International Women’s Day focus on Women’s Health – All about the Menopause

So, what does the menopause mean?

Lexie: The menopause is a natural biological process that marks the end of a woman’s reproductive period. It refers to a period of 12 months where you don’t have a single period. In Lexie’s words, “it’s a bit like eating a box of chocolates and realising they’ve all gone – you find out it’s suddenly just happened!”. If each chocolate refers to one period every month, at some point, you’ll look down and realise that you’ve finished the whole box; there are no more periods to come.

In the UK, on average, this happens to women at around the age of 51 or 52, but it’s important to mention that women can enter the menopause at any age from 12 upwards. Women who enter the menopause below the age of 40 are described as having a premature ovarian insufficiency, whilst becoming menopausal aged 40-45 is usually termed an early menopause.

During the menopause, the ovaries gradually stop producing eggs, and the body’s production of oestrogen and progesterone (the hormones that regulate the menstrual cycle) decreases. This hormonal shift can cause a variety of symptoms, including hot flushes, vaginal dryness, mood changes, and sleep disturbances .

Medical treatments like chemotherapy or surgical removal of the ovaries can also induce the menopause. Celebrities who have experienced a medically provoked menopause include Michelle Heaton, Kate Walsh, and Angelina Jolie.

Whilst the menopause is a natural process that every woman will go through, the experience can be different for each individual. Many women may require medical treatment or support to manage their symptoms, and there’s nothing wrong with this!

So, the menopause means having no period for a year. Twenty-four hours later, once you’ve experienced one year and one day without a period, you’ve officially entered the post-menopausal period. In Lexie’s words, “it’s a rather eventful 24 hours!”!

What does the perimenopause mean? Are there any common symptoms?

The perimenopause refers to the 10 years leading up to menopause, when a woman’s body undergoes hormonal changes and prepares for the end of her reproductive years. During the perimenopause, the levels of oestrogen and progesterone in the body fluctuate, which can cause a range of symptoms. One month you might feel like you’re ready to tackle the world, but the next month you might have enough difficulty getting yourself out of the front door and on the way to work without forgetting your phone, your wallet, your keys… It can be completely discombobulating.

Some common symptoms of the perimenopause include:

• Irregular periods: Menstrual cycles may become shorter or longer, or the flow may become heavier or lighter.
• Hot flushes and night sweats: These are sudden, intense feelings of heat that make you sweat.
• Mood changes: Some women experience mood swings, irritability, and depression.
• Sleep disturbances: Difficulty falling or staying asleep is common.
• Vaginal dryness: Lower levels of oestrogen can cause vaginal dryness and discomfort during intercourse.
• Decreased libido: Changes in hormone levels can also cause a decrease in sex drive.

As Lexie explains, “the perimenopause is full of all these bizarre symptoms that often feel like they just don’t make sense – they’re just so variable and vague. For most women the earliest perimenopausal symptoms will be increasing anxiety, difficulty sleeping, joint pain, and plantar fasciitis. Once you get further down the line, hot flushes arrive, and they can last for years afterwards.”

Lexie also highlights the importance of being aware of the warning signs your body can give you earlier in your life, which can indicate how you might fare during the perimenopause (and the menopause). For example, if you suffer from blood pressure issues whilst pregnant, gestational diabetes, or poor mental health before your period, you’re likely to find the perimenopause a really emotionally turbulent time. Having this knowledge can help you feel more prepared.

It’s important to note that not every woman will experience symptoms during the perimenopause, and the severity and duration of symptoms can vary widely. However, if you are experiencing any symptoms that are affecting your quality of life, you should seek medical support. We’ll tackle the best way to go about this in part 2 of this blog post series.

Increasing awareness of the menopause is relevant to everyone, but why?

It’s important for everyone to have an understanding of the menopause, regardless of age or gender. So, if you’re years off the age you expect to enter the menopause, you’ve already been through it, or you’re not someone who menstruates, this conversation is still relevant to you, as everyone has loved ones who will be affected. Knowledge is the best way to offer these people support.

