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What is menopause?

Menopause occurs as a woman ages and her oestrogen levels decline to a level where she no longer can become pregnant and she stops menstruating. Most women enter menopause between the ages of 45 and 55 (the average age in the UK is 51) although about 10% of all women will start menopause before the age of 40. This is sometimes referred to as premature menopause or premature ovarian insufficiency.

Although menopause is not an illness and is an entirely natural part of a woman’s ageing, it can cause problems both mentally and physically. Unfortunately, those who have not experienced it may dismiss it as being less disruptive than it can be.

What causes menopause?

In the time leading up to menopause (known as perimenopause) a woman experiences a number of changes to the hormones produced by the ovaries, mainly oestrogen. While men also have oestrogen, it’s found in higher levels in women, and promotes the health and mechanics of the female reproductive organs. Oestrogen levels naturally decline during perimenopause, but not always in steady increments, thus the road towards full menopause can be quite bumpy for some women.

Two hormones called progesterone and testosterone (a predominantly male hormone but found in lower levels in women as well) also decline around this time. Decreases in progesterone affect menstrual periods both in terms of frequency and pattern, until such time periods stop completely (known as post-menopause).

What are the symptoms of menopause?

Menopause does not appear overnight but begins with perimenopause, a stage where symptoms start to appear but the woman is not yet fully menopausal (think of it as the transition period). Perimenopause can begin months or even years before a woman’s periods stop completely. It’s estimated that approximately 25% of women won’t experience any significant symptoms, while menopause will severely impact the wellbeing of another 25% of women. 50% of women experience symptoms which come and go but which they describe as manageable. Symptoms can be well managed with the right kind of treatment and lifestyle changes.

In both perimenopause and menopause, symptoms can include:

  • Changes to, or irregular, periods
  • Problems sleeping
  • Hot flushes at any time, often without warning
  • Night sweats which can abruptly interrupt sleep
  • Low mood or depression
  • Anxiety
  • A lack of self-confidence
  • Feeling isolated and unsociable
  • Sudden and unpredictable mood swings
  • Problems concentrating and focusing
  • Memory problems known as ‘brain fog’
  • Bloating
  • Weight gain – especially around the midsection
  • Changes to the bones (post-menopausal women are at a higher risk of developing osteoporosis due to lowered amounts of oestrogen)
  • Headaches
  • Reduced sex drive (low libido)
  • Changes to skin (acne, dryness, loss of elasticity) and hair loss or thinning.

Symptoms can also continue well after a woman’s periods have completely stopped, sometimes for a number of years. Granted, some women will experience very few of the above symptoms, but for those who do, the effect can be distressing and all-encompassing. It’s also important to recognise that like any change in life, menopause can bring with it a sense of loss; the loss of opportunity to have a child, a questioning of what older age will be like, and difficulties in relationships, especially with intimate partners.

How is menopause diagnosed?

Most women will know when they are starting to enter menopause; their periods will become less frequent over time, and they may also be experiencing some of the symptoms listed above. Blood tests that assess hormone levels provide definitive confirmation.

Should you want to see your GP for advice, write down any symptoms you’re experiencing, how often they occur, and how severe they are. Also note when you had your last period and report any irregularities in timing that might have occurred. Finally, be sure to make a list of medications and supplements you’re currently taking. Your GP will likely perform a physical check, and may also perform a blood test to check your levels of FSH (follicle stimulating hormone) and oestrogen.

Because some conditions can present with symptoms similar to those menopausal in nature, your GP may also request tests to rule out other things such as ovarian failure or a thyroid condition. These tests may include a thyroid function test, a lipid (cholesterol) profile, and/or tests for liver and kidney function.

How is menopause treated?

