What is Menopause?

What is Menopause?

Menopause is a naturally occurring event in a woman’s life when menstruation (periods) stops. Before this happens there can be up to several years of change in how frequently periods come and during this time menopausal symptoms can develop – this is called perimenopause. In perimenopause, levels of a hormone called oestrogen fluctuate, before eventually falling so low that periods stop altogether.

During our productive years, we have a monthly menstrual cycle, in which we release an egg from one of our two ovaries, and there is a cyclical release of the hormones oestrogen and progesterone. An area in the brain called the pituitary gland releases hormones, FSH (follicle stimulating hormone), which promotes the production of oestrogen and maturation of egg-containing follicles; and LH (luteinising hormone), which triggers ovulation (egg release).

We have a finite number of eggs, and when we start to run out, the remaining eggs also become more resistant to the influence of FSH. Our ovaries produce less oestrogen and our FSH levels rise as the brain tries to elevate levels of circulating oestrogen. It’s the drop in oestrogen that leads to many of the symptoms of menopause.

The term ‘menopause’ relates to our last period, and the time before it, when we may start to experience symptoms, which is known as perimenopause. Once a year has passed since your last period, you are in the postmenopausal phase of life.

In the UK, the average age to go through the menopause is 51, and eight out of ten women will experience symptoms of menopause, for around 5-8 years.

What are the symptoms of menopause and perimenopause?

Some women appear to sail through menopause without difficulty, but many women experience symptoms and for some women they can be debilitating. In perimenopause, symptoms can creep up gradually, or be misinterpreted as something else.

There is a constellation of menopausal symptoms, which include:

Hot flushes feel like an intense heat surge within the body, which can lead to a sudden onset of sweating.
We believe that the drop in oestrogen affects the area in the brain responsible for temperature regulation as if the body’s thermostat misbehaves. Hot flushes can be triggered in many ways (e.g. during a moment of stress, or after drinking a hot drink), and they can be particularly distressing in the workplace, or, if they disturb your sleep at night.

Night sweats occur because of a decline in the oestrogen and progesterone levels in the body, and they tend to last longer than hot flushes and produce more sweating. Frequently disturbed sleep leads to fatigue and anxiety. For some women, the problem can be so serious that they may consider leaving work.

It’s very common to feel anxious or irritable when you’re menopausal, and this can lead to a loss of confidence at work and even social isolation. Many women (and even Doctors) mistakenly believe that they are becoming depressed, when in fact, their low mood is a symptom of menopause.

Oestrogen affects all areas of the body, including the brain, and during menopause, we might find ourselves struggling with our memory, and struggling to get the words out. This in turn heightens anxiety levels and reduces confidence.

Many women are surprised to learn that their muscle and joint aches and pains (which can even affect our hands) are symptoms of menopause. If we’re feeling achy and stiff, we’re less likely to get exercise, which leads to deconditioning and muscle loss; this in turn can make joint pains worse.

Sadly, according to studies, between 17 and 45% of perimenopausal and menopausal women find sex painful. Low oestrogen levels cause dryness and thinning of the walls of the vagina, and the vulva (entrance to the vagina). Sometimes this can lead to severe pain with penetration, and there can even be tearing of the vaginal tissues. The experience of pain can lead to anxiety around sex, further reducing arousal and natural lubrication. The good news is, that much can be done to help, and even topical oestrogen cream can be transformative.

Urinary tract infections are more common during menopause, as the reduction in oestrogen leads to thinning of the tissues of the bladder and urethra, rendering them more susceptible to infection. Also, the natural balance of bacteria in the vagina changes during menopause, which can contribute to infections starting up in the urinary tract.
Many women find that they need to pass urine more frequently during the day (and the night!), and they may experience burning when having a wee. Some women struggle with stress continence because of the weakening of the pelvic floor during menopause, and many experience urge incontinence, which is the feeling you need to have to dash to the loo at a moment’s notice. It’s important not to just ‘put up’ with these symptoms, or feel embarrassed about discussing them. Much can be done to help.

During perimenopause, oestrogen and progesterone levels go up and down, often erratically, and this can lead to breast pain. Thankfully this tends to improve as we transition through into the post-menopausal phase of life.

Losing interest in sex is a very common experience during the perimenopause and menopause. The problem may also be compounded by an experience of painful sex because of vaginal dryness. As well as a reduction in oestrogen production during menopause, we also experience a decline in our testosterone levels (and yes, women make testosterone as well as men!). Both oestrogen and testosterone are important in arousal and sex drive, and lower oestrogen levels can make orgasm a little harder to achieve.

Many women experience an increase in fatigue and feeling tired all the time during menopause, and there are several factors behind this. Sleep, which is so often interrupted during menopause, is vital for sustained energy levels during the day, and a decline in oestrogen also brings about an increase in cortisol, the stress hormone, further increasing our tiredness.

