such as milk and cheese), tofu, fortified food products such as bread and dairy alternatives (such as soya milk) and green leafy vegetables such as broccoli and kale.

It is currently recommended we have 700 mg of calcium daily. 

The table below outlines some food sources of calcium and the estimated quantity they provide [15]:

Food Amount of Calcium (mg)
10 almonds 50 mg
1 slice of white bread 50 mg
Steamed broccoli (110g) 50 mg
1 small bag watercress (40g) 50 mg
2 tbsp cottage cheese 100 mg
2 dried figs 100 mg
1 small tin baked beans (200g) 100 mg
50g canned sardines 200 mg
200 ml soya milk (calcium fortified) 200 mg
40 g edam cheese 300 mg
30 g parmesan cheese 300 mg

You can find more information on the amount of calcium in foods here

If you think you are struggling to get enough calcium in your diet or are already experiencing osteoporosis, you may want to consider a supplement. Speak to your GP before taking new supplements, as too much supplemental calcium may be harmful.

Vitamin D is also essential to build and maintain strong bones. We get most of our Vitamin D from sunlight but during the winter months you may not get enough, so a 10ug supplement is currently recommended. If you have darker skin, spend most of your time indoors, or cover your skin you may want to take a 10ug supplement all year round. You may be interested to assess your body’s vitamin D levels using our Vitamin D (25 OH) Blood Test.  

Nutrition for heart health

Menopause and post-menopause can put you at increased risk of developing heart disease and other cardiovascular conditions [11]. Eating heart healthy foods can reduce your risk. These include high-fibre and whole grain foods (such as beans, pulses and brown rice) fruit and vegetables and oily fish. Try to cut down your saturated fat intake and choose healthier fats such as olive and rapeseed oil. You may be interested to follow a Mediterranean diet, which is known for its heart health benefits. Read more here

Nutrition to maintain a healthy weight

At the time of the menopause the amount of muscle in your body will reduce – this unfortunately means that you need to eat fewer calories in your day. Without being aware of this, it is easy for excess body fat to creep up [11].

Being overweight is associated with increased risk of breast cancer and this is especially true for women who have been through menopause. Fat cells can secrete the hormone oestrogen, which can stimulate the growth of cancerous cells. Therefore, ensuring you maintain a healthy body weight is especially important during this time [14].

Be mindful of your portion sizes and try not to eat energy-dense foods regularly (foods high in fat and sugar). Combining healthy eating with regular exercise is a perfect way to keep your weight in check [11].

Nutritional supplements for the menopause

Scientists have found that taking supplements containing plant-derived compounds called isoflavones (a type of phytoestrogen) can help to reduce the incidence and severity of hot flush symptoms [15]. The scientists also found that the most important type of isoflavone is called genistein; supplements containing high amounts of genistein were twice as effective at reducing the frequency of hot flushes. Look for supplements containing at least 18.8 mg of genistein, but always speak to your GP before taking new supplements.     

3. Cognitive behavioural therapy (CBT)

Your GP may recommend CBT which is a type of talking therapy that can improve low mood and anxiety [9]

4. Exercise

Exercising regularly has huge benefits for everyone, through all stages of life. One simple reason is that it makes you feel good! During the menopause you may find some light to moderate exercise, such as an aerobics class, helps to improve symptoms such as low mood and sleep disturbances. In addition, weight bearing exercises, such as playing tennis or running, are particularly good for your bones so can help reduce the risk of menopause-related health complications such as osteoporosis [7].

Life after the menopause – what to expect?

If you have transition ‘through’ the perimenopause and menopause, you are now in the postmenopausal life stage. Many women find that this postmenopausal life stage offers a new sense of freedom away from both monthly periods and menopausal symptoms. 

If you do experience bleeding after the menopause, it is important to get it checked out by a GP [12]. Also, try to attend regular health check-ups and screenings. Women in England who are aged from 50 to 71 years and are registered with a GP are automatically invited for breast cancer screening ever 3 years [13].

How ever you choose to spend your menopause, and postmenopausal life stage, we say - embrace it! It gives us women an evolutionary advantage after all. 


References

[1] https://www.nationalgeographic.com/science/phenomena/2013/04/18/why-menopause/
[2] https://pubmed.ncbi.nlm.nih.gov/28913040/
[3] https://www.sciencedirect.com/science/article/pii/S0165032716308746
[4] https://www.nhs.uk/conditions/menopause/symptoms/
[5] https://www.nhsinform.scot/illnesses-and-conditions/sexual-and-reproductive/menopause
[6] https://www.nice.org.uk/guidance/ng23/ifp/chapter/Benefits-and-risks-of-HRT
[7] https://www.nutrition.org.uk/healthyliving/lifestages/menopause.html?start=3
[8] https://www.nhs.uk/news/heart-and-lungs/active-and-secondhand-smoking-both-linked-to-early-menopause/
[9] https://www.nhs.uk/conditions/menopause/treatment/
[10] https://www.nhs.uk/conditions/menopause/
[11] https://www.bda.uk.com/resource/menopause-diet.html
[12] https://www.nhs.uk/conditions/post-menopausal-bleeding/
[13] https://www.nhs.uk/conditions/breast-cancer-screening/when-its-offered/
[14] https://www.nhs.uk/conditions/breast-cancer/causes/ 
[15] Taku, K., Melby, M.K., Kronenberg, F., Kurzer, M.S. and Messina, M., 2012. Extracted or synthesized soybean isoflavones reduce menopausal hot flash frequency and severity: systematic review and meta-analysis of randomized controlled trials. Menopause, 19(7), pp.776-790.
[16] https://theros.org.uk/information-and-support/bone-health/nutrition-for-bones/calcium/calcium-rich-food-chooser/
[17] Hawkes, K., O’Connell, J.F., Jones, N.B., Alvarez, H. and Charnov, E.L., 1998. Grandmothering, menopause, and the evolution of human life histories. Proceedings of the National Academy of Sciences, 95(3), pp.1336-1339.