Treatments depend on the severity of your symptoms, and the stage of menopause you have reached. It’s important to see your GP if you think that you may be starting the menopause and your symptoms have become a barrier to enjoying your everyday life. Some treatments can include:

  • Medications such as hormone replacement therapy (HRT), anti-depressants,medication to manage anxiety, or medication to support healthy bones
  • Cognitive behavioural therapy (CBT) or talking therapy to help manage the emotional distress some women can experience during menopause 
  • Sleep coaching from a specialist sleep clinic (See our guide to Everything you need to know about sleep)
  • Natural remedies (it’s important to speak to your GP if you’re keen to try this approach – natural remedies can still have an impact on other medications you might be taking and may not be right for you)
  • Lifestyle changes such as eating healthily, stopping smoking, and cutting back on alcohol (see our resources on Benefits of health eating and Managing unhealthy habits)
  • Reducing caffeine to help lower anxiety levels
  • Practicing regular stress-reducing activities such as yoga, tai chi, pilates, and meditation (see our guide to Stress management techniques)
  • Staying physically active to boost mood, promote bone health, and reduce stress. (See our resources on the Benefits of physical activity)

How partners can help

The menopause can also affect partners who may be at a loss as to how to help and what to do.

Changes to a couple’s intimate life can be difficult for both to understand and navigate, and the emotional impact on a woman (caused by hormones and uncertainty about this new phase of life) can cause upset and tension in the relationship.

Here are some tips to help ease the journey and maintain a healthy, happy relationship:

  • Educate yourself – learn as much as you can about the process and what symptoms your partner may be experiencing. Ask your partner questions both about how she’s feeling emotionally, and what she needs from you in terms of practical support. The symptoms of menopause are not your fault but nor are they your partner’s. Know that this will pass.
  • If your partner is in agreement, it can be very helpful for you to attend a joint GP appointment so that you have a better understanding of what to expect, and learn ways of working together during what can be a difficult time.
  • Take the time to understand any treatments her GP recommends. Ask what you can do to help. If your partner is feeling overwhelmed with too much to do, try to take on some of the household chores or other tasks that can feel overwhelming when menopausal symptoms feel intense.
  • Some women don’t recognise their behaviour when affected by severe symptoms – they may ask themselves why they are so unhappy, or why their emotions seem out of control. Take it in your stride and be aware that compassion and understanding are key; she is still the same woman you love and care about. She is not her symptoms.
  • Be aware that your partner may feel less confident about her body and her attractiveness at this time. Disagreeing with her isn’t helpful, but continuing to give her compliments can go a long way to making her feel more secure during this time of change.
  • Support her health and wellbeing, whether helping to cook healthy meals, or getting out together for regular walks or bike rides. Exercise is key in managing some of the symptoms of menopause and it can help if you’re a part of that.

Coping with menopause at work

Issues relating to stigma and embarassment mean that many women don’t feel confident sharing the information that they are perimenopausal or menopausal. However, the reality is that symptoms don’t just occur at home and a woman can feel overwhelmed at work.

  • Remember you are not alone – in fact, according to the CIPD (2019), there are around 4.4 million women over the age of 50 in work and the vast majority of these will experience menopause during their working lives. Consider speaking to colleagues who are going through what you’re going through. A regular catch-up over lunch or coffee to share your feelings can work wonders and decrease feelings of isolation at work.
  • It can be difficult to feel in control at work when you’re dealing with the symptoms of menopause. Difficulty sleeping or night sweats can wreak havoc on how focussed you feel during the day. If you’ve not seen your GP for advice, it’s a good time to ask. You don’t need to suffer in silence.
  • In addition to sleep deprivation, which will make anyone feel wobbly, you might also lack your usual ability to focus and may also suffer from short-term memory loss (sometimes referred to as brain fog). Analysis paralysis – a feeling of not knowing where to start – can also cause some women to feel less confident. These symptoms are normal but can mean that things you would usually have dealt with easily become more stressful and feel more daunting. Ask your HR team what kinds of support they can offer. Some companies have flexible working policies, or can offer rota changes to accommodate any menopause-related GP or clinic appointments. You are not the only woman in your company who has needed this kind of help, so don’t be afraid to ask.
  • Share this article with your line manager and HR team – while menopause may still be a taboo in our society, it needn’t be. Educating people about this phase of life can clear up any misunderstandings, and build other people’s confidence so that a discussion about best ways to help doesn’t feel awkward or intrusive.
  • Contact retailTRUST for support. We can offer you confidential emotional support and help you to work through the very normal emotions connected to menopause.

 Video Source: NHS Choices