MENOPAUSE means cessation of periods and is derived from two words – “meno” or menstruation, and “pause”, or stopping.

The diagnosis of natural menopause can only be made 12 months after a woman’s last period, whereas surgical removal of the ovaries, or any event that causes ovarian failure, results in immediate cessation of periods.

Perhaps less well known is the term perimenopause, used to define the period before this event and after, when declining levels of sex hormones may result in several symptoms both physical and mental, to varying degrees.

The average age of natural menopause in the UK is 51, yet women may experience hot flushes and night sweats as early as their early forties, sometimes even before this. These may continue for years after menopause has occurred.

Other complaints including brain fog, anxiety and depression, reduced libido, joint and muscle pains may also be due to declining levels of the principal hormone oestrogen, as well as progesterone and testosterone.

Although the menopause is a natural event, 25 per cent of women classify their symptoms as severe, with 1 in 10 admitting to feeling suicidal as a direct result.

The perimenopause has been trivialised by some, and many women will undoubtedly have been reluctant to come forward due the associated stigma, leading to many suffering in silence.

Furthermore, poorly conducted studies in the early 90s advised that the risks of venous thromboembolism (deep vein thrombosis and pulmonary embolism), cardiovascular events (heart attack and stroke) and breast cancer made HRT unsuitable for the majority, to a point where doctors were scared to prescribe, and women fearful to enquire about it.

The diagnosis of perimenopause can be made without blood tests to check for hormone levels, although they may be performed under the age of 45, when considering a potential diagnosis of early menopause.

It is important for women to come forward as some of the reported symptoms may be due to causes other than the menopause, and will need investigating, especially those which are severe, or where another diagnosis is strongly suspected.

You don’t need to have gone through the menopause to commence treatment for it. Women who have had an early menopause, currently defined as under 45, will be offered HRT until the age of 50, to reduce the chances of osteoporosis, providing it is suitable for them.

The diagnosis of perimenopause is largely made on reported symptoms, and once this has been established, treatment options can be discussed with the majority available in general practice and not requiring a referral to a gynaecologist.

Naturally occurring botanicals including black cohosh and red clover have not been shown to be superior to placebo in trials and hence are not currently prescribe. However, they are available in health shops, with many women reporting symptom relief.

There has been much controversy about the use of antidepressants in treating the menopause, with complaints of feeling dismissed or that symptoms have been incorrectly ascribed to a mental health issue. Yet citalopram and venlafaxine are more effective than placebo in reducing perimenopausal hot flushes and sleep disturbance.

HRT is available in multiple preparations, including oral, patches, and topical treatments, for example vaginal oestrogen which can be directly applied to the area to reduce symptoms of itch, cystitis and difficulties with sexual intercourse.

Preparations including oestrogen and progesterone are required for anyone who has a womb, as oestrogen on its own may cause abnormal changes to the lining of the uterus.

Before prescribing these, your doctor will take a careful history and examination, checking for any reason that might make HRT less suitable or inappropriate.

Lifestyle measures should not be forgotten when addressing the perimenopause. One of the biggest concerns with declining oestrogen is the increased risk of osteoporosis and fractures, as well as cardiovascular disease, with premenopausal women largely protected from these. Smoking can bring the menopause forward by up to two years, smoking and excess alcohol consumption both reduce bone mineral density.

Obesity can make menopausal symptoms worse. Though the menopause is associated with weight gain, thankfully this is not inevitable.

A good diet, routine cardiovascular exercise and good sleep hygiene are also part of the bigger picture.

Levels of distress and disruption to daily life associated with the perimenopause should not be underestimated. I would urge any woman struggling either physically or psychologically with any aspect of the peri or actual menopause to seek help from your GP.

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