The Menopause, the Perimenopause, and why both matter
The menopause will affect all women, but many don't fully understand what happens, how it affects them and how it can be managed. This page and the associated resources have been developed by Dr Gowan to help raise awareness, share valuable information and promote therapies such as Hormone Replacement Therapy (HRT), which can help our patients to cope with this phase of life.
What is the Menopause?
The menopause is when your periods stop, usually around the age of 50. At this time your ovaries have ceased producing oestrogen (a hormone that affects many parts of your body). When you have not had a period for 1 year you are called 'post-menopausal' (the menopause has happened). Because every cell has oestrogen receptors, every cell is affected by the low oestrogen levels. This means the menopause can affect many parts of the body.
What is the Perimenopause?
In the run up to the menopause your hormone levels can fluctuate a lot. This time is called the 'perimenopause'. This can begin to happen in your early 40’s, but usually by the mid 40’s the levels are changing a lot. Very occasionally, hormonal changes can occur before you are 30 years old, but this is rare.
What symptoms can they cause?
As you get closer to the menopause, your periods usually happen less frequently, and they are often lighter. You may start feeling warmer, getting hot sweats or even night sweats. However, there are a lot of other changes you might start noticing, and these may be unexpected if you haven’t read or heard much about the menopause.
How does the Menopause affect you?
You may have aches and pains and worry there is something wrong with your joints; you may get palpitations and feel faint or dizzy and then worry something is wrong with your heart. It can also be a time when women (who previously have never had problems with anxiety or depression) find they have times of feeling highly anxious, or experience panic attacks, drops in mood or feelings of great anger or irritability.
Some women also may find they have overwhelming tiredness, making it hard to concentrate and struggle with their memory, in what is often termed ‘brain fog’. Many of these women worry that they are ‘going mad’. It is unfortunately a time when some women even feel they must give up work as they can’t perform as they used to.
Things may be compounded by relationship problems stemming from low libido and vaginal dryness, causing pain during sexual intercourse.
If these symptoms are happening when you have had no changes in your period, or if you are on the pill or have a Mirena (hormone coil) in place and you don’t have periods, you may not understand why these things are happening to you. You may therefore feel you need investigations or a referral to a specialist when all you need is reassurance that your experiences are related to the perimenopause.
Why do so few people talk about the menopause?
A huge stigma surrounds the menopause. It is generally not something anyone in the past has talked about, either in the media, between friends, or with their partner. Thankfully this is now beginning to change, with well-known celebrities getting involved with raising awareness; there are even podcasts about it.
Because every woman will eventually experience the menopause, it has historically been seen as something to ‘get through’. People talk about battling through it and in the past has been seen as an ‘ageing’ process with all the associated stigma. Some women feel they don’t want to trouble the doctor with it, because it’s not an illness, it’s a ‘natural’ process one goes through. If you are one of the 15% who get no symptoms that may be ok for you, but if you are amongst the 85% who do get symptoms (let alone the 25% who get severe symptoms), it can completely debilitate you.
Menopausal symptoms can have a huge impact on quality of life, affect work and wreck relationships. They may even be a factor in the statistic that - over 60% of divorces are initiated by women in their 40’s, 50’s and 60’s.
What can you do?
Track your Symptoms
You can track your symptoms using an app such as 'balance' menopause support https://www.balance-menopause.com/balance-app/
Record your Symptoms
Fill in one of these questionnaires:
If you want, you can bring your completed questionnaire to your GP or specialist nurse to explore whether you are experiencing the perimenopause or menopause and find out what you can do to manage your symptoms; including HRT (Hormone Replacement Therapy), if that is something you wish to try.
HRT - Frequently asked questions
Why are Selsey Medical Practice so keen on HRT?
HRT has so many benefits that go beyond controlling hot flushes and night sweats. It keeps your bones strong and stops you fracturing them if you fall over. It may help improve muscle mass and strength and help with joint pains, skin problems and hair changes. It can help with brain fog, menopausal anxiety, and mood swings/irritability. It can help with urinary symptoms such as frequency of urination and gynaecological symptoms including vaginal dryness, soreness and itching. It also can decrease the likelihood of you getting type 2 diabetes, bowel cancer and possibly dementia. There is also emerging evidence it may decrease your risk of having a stroke. Only about 10% of eligible women ever go on HRT, our aim is to get the word out and get at least 60% of eligible women on it.
How long do I have to be on HRT for?
Many women incorrectly think that taking HRT just delays the natural onset or duration of the menopause. HRT just treats the symptoms of menopause when you would have had them, and does not delay them. HRT can help you avoid those symptoms and have a better quality of life.
Should I come off HRT as soon as possible?
No, for the above benefits regarding bones, joints, brain and for urogynaecological reasons, there is no need to come off HRT if your medical history has not changed. You can stay on it for as long as want.
What about the risks?
The main one is breast cancer - there is a small increase in risk, but this is a lot less than people think. Please read our leaflet for a more detailed discussion. The other two risks are clots in the lung or leg, and stroke. Both risks are eliminated if you take your oestrogen through the skin (this is called transdermal), via patch, gel, or spray. But even if you do take your HRT tablets the risks are still very small.
So why did everyone come off it during the scare, all those years ago?
Because of a poor study several years ago (for which the actual investigators involved have apologised), there was a widely publicised ‘HRT’ scare. This caused many women to suffer when they unnecessarily came off their HRT, and made many others suffer as they were too scared to start HRT when they reached the menopause.