Menopause and Perimenopause

Understanding Menopause

Menopause is a natural biological process that marks the end of a woman’s menstrual cycles and fertility. Menopause is classified as the one day after 12 consecutive months without a menstrual period and after this is post-menopause.

Menopause typically occurs in women in their late 40s to early 50s, with the average age being 51. However, menopause is a slow process that starts several years before a woman’s last period. The years leading up to menopause are called “perimenopause” and represent declining ovarian reserve.

During perimenopause, the levels of female hormones fluctuate, affecting a woman’s mood, sleep, musculoskeletal system, and menstrual cycles. Many women are seen by different professionals during this time without a clear diagnosis because perimenopause usually has normal blood test results.

Often, they are mistakenly diagnosed as having a psychiatric condition or rheumatological disorder, when in reality, their symptoms are purely related to the fluctuating estrogen and progesterone levels.

If a woman has menopause before the age of 40, it is called ‘premature menopause, or Premature Ovarian Insufficiency (POI). Menopause after 40 but before the age of 45, is called ‘early menopause.’

Risk Factors for Menopause

Menopause is a natural part of aging, but certain factors can influence its onset and symptoms:
- Age: Menopause usually occurs between ages 45 and 55.
- Genetics: Family history can affect the timing of menopause.
- Medical treatments: Chemotherapy, radiation therapy, or surgery that removes the ovaries can induce menopause.
- Lifestyle factors: Smoking can lead to earlier menopause.

Recognising the Symptoms of Menopause

Menopause symptoms can vary widely among women but often include:

Hot flashes: Sudden feelings of heat, often accompanied by sweating.
Night sweats: Hot flashes that occur during sleep.
Irregular periods: Changes in menstrual cycle frequency and flow.
Vaginal dryness: Discomfort during intercourse due to decreased lubrication.
Urinary frequency: Increased need to urinate.
Discomfort with sexual intercourse: Pain or discomfort during sex.
Mood changes: Irritability, depression, or anxiety.
Sleep problems: Difficulty falling or staying asleep.
Weight gain: Changes in metabolism leading to increased body fat.
Aches and pains: General discomfort in joints and muscles.
Crawling or itching sensations under the skin: Unusual skin sensations.
Forgetfulness: Memory issues, brain fog or word finding difficulties
Headaches: Frequent headaches.
Lack of self-esteem: Reduced confidence.
Reduced sex drive (libido): Decreased interest in sexual activity.
Tiredness: Persistent fatigue
Drop in athletic performance: Decreased power or aerobic capacity

Understanding Perimenopause

Perimenopause, also known as the menopausal transition, is the period leading up to menopause when the ovaries gradually produce less estrogen. This phase can start in a woman’s mid-30s to mid-50s and can last for several years. During perimenopause, women may experience menopause-like symptoms such as irregular periods, hot flashes, sleep problems, and mood changes. This is usually the most difficult period in terms of symptoms and is a high risk period for new or recurrent depression.

Diagnostic Methods for Menopause

Menopause is typically diagnosed based on symptoms and the absence of menstrual periods for 12 consecutive months. In some cases, and especially if less than age 45, doctors may recommend blood tests to measure levels of:
- Follicle-stimulating hormone (FSH): Elevated levels can indicate menopause.
- Estrogen: Decreased levels are common during menopause.
- Thyroid-stimulating hormone (TSH): To rule out thyroid issues that can mimic menopause symptoms.
- Prolactin: To exclude a prolactin secreting tumour

Steps to Take if You Suspect Menopause

If you think you are experiencing menopause, it’s important to consult with your healthcare provider. Keeping a record of your menstrual cycle and any symptoms can help your doctor make an accurate diagnosis. They can confirm the diagnosis and discuss treatment options to manage symptoms. The most effective treatment for Menopause symptoms is some form or Menopause Hormone Treatment (MHT) which is very safe for most people. There are other effective non-hormonal and lifestyle treatments as well as measures to mitigate the risk of health conditions that increase after menopause.

Complications of Menopause

Menopause can lead to a decline in quality of life that can significantly affect a woman’s personal, sexual, and work life. Other complications include:

Weakening of the bones (osteoporosis): Higher risk of fractures.
Higher risk of heart problems and stroke: Increased cardiovascular risks.
Recurrent urinary infections: Due to vaginal dryness.
Loss of muscle mass and skin elasticity: Physical changes.

Lifestyle Changes

Regular exercise, a healthy diet, and stress management can alleviate menopause symptoms. Weight-bearing exercises, such as walking and strength training, can help maintain bone density. A balanced diet rich in calcium and vitamin D supports bone health. Mindfulness practices, yoga, and relaxation techniques can help manage stress and improve sleep.

Alternative Therapies

Some women look for relief from menopause symptoms through herbal supplements, acupuncture, and other alternative therapies, but they have far less efficacy evidence compared to MHT. Although they are usually low risk, it is still important to discuss these options with your healthcare provider to ensure they are safe and effective for you.

Treatment Options for Menopause

There are several treatment options available to manage menopause symptoms:

Menopause Hormone Therapy/MHT (formally called Hormone Replacement Therapy/HRT): Estrogen therapy is highly effective for relieving hot flashes and other symptoms. It is often combined with progesterone if the woman still has her uterus. MHT can also help prevent bone loss and reduce the risk of fractures. However, it may not be suitable for everyone, especially those with a history of breast cancer, heart disease, or blood clots.
Vaginal Estrogen: For vaginal dryness, discomfort during intercourse, and urinary symptoms, low-dose vaginal estrogen in the form of creams, pessaries and tablets. This localised treatment has minimal absorption into the bloodstream, reducing the risk of side effects and can be considered for some women after breast cancer.
Low-Dose Antidepressants: Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) can help reduce hot flashes and mood swings. These medications are particularly useful for women who cannot take hormone therapy.
Gabapentin: Originally used to treat seizures, gabapentin can help reduce hot flashes, especially those that occur at night. It is an alternative for women who cannot use hormone therapy.
Clonidine: This medication, typically used to treat high blood pressure, can also help reduce hot flashes. However, it may have side effects such as dizziness and dry mouth.

Is Menopausal Treatment Safe?

Unfortunately, due to misinterpretation of a couple of studies on menopause hormonal treatment (MHT), women have been led to believe that hormone replacement is dangerous. However later analysis of data and other studies have shown MHT, when prescribed within ten years of menopause or before the age of 60, is safe and effective for most women. The type and dose of MHT can also improve safety and efficacy.

The Australian Menopause Society and other international guidelines support the use of MHT and that the benefits outweigh the risks for most women experiencing menopause symptoms. There are clear guidelines to identify the minority of women who should not receive menopause treatment for medical reasons.

Dr Smith's Blog Posts on Menopause

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