Menopause is Inevitable… how we handle it isn’t… Credit Dr Louise Newson BSc(Hons) MBChB(Hons) MRCP FRCGP, Founder of The Menopause Charity and the Menopause Support App, BALANCE.
The Menopause can be a happy and healthy time for us! Midlife Women CAN THRIVE! … we, even those of us in “riskier” health categories, have the choice to take control of our health and our lives! And, please remember that the female body is AMAZING!
Question: How do we do take control and manage this natural transition?
Answer: By becoming knowledgeable and making informed decisions that serve us as individuals.
What is the Menopause?
The Menopause is one day in a female’s life; the day 12 months after her last menstrual period. A day that is retrospectively determined.
However, the term “Menopause” is commonly used to refer to the period prior to the Menopause, the Menopause itself and the period post-Menopause ie the Perimenopause, the Menopause and our post-Menopausal years. The Perimenopause, which can last up to 10 years in duration, is the period prior to the Menopause and is the period during which perimenopausal symptoms start to appear. However, a BIG issue is that many women do not recognise that the health symptoms that the majority of us start to experience in our 40s are actually perimenopausal symptoms and hence do not look for the appropriate support nor push for the most effective treatment. Likewise, too many GPs do not make a holistic assessment of potentially perimenopausal women and mismanagement, and the related costs (health, relationships, societal, NHS, corporate and economic), follows.
The Menopause, a natural transition in a woman’s life, marks the end of her reproductive years and is driven by a reduction in, and then cessation in the production of, the critical female hormones Estrogen, Progesterone and Testosterone. The “Menopause” is a CRITICAL HORMONE DEFICIENCY which, in my opinion, should be discussed and treated as such. Many of the other hormone deficiencies, in women and men, are treated by topping up or replacing the deficient hormones, thereby returning our bodies back into hormonal balance. This, sadly, is not currently the case for the majority of perimenopausal, menopausal and post-menopausal women worldwide.
Our experience of the Menopause is unique; we are all individuals and will experience this significant transition in a highly individualised way. Our choice of how we manage this transitional phase should also be individualised … as knowledgeable women, we can make the right, well informed choices for us! NICE (National Institute for Health and Care Excellence) guidelines talk to the requirement for Shared Decision Making between ourselves and our healthcare providers; we CAN influence our GPs and get what’s right for us.
Average Age of the Menopause & POI
The average age of the Menopause in the UK is 51 years with the majority of women starting to experience perimenopausal symptoms in their mid-40s. 1 in 100 women in the UK will experience their Menopause under the age of 40, while 1 in 1000 will transition to a post-menopausal state under 30; Premature Ovarian Insufficiency (POI) is the term for an early Menopause. It is recommended that women experiencing POI take action to avoid the significant health issues associated with a prolonged period of hormone deficiency.
For women of 45 years of age and over, diagnosis is a clinical diagnosis taking a holistic view of symptoms and other factors prevailing for the female. With the correct knowledge and signposting, we can self-diagnose and help our stretched GPs to help us! Blood tests for this age group are generally of no value as the fluctuation in our hormones is significant and hence our FSH levels will be yo-yo-like and blood tests inconclusive.
Blood tests can be of diagnostic value to those women in their early 40s and below.
…where do we start? There are many differing views on the number of perimenopausal symptoms and the list appears to be growing; however, the consensus is that there are over 38 symptoms! The following is a list of the symptoms most commonly appearing on diagnostic questionnaires:
- Heart palpitations – strong or rapid beating
- Feeling tense or nervous
- Difficulty in sleeping
- Memory problems
- Anxiety / Panic attacks
- Difficulty in concentrating
- Feeling tired or lacking in energy
- Loss of interest in most things
- Feeling unhappy or depressed
- Crying spells
- Feeling dizzy or faint
- Pressure or tightness in head
- Tinnitus (ringing or buzzing in the ear)
- Muscle and joint pains
- Pins and needles
- Itchy and/or dry skin
- Breathing difficulties
- Hot flushes
- Night sweats
- Loss of interest in sex
- Urinary symptoms
- Symptoms due to vaginal dryness
As the female body has Estrogen receptors in EVERY cell, it is no surprise that symptoms of Estrogen deficiency are felt throughout our bodies and across our physical and emotional systems. The female body needs Estrogen to support optimal functioning.
