Menopause

The menopause doesn’t happen overnight. The shift in hormones, periods and potential for symptoms changes over years. While the word ‘menopause’ describes the complete end to periods, the ‘perimenopause’ is the time (often years) before and after where women notice changes and experience symptoms. Women often ask ‘is it menopause?’ and ‘where am I in all this?’  It can be helpful to see an overview of the process to pinpoint where we are now and understand what might be coming up.

Menopause is a journey with a variable course

2. The Symptoms of Menopause

With over 34 recognized symptoms of menopause, it can cause more than the stereotypical hot flushes and night sweats. Some of the most problematic symptoms can be mood changes, migraine, disturbed sleep, fatigue, joint pain. In perimenopause, changes in bleeding pattern can wreak havoc on daily life. Later on, vaginal discomfort is a little talked about symptom which women do not need to suffer in silence.  Every symptom has at least one other possible cause, so it can be helpful to talk to a specialist who can look at the whole picture with you.

3. Changes to body chemistry

Whether you experience symptoms or not, the drop in female hormones around the time of menopause triggers wider changes to our metabolism that we can’t see. We might notice this as a gain in weight around our middle, or increased desire for sugary food. We almost certainly won’t be aware of the changes taking place to our bone, shown in the diagram below.

We reach peak bone density (strength) in our 30s and after this is, it starts to decline (get thinner and weaker). The speed at which we lose bone increases around the time of the final period (2-5% per year) before leveling off again to a steady loss of 1-2% per year .  Some people lose bone faster than others, and there are external factors that influence this too. If you want to keep your bones strong into older age, midlife is the ideal time to take action.

(Compston JE 1990 ;Clinical Endocrinology)

4. Changes to blood cholesterol

We tend to think of cardiovascular disease – diseases caused by the furring up of our arteries and blood vessels – as something that affects more men than women. It includes heart attack, heart disease, stroke, certain kinds of dementia.  Although women tend to be affected 7-10 years later than men, overall the absolute numbers are approximately the same.

Until the average age of menopause, women are relatively protected compared with men. However, with age plus the loss of estrogen, our cholesterol levels can overtake men at this point, increasing our cardiovascular risk.  Most women are not aware this is likely to happen, but it’s the ideal time to find out your cholesterol level and wider lipid profile, so you can keep your arteries healthy!

5. The effect of HRT on bone

Replacing estrogen maintains bone strength. Estrogen can increase bone density by 3-6% and maintain it over time. As we saw in (3) with very low levels of estrogen, we gradually lose bone density.  Women who take HRT to treat symptoms will not get the benefits of bone protection. They need to get their estrogen to the proper level.