HRT

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Signs and symptoms of menopause

Signs and symptoms of menopause

As you age your oestrogen levels decline and, eventually, your ovaries don't release eggs anymore - which means you’ll stop having periods. Sometimes this happens quite suddenly, but usually leading up to it you’ll notice increasingly irregular periods and some unpleasant symptoms. You won’t know that you’ve gone through the menopause until you haven’t had a period for twelve months or more. Once you’ve not had a period for twelve months, you’ll then be ‘post-menopausal’. Your menopause would've happened during the year when you had no periods.

The most common symptoms of menopause include hot flushes, mood changes, difficulty sleeping, night sweats, low libido, vaginal dryness, low concentration and memory problems.

If you’re starting to experience menopause symptoms, or want to know what to expect when they eventually come, we can help to break them down and give you all the information you need.

Daniel Atkinson
Medically reviewed by
Daniel Atkinson, GP Clinical Lead
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Medically reviewed by
Dr Daniel Atkinson
GP Clinical Lead
on August 02, 2022.
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What are the stages of menopause?

Menopause symptoms usually begin with irregular periods. This irregularity can last for years, and it’s called the perimenopause phase. When your periods stop completely, you’ll officially be in the menopause stage, but you won’t know for sure that you’re in this phase until after twelve months, as sometimes there can be a gap of many months between your periods. Once you haven’t had a period for 12 months straight, you will be in the postmenopause stage. You’ll be ‘post-menopausal’ for the remainder of your life, but symptoms won’t usually continue for more than a few years.

From perimenopause to postmenopause, you’re likely to experience a range of symptoms. Some will be stronger and more frequent than others, and they’ll typically be more severe if you go through all of these stages in a short period of time.

  • Perimenopause

  • Menopause

  • Postmenopause

Perimenopause

The perimenopause starts when your periods become irregular, triggered by a decrease in your oestrogen levels. They’ll happen less frequently over time until you finally have your last period. This can be a very slow process, usually lasting around four years . Other than irregular periods, other menopause symptoms may be at their strongest at this stage.

Menopause

During the menopause stage, your body will stop releasing eggs and you won’t have periods any more. You also won’t be able to get pregnant naturally. The menopause stage is usually described as the twelve month period following your last period.

Postmenopause

Once you haven’t had a period for a year straight, you’ll be in the postmenopause stage for the rest of your life. You may still get menopausal symptoms for a few years at the beginning of this stage, and you can be at greater risk of high cholesterol, osteoporosis and heart disease.

When do menopause symptoms start?

There’s no set timeline for when each menopause stage should start and end, and each person’s experience will be unique. On average, a woman usually starts getting perimenopause symptoms in their mid to late 40’s, but some can get it in their 50’s, or more rarely, early 60’s. The first symptom women experience tends to be irregular periods, and this can last for a long time before they enter the menopause stage.

On the other end of the spectrum, some women might have their menopause before they hit 40. This happens to around 1 in 100 women and the cause for it is unknown . Although it’s not very uncommon for it to happen, you should still speak to a clinician if you notice menopause symptoms before you’re 45, so they can rule out any underlying causes.

When do you stop getting menopause symptoms?

Usually most women will stop having menopause symptoms in their late 50’s to early 60’s, but everyone’s experience with menopause will be different. On average, you should stop experiencing symptoms about four years after your last period, but some women’s symptoms can continue for up to twelve years after their last period. When the symptoms stop, though, there can be other long-term worries – such as the development of osteoporosis or heart disease .

You’ll usually stop getting postmenopause symptoms by age 60, but this can vary. Also, symptoms can often be less strong in the postmenopause stage than they are during perimenopause and menopause.

The symptoms of menopause

medically-reviewedThere are many different symptoms of menopause, their severity will change from person to person, and you might not experience all of them. If you’re struggling with any menopause symptoms, you should speak with a clinician so they can prescribe you something to help manage the problem.

