It is also known as menopause transition – the time when a woman moves from ovulating every month and having normal periods (menstruation), to a time when this stops.
During this time, the number of ovarian follicles becomes less and this results in low estrogen levels and high FSH (Follicular Stimulating Hormone) levels. This is what causes the symptoms of menopause.
The perimenopause usually lasts around 4 years (2-8 years) It usually commences around the age of 47 yrs (39 – 51 yrs)
A woman is called “post menopausal” when she has not had any periods or bleeding for one year. The average age is 51 years all over the world, although some women can still have regular periods even after this age. It is uncommon to have periods after the age of 55 years.
Any bleeding after one year of no bleeding is known as Post-Menopausal bleeding and has to be taken seriously. Medical advice should be sought as cancer needs to be ruled out urgently.
8 out of 10 women experience the following symptoms but only 3 in 10 women seek help.
After the age of 45, a diagnosis made on symptoms alone (clinical diagnosis) is often enough, unless there are also other health problems which may cloud the picture. Your GP will make that decision.
Between 40-45 years – Diagnosis is based on clinical symptoms (Hot flushes, no periods) & some blood tests.
Under 40 years (diagnosis is “premature menopause” or “primary ovarian insufficiency”). Your doctor should ideally refer you to a gynaecologist, as this needs specialist input and tests.
It is recommended that women should use effective contraception every time to avoid unwanted pregnancy (condoms/coil/sterilisation/pill) for at least two years after their last period if the periods have stopped before the age of 50.
If above the age of 50 years, it is recommended to use reliable contraception every time for one year after the last menstrual period.
If on Hormone Replacement Treatment, consult your doctor for further advice.
It is important to eat low down in the food chain, which means plenty of vegetables/fruit/grains/berries/lentils/nuts and seeds and water. Many of these foods are excellent sources of natural phytoestrogens (Lignans and isoflavones).This will not only help with hot flushes, but also with general overall health and wellbeing.
Avoid becoming overweight by regular gentle exercise, and avoid a diet high in Trans fats/saturated fats and processed foods (biscuits/cakes/chocolates/ready meals). Reducing the amount of alcohol you drink, and red meat in your diet, and not smoking, can all help in reducing cancer and heart disease risk.
Urgency and Urge Incontinence – Avoid too much tea/coffee/smoking.
» See GP who may recommend lifestyle changes/Bladder Drill/ medication
Stress Incontinence ( leaking of urine on coughing/sneezing/running etc)
» See GP who may recommend Pelvic Floor Exercises/ Physiotherapy/ tablets/referral to a specialist for tests and surgery if indicated.
Blood in the urine
» See GP for urgent attention to rule out serious causes.
Symptoms of urine infection (burning/increased frequency) need to be investigated and treated by your doctor if proven infection.
Depending on the condition, the following tests may be suggested
HRT provides low doses of estrogen and progestogens (rarely testosterone) to try and replace the levels the body lacks in the post menopausal period.
HRT is available as tablets, skin-patches, gels or nasal spray.
A cream, pessary, or vaginal ring containing estrogen works best for local vaginal symptoms. This can be used for as long as a woman needs to help with local symptoms.
Before starting HRT, your doctor will take a thorough history from you and examine you appropriately.
Your GP or specialist will talk you through various preparations, risks and benefits before recommending HRT.
Be aware of family history and mention to your doctor of relevant information, including allergies and medications.
Continue to follow a healthy lifestyle and diet.
Make sure you attend the screening programmes as recommended by the NHS such as smear tests and mammograms.
Be Breast Aware.
A menopausal woman is advised to take HRT only when she finds that her quality of life is affected by her symptoms, usually hot flushes and natural methods are not working.
HRT is effective for symptomatic relief and its use is justified when symptoms adversely affect quality of life.
The lowest effective dose for a particular woman should be used for the shortest period needed.
Treatment should be reappraised at least annually with the GP or specialist.
HRT is usually recommended for the shortest possible time a woman needs it to reduce risk of breast cancer. This is usually 2-3 years and up to 5 years.
If a decision is made to stop HRT, it should be phased out slowly in symptomatic women to prevent return of symptoms.
If menopausal symptoms return after stopping HRT, women may wish to consider restarting it and, provided they are fully informed of the risks, it should not be withheld.
If a woman is counselled properly of the risks and wishes to take HRT for longer, then she may be prescribed HRT after discussion with her GP/specialist.
Vaginal Dryness and some urinary symptoms may be helped with local use of lubricants and if appropriate, vaginal estrogen.
Generally, a woman with a history of cancer (especially Breast or womb) is not recommended (contraindication) to have HRT. If it is to be used, this would be a highly specialised decision made by a team of experts.
Similarly, a personal history of thrombosis is considered a contraindication for HRT. With a family history, certain tests may be needed before starting HRT.
The risk of thrombosis is the greatest in the first year of starting HRT. A history of heart disease (ischemic heart disease, peripheral arterial disease) is considered a contraindication for the use of HRT.
There are other preparations available that can help with hot flushes.
Many of these medications and preparations have not been fully studied, hence their effects on the body and on other drugs that one may be taking is not fully understood.