Resources

Menopause FAQs

 

What is the menopause?

The menopause refers to a woman’s last menstrual period. This happens when your ovaries stop releasing eggs and, as a result, the levels of your hormones (oestrogen, progesterone and testosterone) fall.

A woman’s menopause is said to have occurred when her last menstrual period was one year ago. After this date, she is considered post-menopausal. Menopausal symptoms often occur in the months or years leading up to a woman’s final period. This time is often referred to as the perimenopause.

The average age of menopause in the UK is 51 years of age, but any time after 45 is considered normal. If menopause occurs between the ages of 40 and 45 this is called an early menopause. One in a hundred women will experience menopause below the age of 40 – this is referred to as premature menopause or Premature Ovarian Insufficiency (POI).

Menopause is natural process, but can also occur as a result of surgery to remove the ovaries (called a bilateral oophorectomy), medical treatment (e.g. following radio- or chemotherapy), infection, auto-immune conditions (e.g. type 1 diabetes) and genetic causes (e.g. Turner Syndrome). Although a cause for early or premature menopause is not always found, it can sometimes run in families. Some women may experience an early menopause as a result of having a hysterectomy (removal of the womb), even if they do not have their ovaries removed at the same time.  

How is the menopause diagnosed?

If you are over 45 years of age and are experiencing menopausal symptoms, together with a change in your menstrual cycle (your periods may have become irregular or more frequent, may be lighter or heavier), then no tests are needed to diagnose the menopause. If you are using contraception that stops your periods (e.g. the progesterone-only pill or a hormone containing coil such as the Mirena IUS) or have had a hysterectomy, then it would be a good idea to write down your symptoms, or record them using an electronic app, and discuss these with your GP.

If you are under 45 years of age and believe you are experiencing menopausal symptoms, you will need to have a blood test to measure the level of a hormone called follicle stimulating hormone (FSH). This blood test is often repeated 4-6 weeks later. If you are below the age of 40 you will require other tests to ensure you have the correct diagnosis.

What are the symptoms of the menopause?

Pre-menopause, the hormones oestrogen and progesterone work together to release eggs from the ovaries and regulate your menstrual cycle. During the perimenopause, the levels of oestrogen and progesterone fluctuate widely and the imbalance in these hormones can lead to menopausal symptoms. Other symptoms are often a result of an overall low level of oestrogen in the body. Many different parts of the body can be affected, including the bones, joints, heart, brain, skin and vagina.

Most women will experience some menopausal symptoms, but the severity of symptoms can vary hugely. Symptoms can start several years before a woman’s final period and may continue for months to years after her menopause. However, the average length of time for women to experience symptoms is 7 years.

Hot flushes are one of the most common menopausal symptoms and affect three out of four women. These are often felt as a sudden sensation of warmth which spreads throughout the body. They may be associated with sweating, dizziness, anxiety and feeling sick or light-headed. Hot flushes often come on suddenly, but certain things can also trigger them e.g. after drinking alcohol, coffee or eating spicy food, smoking cigarettes.

Other symptoms include: irregular or heavy periods, night sweats, joint pains, poor sleep (insomnia), heart palpitations, low mood (depression), anxiety, mood swings, poor memory, tiredness, headaches, vaginal dryness, hair and skin changes, urinary symptoms (needing to pass urine more frequently), painful sex, and low sex drive (libido).

Are there any long-term health problems associated with the menopause?

After menopause, women have an increased risk of osteoporosis (thinning of the bones), heart disease and dementia. This is believed to be as a result of the falling levels of oestrogen, as this hormone protects our bones, heart and our brain.

Hormone replacement therapy (HRT) may help reduce these risks. For this reason, it is very important, if possible, for women who experience an early or premature menopause to take HRT until at least the age of 51.

There are also things you can do to help yourself to reduce your risk of long-term health problems after the menopause, including eating a well-balanced diet, exercising regularly and reducing stress (see below)

What can I do to help myself during menopause?

Diet and lifestyle are very important in helping to manage menopausal symptoms and in protecting long-term health.

Stopping smoking, if this is relevant to you, is one of the best things you can do to reduce your symptoms and improve long term health. Consider seeking support/smoking-cessation therapy if you feel you will struggle to do this alone.