Hot flushes are one of the most common menopause symptoms. Studies show that over 80% of women will experience them at some point during their menopause . Most people start getting them during the perimenopause stage, followed by an increase in the severity and frequency of episodes during the menopause stage, and then a decline in the postmenopause stage.

Some women only have mild hot flushes occasionally, which cause no real issues in their day to day lives. But others can have them several times a day, and they can be very intense – causing discomfort, embarrassment, and disrupting their routine. Hot flushes can start a few months, or even years, before your period stops and may continue for years after your last period, making this symptom one of the most persistent and worst to deal with.

Hot flushes are thought to be caused by changes in your hormone levels which affect your body’s temperature control. They can happen without warning but are usually associated with certain triggers, like eating spicy foods, smoking, drinking alcohol, wearing hot clothing or even stress and anxiety. If you can find your triggers, you might be able to prevent them from happening too often. But finding triggers can be tough, especially if you get triggered by different things each time, or if you have multiple triggers.

Night sweats are hot flushes that occur while you’re sleeping. They may be strong enough to wake you up and make it harder for you to have a full night’s sleep.

Menopause can often disrupt your sleep. You might find it difficult to stay asleep all night if you’re experiencing night sweats, but that’s not the only thing that can cause difficulty sleeping during menopause. Stress and anxiety caused by other menopause symptoms can also contribute to problems sleeping.

A lower sex drive usually happens because of lower levels of oestrogen in your body when you’re reaching menopause. But it can also be explained by the emotional toll that this phase of your life can have on you. This can become a ‘vicous cycle’, as stress and anxiety can cause your sex drive to deplete, and the lower sex drive can also be the cause of your stress and anxiety.

Other menopause symptoms also contribute to a lower libido, such as a decrease in blood flow to the vagina, which can cause it to become dry, making sex uncomfortable or painful.

But this isn’t always the case. Some women experience the opposite effect and enjoy sex more after menopause, sometimes because the fear of becoming pregnant isn’t an issue anymore.

Memory problems and trouble concentrating can also be frustrating symptoms of the menopause. The cause for this is not fully known , but it can lead to high levels of stress and anxiety. If you’re having problems with your memory or focus, talk to your clinician about it – they might be able to help. Sometimes doing simple tasks, like keeping your brain active with puzzles or exercise, can help.

The anxiety and stress caused by menopause can also be the cause of your memory and concentration issues, so you might find that by getting emotional support or counselling, these other problems can get better too.

Vaginal dryness is one of the most common symptoms of menopause, and it’s caused by a decrease in blood-flow to the vagina due to hormonal changes. This can cause significant discomfort and pain during sex, making it one of the reasons why women might experience a lower sex drive during menopause.

The hormonal changes that come with menopause, as well as other menopause symptoms like difficulty sleeping and lower libido, can make you more likely to develop problems with your mental health – like anxiety or depression. Or you might notice that your general mood can fluctuate more than it used to.

Menopause can come with a range of symptoms, and you might not experience them all. Apart from the most common symptoms that most women will experience, you may also get:

  • Dry and thinning hair and skin.
  • Weight gain, usually around the abdominal area. Your body might store more fat and gain less muscle than before.
  • Stiff joints that hurt when you move around.
  • You might feel the need to urinate much more often, and urgently. You might also become more prone to develop urinary tract infections.
  • Dry eyes and mouth.
  • Tender breasts that lose some fullness.
  • Headaches.
  • Heart palpitations.
  • Increased hair growth in the face, neck, chest and upper back.
  • Glare sensitivity and blurry vision.
  • A change in your body odour.
  • Chills.
  • Dental problems.
  • Fatigue.
  • Vaginal pain. You might be aware of the vaginal dryness that’s usually associated with menopause, but you might also experience a thinning of the vaginal and vulval tissue. This will make your intimate area more prone to irritation and inflammation which will cause pain, especially during sex.
  • Bloating.
  • Stomach pain. This is usually caused by the higher levels of stress you may experience during menopause.
  • Burning mouth syndrome. Some women experience a decrease in saliva production during menopause, giving you a burning sensation on your inner cheeks, the roof of your mouth and your lips. This can also cause a slight metallic taste.
  • Dizziness. This is usually caused by the fluctuating hormone levels a menopausal woman goes through.

