Even in this day and age, the thought of menopause leaves so many women anxious simply because they don’t feel prepared or know what to expect. Menopause is different for everyone - some women might breeze through it but many will share the challenges of feeling displaced in their own bodies and perhaps even feeling displaced amongst friends/family/the world around them. Understanding menopause and knowing your treatment options can help you feel really prepared for it.
When will it start?
Firstly it is important to say that hormones can start to change and get out of balance years before the menopause! Many women find that from their 40s, their periods are never the same. Hormones begin to decline but at different rates: usually progesterone declines before oestrogen. Even if the periods are still regular, women may notice that they suffer from much worse PMS, or experience hot flushes before their periods, or start to feel foggy, or increasingly anxious and unable to cope. The periods may become much heavier with cramps. Then the interval between periods may reduce so that they are coming more frequently. Later the periods might get much more irregular and infrequent and when they are some months apart, more frequent hot flushes may come because now oestrogen is also starting to fall. This usually happens closer to the menopause. The perimenopause is particularly characterised as oestrogen levels swinging about which can cause a multitude of changing symptoms: bursts of hot flushes and feeling premenstrual that then abates to feeling flat.
How do I know when I’m through the menopause?
Menopause is the absence of a period for one full year after the age of 50. When you’ve been a full year without a period after the age of 50 with menopausal blood tests (or a full two years without a period under the age of 50 with menopausal blood tests) then you are ‘through’ the menopause. However, I think what women really want to know is: "When will my symptoms stop?” Sadly there’s no sure answer to this. Although its true that usually symptoms are worst in this first year of not having a period, even after this one year many women continue to have symptoms. Some women have hot flushes into their nineties! A study published in JAMA found that the average duration of hot flushes was 7.4 years. Moreover, women who were premenopausal or at the beginning of perimenopause when they first reported frequent hot flushes (which in my experience is a lot of women) had an average duration of 11.8 years of hot flushes. [1] Another study found that the median duration of hot flushes was 10.2 years which again considerably exceeds the time frame that so many doctors refer to.[2] I think this is something doctors don’t explain well because too often women have been given the impression that if they just ‘push through’ that first year of no periods, all their symptoms will disappear. So if you're still surprised that you're experiencing symptoms, don't be: seek help.
Post-menopause: once you have been one full year without periods after the age of 50, you are post-menopausal. Essentially your ovaries are not producing significant amounts of hormones ( a blood test would read the Follicle Stimulating Hormone as raised, and an oestrogen levels as <44 or ‘undetectable') and this is not going to change unless you take hormone replacement therapy.
What are the symptoms that I may experience during these stages?
Physical: hot flushes, night sweats, insomnia, fatigue, irregular bleeding, dry skin, hair loss, breast tenderness, acne or facial hair, migraines, heart palpitations, weight gain, joint aches, itchy skin, dry eyes, bladder symptoms, vaginal dryness and loss of libido.
Emotional/mental: anxiety, depression, irritability, weepiness, memory loss, depersonalisation, feeling unable to cope, memory loss and lack of motivation or joy.
Bioidentical hormones are extremely effective at alleviating all these symptoms.
Why did my GP offer me antidepressants?
Serotonin re-uptake inhibiting antidepressants aren't just used for depression, they may also help relieve hot flushes in menopause. However they won't help with all the other symptoms and they do have side effects: many women report feeling numb or spaced out, or experiencing loss of libido on antidepressants. Moreover, anti-depressants aren't treating the root cause of the problem (which is lack of hormones), nor providing any potential health benefits (such as osteoporosis prevention). In my experience many women quite rightly don’t want to take antidepressants for menopausal symptoms! Hormones are the most effective means to address symptoms holistically, and earlier is better - starting hormones within 10 years of menopause gives greater benefit than hormones started later. There is no arbitrary maximum duration of how long you can stay on hormones - it depends on each individual's circumstances, but doses may need to be adjusted. Doses should be individualised.
[1] Duration of menopausal vasomotor symptoms over the menopause transition.
[2] Duration of Menopausal Hot Flushes and Associated Risk Factors