Menopause historically has been a bit of a taboo subject and considering it is a natural stage of life that every woman goes through, this is remarkable. The good news is that we are talking much more openly about the effects of peri-menopause and menopause these days and increasing the understanding of symptoms and treatments.
So, what is menopause?
Menopause is actually just one day – it is defined as 12 months from the last monthly period. After that the stage is post-menopause and before that, it is peri-menopause. Peri-menopause is the time leading up to menopause, and this may be 5 – 10 years before the last monthly period, when the ovaries produce oestrogen erratically and unpredictably until production stops. This unpredictability in hormone levels leads to most of the symptoms of menopause.
The average age for menopause is 51 years but it can range on average from 40 – 58 years. Before the age of 40, it is considered to be premature menopause and between 40 and 45, early menopause. Early menopause can also be the result of chemotherapy, radiotherapy or surgery.
What are the effects of Peri-menopause?
Around 20% of women have symptoms so severe that they will significantly interfere with daily life, while around 20% sail through with no symptoms at all, and around 60% have mild to moderate symptoms.
Oestrogen isn’t just involved in the production of eggs each month. There are oestrogen receptors found in some brain regions involved in the regulation of temperature, sex drive, sleep, emotions, attention, and memory. Research suggests that the menopausal drop in oestrogen changes how the brain uses glucose, and how well the brain cells function.
Hot flashes
Hot flashes are caused by the constriction and dilation of blood vessels affecting blood flow. Body temperature is regulated by the hypothalamus in the brain, and it has set thresholds around 37⁰C. The hypothalamus detects changes in temperature and signals flushing and sweating to lower the body temperature and shivering to increase temperature. Around the menopause, the thermostat narrows and becomes more sensitive.
Sex drive
The physical effects of a drop in oestrogen such as hot flashes, night sweats, weight gain and vaginal dryness can undermine sexual motivation and drive. In addition, an age-related drop in testosterone may reduce sexual desire. Some women, however, experience an increase in libido during the peri-menopause.
Sleep
Around 40 – 60% of menopausal women report problems with sleep. In the female, sleep is partially regulated by the sex hormones. The master circadian clock (the body’s internal clock that regulates rhythms such as the wake-sleep cycle) is located in the hypothalamus of the brain and it also has receptors for oestrogen and may be affected by changing oestrogen levels.
Hot flashes can also cause poor sleep and conversely, sometimes waking up in the night can trigger hot flashes.
The general stresses of life and poor lifestyle choices can also lead to wakefulness. Worrying about sleep can develop into a vicious cycle.
Depression
Oestrogen promotes brain health, and our mental health is at it’s most vulnerable when oestrogen levels are falling – both in the monthly cycle and in overall lifetime. Oestrogen is one of the hormones that regulate serotonin synthesis, breakdown, and removal. Serotonin is a natural mood stabiliser, reducing depression and regulating anxiety. When your serotonin levels are normal, you are happier, calmer, more focused, less anxious, and more emotionally stable.
‘Brain Fog’
Many women report ‘brain fog’ as a symptom of the peri-menopause with examples of slow or hazy thinking, difficulty focusing, lack of concentration, forgetfulness, or confusion. It could be attributed to poor sleep, if this is a problem, or it may be due to tiredness and stress. Oestrogen has an important role in the health of the brain, and it enables sharp thinking so brain fog may be due to the hormonal decline.
Diagnosis
If you are suffering from symptoms of peri-menopause, please speak with your GP. You might want to take a look at the NICE guidance on diagnosis of peri-menopause and menopause to help you to understand what might be discussed:
Treatments
Treatments for symptoms of the peri-menopause may be natural remedies, medication, or complimentary therapies.
Natural remedies
A balanced diet can help with a reduction in caffeine, saturated fats and sugar and the inclusion of colourful fruits and vegetables, whole grains, phyto-oestrogens (found in soy, legumes, cereals, nuts), isoflavones (flax seeds and sesame), Vitamin D and Magnesium can help with symptoms. Please take advice from a qualified nutritionist before making changes to your diet.
Regular exercise such as yoga to help the mind-body connection, walking, biking, swimming, dancing all help with symptoms. Walking outside in the sunshine increases Vitamin D levels and provides that important contact with nature.
Healthy living is important too. Including relaxation into your life to calm the mind; controlling stress levels and improving sleep all make a positive difference to managing symptoms. Excess stress can exacerbate hot flashes, for example.
Medication
HRT, or more commonly now known as Menopausal Hormone Therapy (MHT), is a treatment for problematic symptoms. This treatment will only be prescribed after a medical diagnosis so please speak with your GP. MHT contains oestrogen alone or oestrogen plus progesterone and may be taken as tablets, as a skin patch or as a gel applied to the skin and absorbed. MHT is not suitable for all women, and it is worth discussing the benefits and risks with your GP.
There are other prescribed medications to treat various symptoms of the menopause such as low dose antidepressants for mood swings and other medications for hot flashes, aches and pains.
Complementary therapies
Popular complementary therapies for menopause include Hypnosis, Cognitive Behavioural therapy (CBT), relaxation, biofeedback, meditation, aromatherapy, reflexology and acupuncture.
Clinical hypnotherapy has been shown to have benefit for hot flashes and night sweats. A randomised controlled trial of hypnotherapy versus gabapentin for hot flashes in Breast Cancer survivors showed that after 8 weeks, hypnotherapy reduced the number of hot flashes by 80%, while gabapentin reduced the number by 33%. The severity of the hot flashes was reduced by 85% with hypnotherapy and by 33% by gabapentin.
Solution Focused Hypnotherapy can also help with sleep, self-confidence, relationships and generally coping better with life.
The benefits of menopause
It may seem difficult to imagine benefits if you are suffering from the symptoms described above, but menopause is a normal state of life – an inevitable process that will come to an end in time.
- You cannot get pregnant so there is no need to worry about birth control (please note that during the peri-menopause while some cycles do not produce an egg, some still do, so until menopause is confirmed, you should continue to take precautions).
- No more hormonal swings throughout the monthly cycle.
- Sexual experiences can improve dramatically post-menopause, bringing a higher level of pleasure
- Children are likely to be a bit older giving you more time for yourself.
- It can bring a surge of confidence, creativity, self-assurance, the ability to say ‘No’ and a time for putting yourself first.
Post menopause
Besides humans, some species of whales are the only mammals that live for many years beyond the end of the reproductive phase of life. This gives rise to the notion of the grandmother as the wise matriarch. The older females help the grand-offspring to survive – they share the wisdom of their years offering leadership and experience – giving purpose to life after the menopause.
The peri-menopause and menopause may be a difficult time of life, but there are things that can help to relieve the symptoms. We can generally expect to live well into our 80s, so we can go on to have decades of life to live after the menopause.