Navigating Menopause: Symptoms, Stages, and Management

In this blog, we’ll explore the transformative phase of menopause, a natural transition marking the end of reproductive years in a woman's life. This comprehensive guide aims to shed light on the wide range of symptoms experienced during menopause, explore effective management strategies, and provide practical self-care tips to navigate this stage in your life with confidence.

The Menopausal Transition: How Does Menopause Affect a Woman?

There are several reasons why periods stop and menopause occurs in women, including:

Natural menopause: Menopause most commonly occurs naturally with age, as the function of the ovaries gradually declines and the ovaries stop releasing mature eggs. This also leads to the female hormones, oestrogen and progesterone, no longer being produced.

Induced menopause: The surgical removal of both ovaries in a woman, for a wide range of reasons, can cause induced menopause. Chemotherapy and radiation therapy can also bring about menopause in some women.

Premature menopause: Premature menopause is when periods stop before the age of 40. In about 8% of women, this is due to induced menopause caused by chemotherapy, radiotherapy or surgical removal of ovaries. However, periods can also stop spontaneously in about 1% of women, usually due to an unknown cause. This is more accurately known as premature ovarian insufficiency (POI), as the ovaries can begin to function again in a small number of women.

Early menopause: Early menopause is when periods stop between the ages of 40-45. As is the case with premature menopause, it can occur spontaneously or as a result of chemotherapy, radiotherapy or surgery to remove the ovaries. Early menopause affects about 5% of women and is usually permanent, as the ovaries rarely regain function after periods have stopped.

What are the 5 stages of menopause?

Pre-menopause: This stage begins in the late 30s or early 40s and continues until menopause. During pre-menopause, menstrual cycles may become irregular, and women may experience symptoms such as hot flushes, night sweats, mood swings, and changes in libido.

Perimenopause: Perimenopause typically starts in a woman's 40s, although it can begin earlier or later. This stage is characterised by fluctuating hormone levels, irregular periods, and an increase in menopausal symptoms. It can last for several years before menopause occurs.

Menopause: Menopause marks the end of menstruation and fertility. It is diagnosed when a woman has gone without a menstrual period for 12 consecutive months. On average, menopause occurs around the age of 51, but it can occur earlier or later.

Postmenopause: Postmenopause begins after menopause and lasts for the rest of a woman's life. During this stage, menopausal symptoms such as hot flushes and night sweats may diminish, but women are at increased risk of certain health conditions such as osteoporosis and heart disease due to decreased oestrogen levels.

Late postmenopause: This stage encompasses the later years of life, typically starting around age 65 or older. Women in late postmenopause may continue to experience health changes related to ageing and hormonal fluctuations, and they may also face unique challenges such as bone density loss and cognitive changes.

What are the signs of menopause starting?

A range of symptoms are associated with perimenopause, menopause and postmenopause. Most symptoms are related to a decrease in oestrogen levels. Symptoms can be both physical and psychological:

Irregular periods: Leading up to menopause, it is common for periods to become irregular, especially in their frequency, but also they can be lighter or heavier than usual. During this time, fertility becomes reduced and unpredictable, until menopause is reached and it is no longer possible to become pregnant.

Hot flushes: Hot flushes, also known as hot flashes (mainly in the United States), usually occur in the face and neck, and involve a distinct sensation of heat. Hot flushes can also occur all over the body and last for seconds or minutes. They can also involve sweating, headaches, palpitations or fainting, which can become worse with stress, alcohol and hot foods or drinks. Hot flushes are harmless but can cause embarrassment, sleep disruption and anxiety. Some women may experience up to 10 or more per day, for months or even years after their last period.

Night sweats: Night sweats cause mild to severe sweating that may disrupt sleep. However, not all women who experience hot flushes will get night sweats. The reverse is also true, in that not all women who get night sweats will necessarily experience hot flushes.

Vagina and bladder problems: It is common to experience vaginal dryness and alterations in bladder function. The skin within the vagina can lose its elasticity, which can make sex uncomfortable. It is also possible to experience a loss of bladder control, also known as urinary incontinence. This is because the pelvic floor muscles, much like muscles in other parts of the body, become progressively weaker around the time of menopause. These muscles help control bladder and bowel function, therefore weakness can lead to urine leakage, difficulty holding wind and even prolapse (falling down) of internal organs.

Psychological issues: Many women will experience emotional changes. These can include irritability, depression, anxiety, loss of concentration, poor short-term memory, insomnia, or low libido.

Other symptoms can include palpitations, light-headedness or dizziness, joint and muscle aches and pains, dry skin, tiredness, and weight gain.

Strategies for Managing Menopausal Symptoms

Methods for diagnosis:

The diagnosis of menopause is usually based on age and the presence of signs and symptoms. As this can feel like, or be, a life-changing experience for some women, you may want to talk to your doctor about any concerns.

Blood tests are rarely used to diagnose menopause. Measuring certain hormone levels that can change with menopause, such as follicle-stimulating hormone (FSH) and oestrogen, is not always accurate. However, measuring thyroid-stimulating hormone (TSH) can help identify thyroid disease that causes hypothyroidism (which causes a high TSH), which can mimic symptoms of menopause. If hypothyroidism is present, then treatment of this condition can help to improve symptoms.

What is the best thing to do for menopause?

Types of treatment:

Menopause does not require treatment; however, there are treatment options available to reduce the signs and symptoms associated with it. Your doctor will be able to provide advice on treatment options that suit your circumstances. These may include:

Self-care for hot flushes: Cooling gels containing menthol may help to provide relief from your hot flushes. These products are available over the counter without a prescription.

Hormone replacement therapy (HRT): Many of the signs and symptoms associated with menopause are related to decreased oestrogen. To rectify this, hormone replacement therapy (HRT), which increases the body's oestrogen levels, may provide effective relief from symptoms. This involves either taking an oral medication, wearing a skin patch, using a vaginal ring or applying a skin cream or gel.

Other medications: If HRT is not an option due to personal or medical factors, other non-hormonal medications have been shown to reduce discomfort associated with hot flushes. These include certain medications that are more commonly prescribed for depression (antidepressants) and high blood pressure (antihypertensives).

Potential Complications

After menopause, you have an increased risk of developing certain medical conditions, including:

Heart disease: As your oestrogen levels decrease during menopause, your risk of heart disease increases. To help avoid this, it is important to eat a healthy balanced diet with lots of fruit and vegetables. It is also important to maintain a healthy body weight and monitor your cholesterol and blood pressure to ensure they are at healthy levels.

Osteoporosis: Osteoporosis is a condition that causes your bones to weaken and become brittle, which can lead to an increase in bone fractures. An increase in the risk of osteoporosis occurs in the first few years after menopause, when bone density may be lost at a rapid rate. This can lead to fractures, which commonly occur in the wrists, hips and spine. These risks can be dramatically reduced with regular exercise and a healthy diet.

Urinary incontinence: Urinary incontinence is the loss of bladder control that results in unintended urine leakage. Incontinence in menopausal women is treated by pelvic floor exercises that strengthen the pelvic floor muscles, sanitary pads to absorb accidental urine leakage, bladder retraining, medications that reduce bladder overactivity, and surgery to restore normal urinary function.

Menopause is a natural process of ageing. Some women are largely unaffected, while others may have severe or prolonged symptoms. Unfortunately, it is difficult to predict who will develop symptoms or the severity and duration of symptoms.

With proper management and support, women can navigate through the menopausal transition with resilience and maintain their overall well-being.

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