There is some evidence that women who follow a plant-based diet have fewer menopausal symptoms. They also have lower rates of heart disease and cancer. Even if you do not follow a fully plant-based diet, aim to focus your meals around fruits, vegetables, whole-grains, beans/legumes and nuts/seeds. Include foods rich in phyto-oestrogens (plant-based oestrogens) in your daily diet e.g. soya beans, chickpeas/hummus, and lentils. Minimise processed and refined foods, including sugar and junk food, animal products (meat, dairy, eggs) and alcohol.

Some women find that spicy food, caffeinated drinks (coffee and tea) and alcohol worsen their symptoms (especially hot flushes and night sweats). Alcohol and caffeine can also exacerbate psychological symptoms (e.g. anxiety and low mood) and can be detrimental to bone health, so aim to keep these to a minimum (or eliminate completely).

Ensuring you have adequate sleep (7-8 hours a night) is paramount, but menopausal symptoms (especially night sweats) can make this difficult. Make sure your bedroom is well-ventilated, wear light natural clothing e.g. cotton pyjamas, and consider investing in a fan.

To minimise sleep disruption, switch off electronic devices at least one hour before bed and/or wear blue light blocking glasses in the evening. Aim to get up at approximately the same time each day and get outside in the morning daylight (whatever the weather) for at least 20 minutes. If this is not possible, try to have your breakfast/morning drink close to a window/in a naturally lit area. This will help to regulate your sleep cycle (and hormones).

Exercise is very important for physical and mental well-being, symptom reduction and bone, brain and heart health. Aim to move your body daily. If you are able to hike, run, or dance, for example, these are fantastic for improving bone density; if not, Pilates and yoga can provide similar benefits and are also important for developing strength and improving balance. Both cardiovascular exercise (activity that raises your heart rate for a sustained period of time) and weight-bearing exercise (activity that increases lean muscle mass, reduces body fat and increases strength) are equally important.

Stress reduction can have a hugely positively impact on menopausal symptoms. 5-10 minutes of mindfulness meditation and/or breathing exercises, for example, can be incredibly beneficial. Overall, be kind to yourself and allow yourself at least 30 minutes a day to do something just for you e.g. reading a novel, listening to your favourite music/podcast, walking in nature.

Are there any supplements I should consider taking during menopause?

Everybody over the age of 50, regardless of dietary choices, should take a regular vitamin B12 supplement. Aim for 10 micrograms daily, or at least 2000 micrograms once a week.

Vitamin D3 is important for everyone in the UK between the months of October and April. This is because we do not have enough sunlight in the northern hemisphere at this point in the year to make this vitamin (which is technically a hormone itself). Aim for 10 micrograms/400 IU daily. In spring/summer, try and get at least 20 minutes’ exposure to sun on your arms/legs/back (no sunscreen); if this is not possible, then continue to supplement. Vitamin D3 is particularly important for bone health.

Consider taking an algae-derived EPA/DHA omega-3 supplement (250 milligrams daily) or add 1 tablespoon of ground flaxseed and 6 walnut halves to your daily diet. Omega-3 fatty acids are essential for good heart and brain health.

Iodine is important when it comes to hormonal health and many people are deficient in this mineral (in many countries salt is iodised to guard against this, but this is not the case in the UK). Adults require 140 micrograms daily (donotexceed 0.5 milligrams a day and avoid kelp-based supplements).

What medical treatments are available to help with the symptoms of menopause?

Some women will only experience mild symptoms of the menopause and may not need any treatment at all. Others may be able to manage their symptoms with lifestyle changes (see above). However, some women experience difficult symptoms and will require further help and support.

Hormone replacement therapy (HRT) is the most effective medical treatment for symptoms of the menopause, and also helps protect your brain, heart and bones. All HRT contains the hormone oestrogen and, for women who have not had a hysterectomy, a progestogen (a synthetic form of progesterone).

HRT is available as tablets, gel or patches to be placed on the skin. Tablets and gels are taken/applied daily and skin patches are usually changed twice weekly.

If you are prescribed HRT when you are still having periods, you will be given a type that still gives you monthly bleeds. If you have not had your period for at least one year you will be given a type of HRT that does not give you a bleed.