• The menopause affects half the population – it’s such a common experience that many people will encounter, either through personal experience or a partner, family member, or friend. It can happen from roughly the age of 14, and some women will continue having a period right through their 70s, 80s, and 90s.
• The menopause can have a significant impact on quality of life – the hormonal changes that occur during the menopause can cause a range of physical and emotional symptoms that can significantly affect a woman’s quality of life. The average age of suicide in women in the UK is between the ages of 45-49, which is right around the perimenopausal and menopausal transition periods. Therefore, it’s vital that everyone is aware of how these hormonal changes can affect women’s mental health and wellbeing.
• The menopause can have long-term health implications too – the loss of oestrogen that occurs during the menopause can increase the risk of developing certain health conditions, including osteoporosis, heart disease, and cognitive decline (which can lead to dementia and Alzheimer’s).
• Despite the fact that the menopause is such a common experience, it is often still viewed as a taboo subject that is stigmatised and poorly understood in many cultures. This can lead to a lack of support and understanding for women who are going through the menopause, which can make the experience even more challenging.

By increasing awareness of the menopause, we can help reduce stigma and improve understanding of this time of transition. This can help women feel more empowered to seek advice and manage their symptoms, but it can also support partners, family members, and friends to provide better support and understanding for their loved ones.

What is oestrogen used for, and what impact can the decline in oestrogen levels during the menopause have on the body?

Oestrogen is a hormone that is primarily produced in the ovaries. It plays an important role in many bodily functions, including:

• The regulation of the menstrual cycle: oestrogen helps to thicken the uterine lining in preparation for potential pregnancy – it also triggers ovulation.
• The maintenance of bone health: oestrogen helps to maintain strong bones by regulating bone turnover and promoting calcium absorption.
• The regulation of body temperature: oestrogen helps to regulate body temperature, which is why hot flushes can be a common symptom of the menopause.
• Mood: oestrogen can affect mood by regulating the levels of neurotransmitters like serotonin and dopamine.
• The maintenance of vaginal health: oestrogen helps to maintain the health of the vaginal tissues by promoting blood flow and moisture.

When oestrogen levels decline during the menopause, the body undergoes several changes which can manifest in a variety of short- and long-term symptoms:

• Oestrogen produces collagen, so losing this oestrogen results in the skin ageing.
• In Lexie’s words, “oestrogen is like a facial for your vagina” – losing oestrogen during the menopause can lead to significant internal tissue changes. The vaginal tissues can become thinner, drier, and less elastic, causing discomfort, pain, and recurrent infections. Many women suffer from these infections well into old age, so could benefit from HRT long after they’ve been through the menopause.
• Losing oestrogen can also tip the body into a more insulin-resistant state, resulting in a higher body mass index and a fat distribution that collects around the middle as the body desperately tries to hold onto oestrogen in this area.
• Oestrogen is also immune-protective, so lower levels of this hormone can mean that women suffer from infections more often.
• Mood changes: oestrogen can affect mood by regulating neurotransmitters in the brain, so lower oestrogen levels can lead to mood swings, irritability, and depression.
• Decreased bone strength and density – oestrogen helps to maintain bone health, so lower levels of oestrogen can increase the risk of osteoporosis and bone fractures. This can make women more susceptible to breaks, often leading to undiagnosed fractures and long-term care needs in old age.
• Changes in cholesterol levels – oestrogen helps to regulate cholesterol levels, so lower levels of oestrogen can lead to an increase in LDL cholesterol (“bad” cholesterol) and a decrease in HDL cholesterol (“good” cholesterol). Higher cholesterol levels can make you more likely to develop cardiovascular diseases and diabetes, endangering your long-term health.

Overall, the decline in oestrogen levels during the menopause can have a significant impact on a woman’s physical and emotional health. HRT may be recommended to manage symptoms and reduce the long-term health risks associated with low oestrogen levels.

Is it normal for menopausal or post-menopausal women to experience some level of urinary incontinence?

It is common for menopausal and post-menopausal women to experience some level of urinary incontinence. This is because oestrogen is essential in the proper functioning of the bladder trigone, which controls the release of urine and the urge to urinate, and decreasing levels of oestrogen affect this mechanism. However, urinary incontinence is not normal – it’s never something anyone should have to accept as a standard part of ageing.

In Lexie’s words, urinary incontinence should never be normalised. “Women joke about crossing their legs or not going on trampolines, but I think anything that’s life-limiting is wholly unacceptable. Women frequently just cope and cope and cope, and put up with more and more because they have so much going on in their lives. Often, I’ll ask one of my patients how they bladder is, and they’ll just say, ‘oh, it’s fine’. So I say, ‘so you can jump up and down every day?’, and they’ll explain that actually, they do have to wear an incontinence pad every day. That is not fine – no woman should be walking around struggling with the effects of incontinence”.

There are treatments which can help with this, including HRT, which we’ll be diving into in the second part of this blog post. Remember: if you’re concerned about any symptoms of the menopause, it’s essential that you seek professional medical advice.