Menopause: An Introduction

If menopause symptoms are impacting on the quality of life and relationships you should not suffer in silence. You need to talk to your GP and here in Sloane Square Medical, we take a special interest in alleviating menopause issues. 

The menopause is not something that just impacts women. It has an impact across the whole of society. The importance of the menopause and the impact it has is starting to be recognised by the public, politicians and employers.

The effects are felt by the women who are experiencing the symptoms, partners, and children within the family.  The menopause has a large impact within the workplace which is now finally being recognised.

In 1850 the average life expectancy for a woman was 45 years, so the menopause happened at the end of someone’s life. Now women are living until their late eighties, menopause is something that happens halfway through their life.

Now, the menopause happens to women at a time when they may be at their professional peak when they may be caring for elderly relatives and have teenage children with extensive needs. They are running homes and supporting partners or living alone with the pressures that brings.

There are very few women around the age of 50 who do not have extensive demands on them from multiple sources. Having to also deal with the menopause at this life stage is far from ideal.
Although there is a minority of women who are able to pass through the menopause with no problems for very many women it has a devastating impact on their ability to function.

Most women are just not prepared or able to recognise their symptoms. There is a lack of awareness around the menopause. Women are used to their bodies changing through the monthly cycle and adapt to these changes. This can lead to symptoms being left until near crisis point before women get help.

During that time there is potential for misdiagnosis of depression or other conditions and for job opportunities to be lost and relationships suffer.

A woman’s relationship with the menopause is complicated.

 ·         What happens to me as I go into the menopause?

At some point in your 40’s your oestrogen levels start to fall. The ovaries will still be producing some oestrogen and for a few years, they will have an intermittent level of ovarian functioning.   

The average woman reports eight symptoms of the menopause. Each person is different and the range of symptoms that can occur are discussed below.

Energy

This makes the picture more confusing for women as one day you may feel fine and then the next you are just not able to function. It can also change within the space of a few hours. You may be full of energy first thing in the morning and in bed by mid-afternoon.

Memory

There is a loss of memory. This is also intermittent with an inability to retain short term information, forgetting instantly the key points in a conversation and an inability to recall names from the past. This makes it nearly impossible to work in a job at a high level, again this can be intermittent with someday being fine and others really difficult.

·         Has memory been studied in the menopause?

Yes, control trials with repeat high-definition scans of the brain during the menopause have shown there is a decrease in the size of the area in the brain associated with memory and emotions. That part of the brain starts to atrophy. It is real and it has a big impact.

Sleep

Oestrogen levels also impact sleep. As the levels fall women complain of not being able to get a full night’s sleep and waking early in the morning.  If you are only getting 4-5 hours of sleep from months on end it becomes impossible to function normally. Again, this can be intermittent however women often come in reporting sleep issues for years. This is because it can be difficult to know if you are not sleeping due to stress, children and the many other issues which impact women in their 40-50’s.

Anxiety and depression

There is a definite increase in anxiety and low mood. Again, this can be hard to pinpoint.  Routine repetitive tasks can be fine even at a complex level in business, but new problems or new situations can be overwhelming. There can be an inability to process accurately even the simplest situation leading to a sense of being totally overwhelmed.

Mood changes

Every woman has a different experience through the monthly cycle. Some suffer from altered mood each month and other women notice no changes at all.

The same happens during the menopause. For some women, there is no change in mood during the menopause. For other women during the menopause emotional responses can be both dulled at times and also heightened. This can fluctuate within short spaces of time.

At times everything can be in proportion and at other times emotions can quickly feel extreme. This can be exhausting and can also be difficult to manage.

It can lead to women fluctuating between feeling tearful and annoyed.

The changed in mood can also be subtle but can have a big impact on those around.

Neurological symptoms

Some women get odd neurological symptoms. As the oestrogen levels fall if effects the nerves. This can give pins and needles or other tingling symptoms. This can last for a few years until the low levels of oestrogen stabilise. It occurs as the hormone levels fall. These symptoms often resolve within hours of oestrogen replacement.

Urinary symptoms

There are oestrogen receptors in the bladder. This can lead to changes around the entrance to the bladder as oestrogen levels fall leading to recurrent urinary infections.

Genital symptoms

There are oestrogen receptors in the genital tract. As oestrogen levels fall this can leave dryness and discomfort which can impact intimate relationships.

All of this starts to happen many years before hot flushes and periods stopping. Everyone is aware of these two symptoms but focusing on them has not been helpful in allowing women to understand what is happening to them. If you know something is not as it normally is it is worth discussing with your GP if it is menopause related.

The perimenopause when the hormone levels are going up and down is harder to manage and treat than when the ovaries have stopped fully functioning which occurs usually in your mid 50’s.

Through this process, there are now many treatment options available. 

I hope that with more information and increasing awareness more women will be able to recognise what is happening to them earlier.

Although there is a lot of advice on self-diagnosis discussing this with a doctor will ensure nothing is missed and appropriate treatment options are discussed.

HRT is now recommended as the first-line treatment for anxiety and depression around the menopause. It can make an incredible difference.

It is possible to feel normal and high functioning again. 

Dr Victoria Owen

Dr Owen is a member of the British Menopause Society. This gives access to the latest information, guidance and lectures on the menopause,

Dr Owen attended an advanced course on the menopause in 2020 with the British Menopause Society and is doing a further advance course on the menopause in February 2021 with the British Menopause Society. Highlights from these lectures will be discussed in a further blog.