Some women only need to take HRT for vaginal symptoms (such as dryness, soreness or painful sex). In this case, they may require only topical treatment – a low dose oestrogen in the form of a pessary, cream or a silicone ring (inserted into the vagina). The ring (called Estring in the UK) may be the best option for you if it is difficult or not possible for you to insert the pessaries or cream into your vagina yourself. Topical vaginal treatment can be taken in conjunction with systemic HRT (as above) or used alone. A new vaginal treatment – a daily pessary containing dehydroepiandrosterone (DHEA) – has recently also become available for vaginal symptoms. 

Some women are unable to take HRT for medical reasons (e.g. a hormone dependent cancer). In these cases, there are alternative medications that may help e.g. certain types of anti-depressants such as Fluoxetine or Venlafaxine. These can improve symptoms such as hot flushes, even in women who are not depressed. Recently a new non-hormonal treatment for vaginal symptoms, taken as a tablet by mouth, has come onto the UK market.

Is HRT safe?

You may have heard, or read about, scare stories relating to the safety of HRT. Most of these came about following the results of some large studies, published more than 15 years ago. These studies raised concerns over the safety of HRT (in particular relating to heart disease and breast cancer). However, following their publication, several of these studies have been showed to be flawed; the results were misinterpreted and inaccurate.

More up to date studies have shown numerous benefits of taking HRT and that any associated risks are very small.

For most women, if started within ten years of menopause, below the age of 60, HRT has more benefits than risks and is generally safe and effective.

What are the benefits of taking HRT?

HRT helps reduce symptoms of the menopause, and many women who choose to take HRT feel that they have regained their quality of life.

HRT also reduces your risk of osteoporosis, heart disease (if started within ten years of menopause) and colorectal (bowel) cancer (if taking combined HRT).

HRT is also very important for brain health in women who experience an early or premature menopause, reducing their risk of developing dementia.

What are the risks of taking HRT?

If HRT is started within ten years of menopause, below the age of 60, then there is no increased risk of heart disease (e.g. experiencing a heart attack or stroke); in fact, as mentioned above, there is evidence that HRT appears to reduce this risk.

However, if started after the age of 60, there is possibly a very small increased risk (although we are not entirely clear why, and more research is needed). Nevertheless, a woman’s actual risk of developing heart disease depends on many things, such as family history, lifestyle and general health. Some women do choose to start HRT after the age of 60 if their menopausal symptoms are severe and, in these cases, tend to experience far more benefit than harm.

Many women worry about the risk of developing breast cancer on HRT. This is a complex subject, as breast cancer is a complex disease. If you are taking certain forms of combined HRT (both oestrogen and a progestogen), then you may have a small increased risk of breast cancer if you take it for more than 5 years. However, the overall increase in risk is very small, and taking HRT does not appear to increase a woman’s risk of dying from breast cancer.

Women who are overweight, who smoke, regularly drink alcohol, or do little to no exercise have a higher risk of developing breast cancer than those who choose to take HRT, so it is important to put this into perspective if you feel you may benefit from HRT.

For women who have had a hysterectomy and are on oestrogen-only HRT the increased risk of breast cancer is lower than it is with combined HRT.

Importantly, there is no increased risk of breast cancer in women who take HRT, compared with premenopausal women of the same age, under the age of 51.

For women who take a tablet form of HRT, there is a small increased risk of developing a blood clot. This risk is greater for women who are overweight, who smoke, who have had a clot in the past, or who have a medical history of diabetes or migraine. However, there is no increased risk of developing a blood clot if HRT is taken in the form of a gel or patch (which means that women who do suffer with migraine, or have diabetes, for example, can take this form safely).

What are the side effects of HRT?

As with any new medication, there may be a few side effects when you first start HRT (although not everyone will experience these by any means).

The most common side effects are nausea (feeling sick), breast tenderness and leg cramps. These usually settle within the first month (and usually within a few days).

Some women experience some vaginal spotting or irregular bleeding when they first start HRT. This usually happens in the first 3-6 months of treatment as your body gets used to the hormones. If any unscheduled bleeding happens after this time it is very important that you see your doctor. Most of the time, all that will be required will be a change in medication. In some cases, you may be referred for an ultra-sound scan to check the thickness of the lining of your womb (again, this is rarely anything to worry about but may be important to rule out a more serious cause for your bleeding).

Are there any non-medical alternatives to HRT?

Some women choose not to take HRT, or are unable to take it for other medical reasons.

