Common menopause questions, answered

In this guest post, Dr Louise Newson answers the most common questions people ask around the different stages of menopause.

Menopause happens to every woman and there is often a lot of confusion about the stages of it, what it is, when it happens, and what symptoms you may experience as well as health risks associated with menopause.

Here, I take you through some of the most common perimenopause and menopause questions I get asked by patients and on social media, so you can be better informed and better prepared.

What happens during perimenopause?

Perimenopause is the time directly before menopause, when you still have periods, but the fluctuating and low hormone levels - especially oestrogen - can trigger a whole host of symptoms. However, changing periods may be due to other causes too. Fluctuating oestrogen levels mean your ovaries may not release an egg as regularly as they used to. You may ovulate one month, but not the next, and the quality of eggs also declines as you get older.

Periods during perimenopause can be lighter or heavier, less frequent or come close together. In addition to changing periods, if you have experienced premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD) in the past, you may notice your usual symptoms become more severe.

How long does perimenopause last?

Every woman’s experience is different. Perimenopause typically starts in your 40s, but as I've covered above, it can happen earlier for some women. Sometimes you may only have symptoms for a few months, but other women will experience symptoms for several years.

What is menopause - and when does it start?

Menopause is when your ovaries stop producing eggs and levels of hormones oestrogen, progesterone and testosterone fall. The definition of menopause is when a woman hasnt had a period for 12 months, and the average age of the menopause in the UK is 51.

However, menopause doesnt just happen in midlife: menopause before 45 is known as an early menopause, while menopause before the age of 40 is known as premature ovarian insufficiency (POI) - about one in 30 women under 40 are affected by POI.

For most women with POI, the underlying cause is unknown, but it can be triggered by events such as having your ovaries removed, a hysterectomy, radiotherapy to the pelvic area as a treatment for cancer or if you have received certain types of chemotherapy drugs that treat cancer.

What are some common symptoms during menopause?

Cells in your body are teeming with hormone receptors, so when levels of oestrogen, progesterone and testosterone fall, the effects can be felt throughout your body. Symptoms can include:

Mood swings, low mood and/or anxiety
Memory problems
Hot flushes and night sweats
Joint aches and pains
Brain fog
Disturbed sleep
Headaches and worsening migraines
Dry and itchy skin
Low sex drive
Vulval and vaginal symptoms, such as dryness and painful sex
Urinary tract infections
Menopause-related hormone changes can also lead to some surprising symptoms too, including dry eyes and mouth, a crawling sensation on your skin, weight gain, headaches, pins and needles, and even palpitations.

How will I know if I am perimenopausal or menopausal?

There is no definitive test to diagnose perimenopause. Many women download our free balance app and monitor symptoms as well as learn relevant information, so can often make the diagnoses themselves. Downloading a Health Report from the app can be really useful to take to your healthcare professional to have a conversation about treatment choices. Blood tests arent normally necessary to diagnose menopause, but if you are under 40 they may be used.

What can I do to manage symptoms of perimenopause and menopause?

Its really important to take a holistic approach to perimenopause and menopause, including eating a balanced diet, exercise (including strength exercises to help protect your bones), trying to reduce stress and prioritising sleep.

Hormone replacement therapy (HRT) is usually the first line treatment for menopause-related symptoms - it works by replacing the hormones your body is lacking. There are different types and doses of all three hormones - oestrogen, progesterone and testosterone - so it is important to have the right dose and type of hormones for you. If symptoms are affecting your everyday life, then you should speak to a healthcare professional.

More on menopause:

Dr Louise Newson is a GP and Menopause Specialist and founder of Newson Health and the balance menopause support app. The fully revised and updated version of her Sunday Times bestselling book, The Definitive Guide to the Perimenopause and Menopause, is available now.