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Signs and symptoms of the Menopause

What does the menopause feel like?

The menopause is a very personal experience. While some women have mild symptoms, others experience unpleasant and persistent effects, both physically and psychologically. Knowing what to expect as you transition through the menopause will help you understand and manage your body’s natural changes.

The menopause transition starts with perimenopause, where periods become irregular, and symptoms can arise. The menopause is defined as the point at which a year has passed since your last period.

Read more about stages of the menopause

There are over 20 symptoms of the menopause

These include:

  • Hot flushes (sometimes called hot flashes) and night sweats
  • Low mood
  • Tiredness or fatigue
  • Irritability
  • Difficulty concentrating
  • Migraine or headaches
  • Sleep disturbances
  • Weight gain
  • Loss of interest in sex
  • Irregular periods (eventually stopping completely)
  • Vaginal discomfort
  • Anxiety
  • Depression
  • Urinary incontinence or repeated urine infections (UTIs)
  • Joint pain and aching muscles
  • Bloating
  • Forgetfulness
  • Breast tenderness

Many women have different experiences of the menopause and find that symptoms can come and go.

Perimenopause

Perimenopause typically starts from the age of 45 and over and can last for several years.

You will notice your periods starting to become irregular, and you might begin to experience symptoms of the menopause.

8 out of 10 women experience at least some symptoms of the menopause.

As you progress through perimenopause, your periods become less frequent, and some symptoms can get worse.

Each woman experiences the menopause differently. It can be helpful to try to find a doctor with a special interest in supporting women through the menopause to help you manage distressing symptoms.

 

If you find hot flushes particularly hard to manage, you are not alone.

Up to 80% of women experience moderate or severe hot flushes that negatively affect their quality of life.

The exact cause of hot flushes is not entirely understood.

Mental health and the menopause

Studies have shown that women have increased risk of developing feelings of anxiety and depression during the menopause.

It isn’t clear exactly why women experience low mood during the menopause. It is thought to be caused by a combination of reduced estrogen levels, sleep disturbances and experiencing uncomfortable symptoms.

Postmenopause

Symptoms of the menopause typically persist for up to four years after your last period. For some women, they can last much longer.

Through the postmenopausal years, a lack of estrogen can cause physical and psychological changes and have long term impacts on health.

Vaginal atrophy

Many women experience vaginal changes after the menopause.

The skin within the vagina becomes thinner and less elastic as you age, due to decreasing estrogen and androgen levels.This can lead to a condition called vaginal atrophy. The changes in the wall of the vagina can cause dryness, discomfort, and painful intercourse. You might also experience urine infections and pelvic floor weakness.

Long term health impacts of the hormonal changes of the menopause

A lack of estrogen through the postmenopausal years can cause physical and psychological changes and have long term impacts on health. You may be at increased risk of developing some conditions, including diabetes, cancer, heart disease, osteoporosis, depression, and dementia.

Your doctor can advise about relevant screening programmes and preventative measures to keep you healthy as you age.

Treatments for the menopause

You don’t have to put up with distressing symptoms of the menopause.

There are various treatment options available from both medical and non-medical approaches.

Choosing the right treatment is a very personal decision. A doctor or nurse with experience supporting women through the menopause can talk through your options, and the benefits and drawbacks of each.

Lifestyle choices

In some cases, changing your lifestyle under supervision from your doctor can be enough to manage mild symptoms of the menopause. Maintaining a good level of fitness and a healthy BMI helps your body work at its best. Eating foods rich in calcium and vitamin D, like dairy products, fish, and green vegetables, can help your body maintain bone strength.

Hormone Replacement Therapy

The aim of Hormone Replacement Therapy (HRT) is to replace the estrogen that declines in your body during the menopause. If you still have a womb, you will need HRT that includes progestogen.

Replacing estrogen helps reverse some of the common symptoms of the menopause, including hot flushes. It may also help to reduce your risk of developing conditions such as depression,osteoporosis, diabetes, heart disease, and some cancers.

HRT is available in tablet form, or as a patch or gel.

HRT is not suitable for some women, including those who have had certain types of breast cancer or who are at high risk of getting breast cancer. If this is true for you, your doctor may refer you to a specialist to ensure you receive appropriate treatment.

Vaginal treatments

Vaginal lubricants are often the first treatment option to help manage the symptoms of vaginal atrophy.

Hormonal therapies include:

  • Vaginal estrogen, which can be administered as a cream, gel, tablets, pessary, or a vaginal ring
  • Vaginal DHEA, which is administered as a pessary
  • Hormone Replacement Therapy (HRT)

Non-hormonal medications and laser therapies are available for women who cannot take vaginal estrogen.

Talking therapies

Talking therapies, such as cognitive behavioural therapy (CBT) and mindfulness-based therapy (MBT), can help you develop coping mechanisms to manage low mood and anxiety as you pass through the menopause.