There is some evidence that phyto-oestrogen supplements (e.g. soya and red clover) can improve menopausal symptoms.

Herbal preparations, e.g. black cohosh and sage, may also be helpful. However, if you choose to go down the herbal route it is important to understand that these may interact with other medications you may be taking. As such, always discuss this with your doctor or a pharmacist before starting a herbal medication.

If you buy herbal medicine over the counter, ensure that it has the THR registration (for quality standard and safety). You may wish to consult with a trained medical herbalist e.g. someone who is registered with The National Institute of Medical Herbalists. They will be able to advise you on all your options and will be aware of possible interactions between herbs and prescribed medications.

In some cases, women have found cognitive-behavioural therapy (CBT), acupuncture and magnet therapy (e.g. the LadyCare magnet) helpful in managing their symptoms (although there is no medical evidence to recommend the latter there is no suggestion of harm).

 

 

Top Lifestyle Tips for a Healthy Menopause

NUTRITION

  • Centre diet around plant-based whole-foods: women who follow a plant-based diet have a lower risk of heart disease and cancer. Recent evidence suggests that they may also suffer fewer menopausal symptoms.
  • Think “right carbs, good fats” not “low-carb, high fat” or “no fat”: Complex carbohydrates (e.g. root vegetables, beans, oats, wholegrains) and plant-based fats (e.g. nuts, seeds, avocado, good quality olive oil) are essential for good hormonal health.
  • Eat the rainbow AND the alphabet: fill your plate with a wide variety of brightly coloured fruit & veg. Aim to include at least ten different types of vegetable in your meals each week (aim for 30 varieties over the month) – diversity is key to a healthy gut microbiome (and good hormonal & emotional health). Leafy greens and dark-coloured berries are particularly beneficial.
  • Include a serving (or two) of beans/lentils/hummus in your daily diet – a fantastic source of fibre, protein and micronutrients. Also excellent for heart health.
  • Consider switching cow’s milk for fortified soya/oat/hemp milk (more heart-healthy).
  • Include minimally processed soya foods in your diet: e.g. edamame beans, tofu, tempeh, miso (limit to one serving daily if you have a thyroid condition) – helpful for menopausal symptoms, heart and breast health.
  • Flavour your food with all manner of herbs & spices (rich in anti-oxidants) – experiment!
  • Minimise refined/processed carbohydrates and junk food (e.g. refined sugar, white bread, baked goods, take-aways), alcohol, caffeine & animal products.
  • Aim to eat all meals within a 12-hour window e.g. between 7am & 7pm. This helps with weight maintenance and hormonal balance.

SUPPLEMENTS

Recommended for everyone, irrespective of diet:

Vitamin B12:

Aim for 10 micrograms (mcg) daily or at least 2000 micrograms once a week

Vitamin D3:

Aim for 10 mcg/400 IU October-April (in spring/summer ensure sun exposure to skin on arms/legs/back for at least 20 minutes daily; continue to supplement if not possible)

Iodine:

RDA 140 mcg daily (do not exceed 0.5 mg/day; avoid kelp-based supplements)

For the above, I recommend the VEG 1 Supplement  (affordable & reliable)

Omega 3 Essential Fatty Acids (EFAs):

Algae derived EPA & DHA (250 mg/daily) or 1 tablespoon of ground flaxseed (e.g. added to cereal/smoothies/salad/soups) and 6 walnut halves daily

Resources

SLEEP

  • Aim for 7-8 hours of sleep each night
  • Switch off electronic devices at least one hour before bed and/or consider wearing blue-light blocking glasses in the evening
  • Aim to get up at approximately the same time each day to establish a routine (this will help with hormonal balance)
  • Aim to get outside in the morning daylight (whatever the weather) for at least 20 minutes each day. If this is not possible, try and have your breakfast/morning drink close to a window/in a naturally lit area.
  • Do not drink caffeinated beverages after midday
  • Avoid alcohol before bed – not only does it reduce good-quality sleep, it is an endocrine (hormone) disrupter and can affect HRT.

