Menopause for thought

The word ‘menopause’ comes from ‘meno’, meaning your menstrual cycle, and ‘pause’, meaning to stop. Although the medical definition of menopause is when you have not had your monthly period for at least 12 months, we usually speak about menopause using the following terms:

• Perimenopause is the time of life leading up to, and after, your last period. This is the time when periods usually start to become less frequent over a few months or years before they stop altogether. Sometimes they can stop suddenly.

• Menopause is often used as a catch-all term to encompass perimenopause and the symptoms that come from the changes in hormone levels, whether this comes naturally or through illness or treatment.

• Postmenopausal refers to when a woman hasn’t had a period at all for one year.

At what age do you go through the menopause?

The menopause is a natural part of ageing and for most women in the UK and US this usually occurs between 45 and 55 years of age, with the average age being 51 years .^1,2,3

If you’re younger than 45, it is called an early menopause. Around 1 in 100 women experience the menopause before the age of 40 .¹ This is known as a premature menopause, or Premature Ovarian Insufficiency (POI).

By the age of 54, 80% of women will have stopped having periods .⁴

Menopause occurs because as you age your ovaries stop producing eggs (natural) or your ovaries have been removed (surgically due to cancer or other reasons) and the amount of oestrogen (the main female hormone) in your body falls.

A mentioned earlier, the time before your last period, when your oestrogen levels are falling (the perimenopause) can last from a few months to several years.

Menopausal symptoms

Despite the menopause being a natural event that every woman will go through at some point - it is sometimes difficult to work out whether you are ‘starting the change’.

This can be because symptoms usually start a few months or years before your periods stop and can persist for some time afterwards, lasting on average 7 years !⁴ If you are not aware of what the symptoms are then you may not realise you are perimenopausal. So, what are the common symptoms?

1. The first sign of the menopause is usually a change in the normal pattern of your periods which could be lighter or heavier or become less or more frequent and eventually they will stop altogether. If there is spotting between periods or spotting after sex, then do speak to a doctor as this could possibly be abnormal bleeding.
2. Then there are the menopausal symptoms which over 80% of women will experience due to that dropping level of oestrogen, with about 25% of women having very severe symptoms .¹ The most common ones are:
   • ‘vasomotor symptoms e.g., the well-known hot flushes and night sweats
   • psychological symptoms e.g., depression and lack of concentration, typically referred to as ‘brain fog’
   • joint and muscle pain
   • genitourinary syndrome of menopause e.g., vaginal dryness, burning urination, recurrent urine infections and reduced libido

These symptoms can be non-existent, last for a few years, or even decades.

It may be hard for a woman or even her doctor to recognise that she may be premenopausal as some symptoms can seem quite vague - like hair loss, weight gain, bloating, palpitations, incontinence, fatigue, dizziness. So, it is important if you are having changes to your periods and symptoms to consider that falling oestrogen could be the cause.

Not all changes in your body and wellbeing at this time may be because of your menopause. But it is important to consider the menopause as a cause and consider your wider health and seek medical advice.

When to speak to your doctor

Just because over 50% of the population will experience menopause and menopausal symptoms are quite ‘normal’, that doesn’t mean you shouldn’t consult a doctor to help manage your symptoms and determine which treatments can help manage the discomfort.

If you find that you are struggling to manage the symptoms or that they are impacting on your quality of life, book an appointment with your GP. They will look at your age, period frequency and symptoms and should be able to tell if you’re perimenopausal.

If you're experiencing symptoms of the menopause before 45 years of age, it is important to speak to a clinician and receive the correct management.

Is there a test to confirm the menopause?

For healthy women aged over 45 years who have irregular periods and other menopausal symptoms, a blood test is not necessary for a diagnosis. Your account of what symptoms you are experiencing is the basis for a diagnosis of the perimenopause or menopause.

The Greene Menopause Index, also known as the Greene Climacteric Scale, is a questionnaire to study the symptoms of the menopause. It is a standard list of 21 questions which women use to rate how much they are bothered by their menopausal symptoms. You can fill this in to record your symptoms.

Women under 40 or between 40 and 45 who are experiencing menopausal symptoms or changes in their periods may need investigations such as blood tests (looking at your level of follicle-stimulating hormone and possibly other bloods like your thyroid function) before making a diagnosis.

Can I speak to a Babylon clinician about this?

Yes, you can speak to a Babylon clinician about the menopause, your symptoms and medication options, all via your smartphone, 24/7. Simply download the app and book an appointment.

References

1. Nice.org.uk. 2020. Overview | Menopause: Diagnosis and Management | Guidance | NICEAvailable here
2. Women's Health Concern. 2020. The Menopause | Women's Health ConcernAvailable here
3. Menopause.org. 2020. Perimenopause, Early Menopause Symptoms | The North American Menopause Society, NAMS.Available here
4. Rock My Menopause. 2020. Menopause - Rock My MenopauseAvailable here