The Oxford English Dictionary describes menopause as ‘the ceasing of menstruation’ and menstruation as ‘the process in a woman of discharging blood and other material from the lining of the uterus at intervals of about one lunar month from puberty until menopause, except during pregnancy.’
Over 60% of women going through the menopause experience symptoms resulting in behaviour changes which can last up to fifteen years and one in four women will experience severe debilitating symptoms. The Local Government Association estimate that over 13 million people in the UK are either menopausal or perimenopausal, yet until relatively recently no one really talked about it. Menopause usually occurs between 45 and 55 years of age, as a woman’s oestrogen levels decline. In the UK, the average age for a woman to reach the menopause is 51.
My periods have been erratic for a number of years now. I was fully aware of the reasons why but aside from the nuisance of going from having periods like clockwork to having, what I thought were an increased number of periods, I felt I was managing well with ‘the change’. However, in June 2021, my periods stopped (a day I had looked forward to for almost 40 years) and soon afterwards I began to experience other symptoms. Definitely a case of be careful what you wish for and better the devil you know.
Following a heatwave, I noticed I was still feeling incredibly hot, even though the temperature had dropped. The heat I soon realised was multiple hot flushes and night sweats. Initially, I thought I could manage these too. ‘Don’t be a baby, you’re just a bit hot’ I told myself. However, for six weeks I didn’t sleep through a single night without waking multiple times feeling that I needed to be wrung out, or have a single day without multiple hot flushes, which started as a tingling sensation around my eyes and cheek bones and quickly crept around my whole body, as if the heat was trying to escape, leaving me feeling so hot I felt as if was going to pass out. If that was not bad enough, I watched, as my hair, which had become incredibly dry, disappeared down the plug hole every time I washed it and pulled masses of it out of my hair brush. Hair loss and hair thinning was not something I was at all prepared for. Beginning to feel rather miserable, I decided it wasn’t funny any more and I needed to seek help.
The symptoms I have been experiencing for a few years now, I now know are what is called the perimenopause, that is when a women experiences symptoms due to hormone changes but still has periods that are changing in nature or frequency.
During perimenopause, because hormone levels are fluctuating, women may have a normal period one month, then it can be heavier or missed altogether, before going back to normal for a time and the odd excess periods that I experienced, I now know courtesy of a friend, are not periods at all, but ‘breakthrough bleeding’ that occurs when a woman starts having less periods. Essentially, she explained to me, when you ovulate, a follicle releases an egg, after which the follicle ‘collapses’ in on itself and becomes a gland. The gland releases progesterone, a hormone that stops the lining of the womb from thickening, preparing the womb to receive and implant the egg. However, without progesterone to stop the lining from thickening, the thickening keeps on going until it has to stop because it sort of ‘can’t take any more’ and this causes ‘breakthrough bleeding’, with the womb lining coming away in the absence of egg production and therefore not producing progesterone.
So, rather than menopause being a short sharp event, it is actually the culmination of a gradual process which begins with perimenopause and ends with menopause, when a woman has not had a period for twelve months.
Pre menopause the hormones oestrogen and progesterone work together to regulate menstrual cycles and the production of eggs, however a lack of oestrogen can trigger a range of symptoms and as humans have hormone receptors in cells all over our bodies, changes in hormones can affect many parts of our body, even those we wouldn’t expect. The Greene Climacteric Scale (GCS) tracks a list of twenty one symptoms that are often associated with the menopause, these are:
- Heart beating quickly or strongly
- Feeling tense or nervous
- Difficulty in sleeping
- Attacks or anxiety, panic
- Difficulty in concentrating
- Feeling tired or lacking energy
- Loss of interest in most things
- Feeling unhappy or depressed
- Crying spells
- Feeling dizzy or faint
- Pressure or tightness in the head
- Parts of the body feeling numb
- Muscle and joint pains
- Loss of feeling in hands or feet
- Breathing difficulties
- Hot flushes
- Sweating at night
- Loss of interest in sex
I have experienced many of the symptoms on the list but it is not exhaustive and there can be many other symptoms too. One thing I have learned about the menopause is there doesn’t seem to be a ‘normal’ at all, with women having both similar but individual menopause experiences. It should however be possible to diagnose the menopause on symptoms alone and before I saw my doctor, I completed a symptom checker document which can be downloaded from websites that provide information about menopause.