EXERCISE/MOVEMENT

  • Aim to move your body daily – this is important for mental & physical well-being, as well as hormonal balance.
  • If you don’t already have an exercise regimen, start slowly – even a ten-minute walk around the block has its benefits or consider a five minute morning online yoga session.
  • Weight-bearing exercise (e.g. hiking, running, dancing, weight-training, tennis) – at least twice weekly – is essential for bone health after menopause. Swimming and cycling are great forms of exercise for heart health and general well-being, but will not prevent osteoporosis.
  • Consider joining your local Park Run or Great Run Local – great not only for exercise, but also community-building, social inclusion and gets you out into nature (which has enormous benefits for our mental health). Do not be put off if you do not run (yet!); many people walk or walk-run around the courses. Children and dogs are welcome too!
  • Balance and core-strength are increasingly important as we age, and reduce the risk of falling in later life. Another reason to consider a regular yoga practice, or why not sign up to a local Pilates or tai chi class? Find something you enjoy and can look forward to.

STRESS REDUCTION/SELF CARE

  • Stress reduction is important for all of us and is paramount during the menopausal transition
  • 5-10 minutes of daily mindfulness meditation/breathing exercises can provide enormous benefits and lower the stress response: Headspace, Calm and Insight Timer are all meditation apps you can trial for free.
  • Take at least 30 minutes a day, every day, to do something you enjoy (and solely for you) e.g. reading a novel, playing an instrument, having a bath with relaxing essential oils, listening to your favourite music/podcast.
  • BE KIND TO YOURSELF

 Suggested reading
The 4 Pillar Plan and The Stress Solution: Dr Rangan Chatterjee
Sorted: The Active Woman’s Guide to Health: Dr Juliet McGrattan

Suggested podcasts (for wellbeing and inspiration)
Feel Better, Live More
Deliciously Ella Podcast
Oprah’s SuperSoul Conversations

 

Useful Links

Menopause
Find a BMS-recognised menopause specialist

Menopause and women’s health in later life (RCOG)
Information hub for patients

My Menopause Doctor
Up to date, evidence-based, information on menopause and HRT for patients and health care professionals alike

The Daisy Network
Charity dedicated to providing information and support for patients with POI/premature menopause

Premenstrual Disorders
National Association for Premenstrual Syndrome (NAPS)
UK charity working to support sufferers and raise awareness of Premenstrual Syndrome(s) – PMS/PMDD/PME

International Association for Premenstrual Disorders (IAPMD)
Not-for-profit organisation providing support and information for those affected by Premenstrual Dysphoric Disorder (PMDD) and Premenstrual Exacerbation (PME) of underlying disorders. US based

Find a premenstrual disorders specialist
US-based site, but with global links

Sexual Health
Jo Divine Magazine
Helpful online articles exploring many wide-ranging aspects of women’s sexual health, including sex after cancer, vaginal dryness, low libido and painful sex. 

Pelvic Floor First
All you need to know about your pelvic floor – online videos (including for women with prolapse). Evidence based. Run by Continence Foundation of Australia. Recommended by pelvic floor physiotherapist, and comedian, Elaine Miller aka Gusset Grippers.

Vulval Pain Society
Charity dedicated to promoting and protecting the physical and mental health of sufferers of vulval pain through the provision of support, education and practical advice.

Plant-based Nutrition

Plant-based Health Professionals UK
Mission statement: “To educate health professionals, members of the public and policy makers on the benefits of whole-food plant-based nutrition in preventing and treating chronic disease”. Includes factsheets and a directory of UK plant-based doctors.

The Plant-Based Diet: a healthier way to eat
Booklet on how to transition to a healthy plant-based diet. US based.

 

Articles

Articles

The Thalidomide Trust: Menopause
Includes factsheets and vlogs on menopause, HRT, alternatives to HRT & lifestyle advice. Written primarily for beneficiaries of the Trust, but contains generic information useful for all.

Dr Hannah Short on being a plant-based GP
ProVeg International, March 2019

ProVeg is going to Parliament! “Change can’t come soon enough”: Dr Hannah Short
ProVeg International, October 2018

Let’s talk menopause because we are failing 13 million women
The Guardian, April 2015

 

Podcasts

PMS and PMDD with Dr Hannah Short
Liz Earle Wellbeing Podcast, August 2019

BBC Radio 4: Woman’s Hour
Speaking on the issue of HRT shortages, August 2019

Dr Hannah Short – Menopause & PMS Specialist GP
Fit n’ Chips Chats, May 2019

Hormonal Health with Dr Hannah Short
Liz Earle Wellbeing Podcast, December 2018