I’m Dr Louise Newson. As a menopause expert, I spend a considerable amount of my working week helping and advising women with their menopause or writing articles about the health effects of the menopause.
I am often surprised by how little women know about the menopause and the wide variety of symptoms that can occur when their hormone levels start to drop. They are also unaware of an increased risk of osteoporosis and cardiovascular disease, both of which are associated with the decreasing levels of oestrogen in their bodies as they go through the menopause.
Your own experience of the menopause will be very different from another woman’s. For some women, the symptoms of menopause can significantly affect their lives, and because not enough women talk about their menopause, there is still much uncertainty about what it means and how it can be managed. So let’s try to break it down.
What is the Menopause?
The word menopause actually means your last menstrual period.
Meno – refers to your menstrual cycle and pause – literally means stop.
However, the biological definition is when you have not had a period for one year.
The menopause occurs when your ovaries stop producing eggs and, as a result, the levels of hormones called oestrogen, progesterone and testosterone decrease.
The term peri-menopause is often used to define the period of time during which you experience menopausal symptoms but are still having periods. These periods can often become irregular.
Oestrogen and progesterone work together to regulate the menstrual cycle and the production of eggs. During peri-menopause, the levels of these hormones fluctuate and it is often this imbalance that leads to menopausal symptoms developing.
How long the symptoms of peri-menopause continue can vary from woman to woman –from a few months to a few years before their periods stop – so when you read about menopausal symptoms, this can also refer to peri-menopausal symptoms.
Oestrogen protects a number of different systems in your body – the brain, skin, bones, heart and vagina, which is why many of the symptoms affect these particular areas.
Symptoms of peri-menopause can start to develop at around 45 years, and the average menopause age in the UK is 51 years; however it can start earlier.
If the menopause starts before the age of 40, it is classed as Premature Ovarian Insufficiency (POI); if it occurs when you are under 45 years of age, then it is defined as early menopause.
Although the menopause is a normal progression in a woman’s life, certain more serious conditions can bring about early menopause. Women who have had their ovaries removed during an operation, undergone radiotherapy cancer treatment in the pelvic area, or who have received certain types of chemotherapy drugs, may experience early menopause.
Women who have medical or surgical treatment for endometriosis or PMS may also experience early symptoms. Genetic and autoimmune factors can also play a part.
If a woman has had her womb (uterus) removed (a hysterectomy) before menopause, she may become menopausal as a result, even if the ovaries are not removed.
Although ovaries will still produce some oestrogen after a hysterectomy, it is common that the level of oestrogen will start to fall at an earlier age due to reduced blood flow, and since periods stop after a hysterectomy, it may not be clear when a woman is ‘in the menopause’.
Making the diagnosis of menopause
If you are younger than 45 years of age, you will usually need to have tests to diagnose the menopause. The most common is a blood test measuring the level of a hormone called follicle stimulating hormone (FSH). If this is raised, it is likely that you are menopausal. This blood test is often repeated 4-6 weeks later.
If you are under 40 years, you may be advised to have other blood tests. Some women may also be recommended to have a bone density test (DEXA scan) to determine the strength of their bones.
However, if you are over 45 years and have irregular periods with symptoms of the menopause, you will not need to have any tests to diagnose the menopause.
You may feel unexpected emotional reactions to the changes in your body. Some women talk of a sense of loss and a shift in identity, but for others it can be utterly liberating.
All reactions to the menopause are relevant and should be given space to explore and accept.
The menopause is not the end, it’s just another stage in our lives. Women all over the world are embracing this stage of their life with a newfound determination to live with passion. So own your emotions, inform yourself and find the right support and treatment to progress positively through this stage.
More About Dr Newson:
Dr Louise Newson worked as a GP in a large practice near Solihull, West Midlands, for 15 years. She is a medical writer and editor and has written numerous articles covering a wide range of topics for doctors and patients, as well as organisations such as the Royal College of General Practitioners (RCGP), MIMS Learning, www.patient.info and the British Journal of Family Medicine.
In more recent years, Dr Newson has written an increasing number of articles on women’s health issues, including the menopause and its management. She is involved in running courses that train doctors and nurses about the menopause and hormone replacement therapy (HRT). Dr Newson has given lectures nationally and regionally for healthcare professionals.
Learn more at www.menopausedoctor.co.uk/about