Oestrogen affects all systems in our bodies, including the cardiovascular system. Lowering the oestrogen levels in menopause brings about a stimulatory effect on the heart; many women may experience their heart racing or pounding in their chest, or a sensation that they’ve missed or dropped a beat.

As we age, we naturally lose some of the collagen in our skin which means the skin is less plump, it thins, and is more prone to wrinkling. This process accelerates as oestrogen levels plummet during menopause. Lower oestrogen levels also mean less skin hydration, and as the balance between oestrogen and testosterone hormones shifts during menopause, we may find ourselves prone to acne outbreaks, and growing facial hair (hirsutism). Finally, hair loss and hair thinning can also be a distressing symptom of menopause.

There is a constellation of menopausal symptoms, which include:

Hot flushes feel like an intense heat surge within the body, which can lead to a sudden onset of sweating.
We believe that the drop in oestrogen affects the area in the brain responsible for temperature regulation as if the body’s thermostat misbehaves. Hot flushes can be triggered in many ways (e.g. during a moment of stress, or after drinking a hot drink), and they can be particularly distressing in the workplace, or, if they disturb your sleep at night.

Night sweats occur because of a decline in the oestrogen and progesterone levels in the body, and they tend to last longer than hot flushes and produce more sweating. Frequently disturbed sleep leads to fatigue and anxiety. For some women, the problem can be so serious that they may consider leaving work.

It’s very common to feel anxious or irritable when you’re menopausal, and this can lead to a loss of confidence at work and even social isolation. Many women (and even Doctors) mistakenly believe that they are becoming depressed, when in fact, their low mood is a symptom of menopause.

Oestrogen affects all areas of the body, including the brain, and during menopause, we might find ourselves struggling with our memory, and struggling to get the words out. This in turn heightens anxiety levels and reduces confidence.

Many women are surprised to learn that their muscle and joint aches and pains (which can even affect our hands) are symptoms of menopause. If we’re feeling achy and stiff, we’re less likely to get exercise, which leads to deconditioning and muscle loss; this in turn can make joint pains worse.

Sadly, according to studies, between 17 and 45% of perimenopausal and menopausal women find sex painful. Low oestrogen levels cause dryness and thinning of the walls of the vagina, and the vulva (entrance to the vagina). Sometimes this can lead to severe pain with penetration, and there can even be tearing of the vaginal tissues. The experience of pain can lead to anxiety around sex, further reducing arousal and natural lubrication. The good news is, that much can be done to help, and even topical oestrogen cream can be transformative.

Urinary tract infections are more common during menopause, as the reduction in oestrogen leads to thinning of the tissues of the bladder and urethra, rendering them more susceptible to infection. Also, the natural balance of bacteria in the vagina changes during menopause, which can contribute to infections starting up in the urinary tract.
Many women find that they need to pass urine more frequently during the day (and the night!), and they may experience burning when having a wee. Some women struggle with stress continence because of the weakening of the pelvic floor during menopause, and many experience urge incontinence, which is the feeling you need to have to dash to the loo at a moment’s notice. It’s important not to just ‘put up’ with these symptoms, or feel embarrassed about discussing them. Much can be done to help.

During perimenopause, oestrogen and progesterone levels go up and down, often erratically, and this can lead to breast pain. Thankfully this tends to improve as we transition through into the post-menopausal phase of life.

Losing interest in sex is a very common experience during the perimenopause and menopause. The problem may also be compounded by an experience of painful sex because of vaginal dryness. As well as a reduction in oestrogen production during menopause, we also experience a decline in our testosterone levels (and yes, women make testosterone as well as men!). Both oestrogen and testosterone are important in arousal and sex drive, and lower oestrogen levels can make orgasm a little harder to achieve.

Many women experience an increase in fatigue and feeling tired all the time during menopause, and there are several factors behind this. Sleep, which is so often interrupted during menopause, is vital for sustained energy levels during the day, and a decline in oestrogen also brings about an increase in cortisol, the stress hormone, further increasing our tiredness.

Oestrogen affects all systems in our bodies, including the cardiovascular system. Lowering the oestrogen levels in menopause brings about a stimulatory effect on the heart; many women may experience their heart racing or pounding in their chest, or a sensation that they’ve missed or dropped a beat.

As we age, we naturally lose some of the collagen in our skin which means the skin is less plump, it thins, and is more prone to wrinkling. This process accelerates as oestrogen levels plummet during menopause. Lower oestrogen levels also mean less skin hydration, and as the balance between oestrogen and testosterone hormones shifts during menopause, we may find ourselves prone to acne outbreaks, and growing facial hair (hirsutism). Finally, hair loss and hair thinning can also be a distressing symptom of menopause.