The importance of oestrogen
Oestrogen is important in various ways. Firstly, it provides lubrication for joints and prevents inflammation, it can also affect the texture of hair, with a lack of oestrogen leaving it prone to breaking. As oestrogen declines, androgens (a collective term for male hormones) sometimes become more prominent. This imbalance of hormones shrinks hair follicles making hair fine and it is also responsible for facial hair.
Oestrogen helps protect against osteoporosis. Around 10 per cent of a woman’s bone is lost in the first five years of the menopause and this increases the risk of osteoporosis which weakens bones and makes them more likely to break. Until we are around 30 we normally build more bone than we lose, however during menopause bone breakdown occurs at a faster rate than bone build up, resulting in a loss of bone mass. Oestrogen also protects against other long terms health issues such as cardiovascular disease, diabetes and dementia.
While hot flushes are one of the most well known symptoms of the menopause, the reason for these is not really known. Some believe falling progesterone levels affect noradrenaline, another hormone that regulates our body temperature. Oestrogen also directly affects the thermoregulatory areas of our brain. There is no normal number, frequency or duration for these. In my case, from the time I started experiencing these symptoms, I didn’t go a day without hot flushes or night sweats and they happened multiple times a day. On particularly bad days, they were as little as 50 minutes apart and lasted for around a minute at a time.
Here and now
At the time of writing this post I am two and a half way weeks into taking HRT. This is not a decision I ever thought I would make and I was anxious about starting the treatment but I appear to be tolerating it and I am seeing signs of improvement. The past couple of months have felt overwhelming both in terms of the physical symptoms I have been experiencing but also because of all the learning I suddenly found myself needing to do. However my current mood is cautiously hopeful. Writing this post has partly been about me trying to understand what is happening to my body, while wanting to raise awareness and encourage women to educate themselves about the menopause before it happens to them but it really only touches the surface of all things menopause.
I feel very fortunate, that at the time I am going through this, people are beginning to think differently about menopause and rather than it being a taboo subject, are now talking about it openly. I am grateful for not going through this even thirty years ago, to have a couple of friends who were happy to talk to me when I was feeling at my worst and for a lovely and understanding doctor, which I know is not everyone’s experience.
Since 2011, World Menopause Day has taken place in October each year and as a result of campaigning, from September 2020, menopause was added to the RSE curriculum in England. The Make Menopause Matter campaign is calling for all GPs to receive mandatory menopause training and for a mandatory menopause module to be taught at every medical school, meaning that women in the future will be much more informed than I was. And on 29 October a second reading of the MP Support for Private Members’ Bill: Menopause (Support and Services) will take place. This is an important opportunity for women and families as it aims to improve the support and services given to those experiencing Menopause in the UK, including, crucially, the exemption of hormone replacement therapy (HRT) from National Health Service prescription charges.
The Balance website and The Balance App have been an enormous help to me. The website has a fabulous search function so you can search for specific symptoms and find articles, factsheets and videos relating to these, while the app allows users to journal their symptoms. The book Preparing for the Perimenopause and Menopause was a big help to me too.
There are other websites and books too. Some of these can be found below.
- British Menopause Society
- International Menopause Society
- Liz Earle Wellbeing
- Menopause Matters
- Menopause Support
- The All Party Parliamentary Group On Menopause
- The Menopause Charity
Training and education
National Institute for Healthcare Excellence
If you want to go on HRT but are struggling with getting this prescribed, guidelines to improve the consistency of support and information provided to women in menopause can be found on the National Institute for Healthcare Excellence website.