Current statistics quote 3 out of 4 women experience symptoms with 1 in 4 experiencing severely debilitating symptoms. Symptoms can last for many years, even decades. 50% of women do not see their GP and this could be because they have normalised their symptoms, unnecessarily accepting that this is just a part of growing older.
Given the function of Estrogen throughout the female body, it could be that the 1 in 4 who state that they have not experienced symptoms actually have but have not identified the symptom as perimenopause/ menopause related.
Progesterone & Testosterone
Progesterone is important for the regulation of ovulation and menstruation in pre-menopausal women. Peri and post-menopausal women who choose to use HRT, and who still have a uterus, must take Progesterone as part of their HRT package to maintain their uterine health and minimise any risk of endometrial issues.
When our ovaries are working optimally during our reproductive years, Testosterone is produced in greater quantities than Estrogen; Testosterone is generally linked to sexual function/libido but it also supports cognitive function, mood, bone strength and muscle mass. Depending on their symptoms, women can benefit greatly from Testosterone replacement.
Symptom Management Options
Effective management will look different to each of us individually, and again the choice is ours. A growing number of women are finding that lifestyle changes together with HRT is proving highly beneficial in supporting a happier and healthier menopause and their post-menopausal years. HRT is not a silver bullet and will not provide effective management without the adoption or maintenance of a healthy lifestyle.
The 4 Pillars of Health & Wellness, as documented within our first blog, are important at all stages of our life but they become critically important for peri and post-menopausal women. Self-care during our transitionary years should be prioritised with attention being given to our diets, exercise, sleep and stress management. A growing number of influencers are suggesting that, due to the greater negative impact of raised cortisol and adrenaline in an estrogen deficient body, stress management may be the most important pillar for peri and post-menopausal women.
Hormone Replacement Therapy (HRT)
HRT is a means of bringing the hormones in our bodies back into balance and thereby supports optimal functioning throughout our bodies and minds. In relation to the Menopause, HRT looks to replace our diminishing Estrogen levels first, along with Progesterone if we still have our uterus, and then address any Testosterone deficiency as appropriate to the individual.
Modern day Body Identical HRT has been proven as the safest way to have HRT and is the most regulated, tested and researched type of HRT available. It is derived from the YAM plant and has the same molecular structure as the hormones we produce naturally from our ovaries. Body Identical Estrogen can be delivered via a patch, gel or spray. Micronised Progesterone, known as Utrogestan in the UK, is the body identical option for this hormone.
- The benefits of HRT outweigh the risks for most women who start HRT aged <60 years
- HRT is much safer than many people realise. NICE Guidance (2015) provides evidence and reassurance
HRT is not all about symptom management; HRT is a highly effective means of preventing significant future health risks in women.
Women’s Health Initiative (WHI) Study 2002
It is now generally accepted that the WHI Study, publicised in 2002, which misrepresented HRT as dangerous, was flawed and miscommunicated.
The Unacceptable Cost
*Suicide Reference Warning*
Of all the costs associated with the lack of awareness and mismanagement of the Menopause, the “cost of a life” is heart-breaking and unacceptable.
As we stated above, the average age of the menopause in the UK is 51. The highest incidence of female suicide is within the age range of 50 – 54 years … this is not merely a coincidence! Too many women are suffering unnecessarily and too many are taking their own lives as a result of not receiving the appropriate information, care and treatment for their perimenopausal symptoms! Raising awareness and having open conversations will help and we can all play a part.
The costs, both financial and non-financial, to women, families, society, businesses and the economy associated with the misinformation, misdiagnosis and mismanagement of this natural transitionary phase of a female’s life are immense and unacceptable; with the correct information and awareness, effective steps can be taken to quickly improve the current situation for the majority of women and their networks.
- balance-menopause.com (The Menopause Doctor website)
- Balance App
- NICE Guideline (NG23) – Menopause: diagnosis and management (2015) Information for patients
- Wonder Health & Wellbeing – firstname.lastname@example.org
WONDER Health & Wellbeing empowers women to make the right choices for them! My role as a Menopause Coach is to raise awareness by sharing evidence-based information and my own valuable experience, and supporting clients to make informed decisions that are right for them.
Midlife Women CAN, & DO, THRIVE! … the majority of us have the choice to take control of our health and our lives, benefitting ourselves most importantly AND those around us… be that family, partners, friends, colleagues and employers.
Here’s to a Happy and Healthy “Menopause” … a time to thrive!
Note: Our next blog focuses on Menopause in the Workplace and the need for awareness and support.