How to treat menopause symptoms

Some women have mild menopause symptoms and are able to go through this phase in their lives without significant medical help.

Recognising your triggers can be helpful in the management of menopause symptoms. For example, hot flushes can be triggered by eating spicy foods or wearing thick clothing, and if you can find a pattern in your routine that leads to more hot flushes and night sweats, you might be able to manage them by avoiding those triggers. Physical exercise, cognitive behavioural therapy, and support groups can also help you to manage your menopause symptoms.

But sometimes the symptoms can be particularly strong, and they might disrupt your routine significantly, in which case you should consider treatment . A clinician will usually prescribe you HRT, which will work by providing you either with a combination of oestrogen and progesterone, or only oestrogen-only if you’ve had a hysterectomy. Your clinician will advise you on which HRT you should use, in case you’re not sure.

It usually takes a few weeks for HRT to stop hot flushes, but if in three months you haven’t felt any changes, the clinician who prescribed it to you will review your dose or change treatments. If you want to try and stop your hot flushes without HRT, try to wear thin layers of clothing; avoid alcohol, caffeine and spicy foods; don’t smoke, and try to lose some weight if you’re overweight.

Menopause symptoms are simply symptoms of changing oestrogen levels. Your oestrogen levels will lower gradually as you enter the menopause stage – sometimes too quickly – and you can experience hot flushes, low libido, vaginal dryness and sleep disturbances.

If you take a dose of oestrogen higher than you should be taking, it can lead your oestrogen levels to rise too high above your progesterone levels and cause what is known as “oestrogen dominance”, which can result in some unpleasant symptoms.

If you’re experiencing symptoms of too much oestrogen you should speak to a clinician to make sure that these symptoms are normal, and not a sign of something being wrong. Some of the high oestrogen symptoms include: bloating, breast tenderness, fibrocystic lumps in your breasts, and symptoms usually associated with menopause – which can sometimes lead you to overlook them, thinking that they’re related to something else.

This is why it’s important to start with low doses of oestrogen when you start using HRT, as high doses of the treatment might make your oestrogen levels become too high, making the symptoms worse.

There are a few symptoms of too much progesterone, such as fatigue, weight gain, low libido, bloating, anxiety, and breast tenderness. But it’s unlikely that you’ll have too much progesterone during menopause, even if you’re taking HRT. So if you experience any of those symptoms, they’re probably not high progesterone symptoms, and are more likely to be associated with low oestrogen caused by menopause.

During menopause your body produces less progesterone naturally, but it also produces less oestrogen. HRT will usually work to balance out the amounts of oestrogen and progesterone in your body in order to reduce the risk of oestrogen dominance, to keep your uterine wall from getting too thick, and to reduce the risk of developing cancer.

Yes, your menopause symptoms might come back after stopping HRT. But studies have shown that those who stop HRT gradually will experience less menopause symptoms after their treatment is over than those who stop abruptly .

When stopping HRT you should lower your doses, and the frequency of when you take them, slowly – until you eventually stop. If you experience any symptoms when you’re coming off HRT, these are likely to be menopause symptoms coming back, rather than HRT withdrawal symptoms.

One of the most common complications women can get from menopause is osteoporosis , a complication that can significantly lower your quality of life. This happens because the decrease in oestrogen in your body will weaken your bones as they become less dense, making them brittle and more likely to break. But HRT has been shown to lower the risks of developing osteoporosis if you start taking it during the perimenopause stage, or early in the menopause stage.

Women who reach the postmenopausal stage between the ages of 40 and 55 are also at higher risk of coronary heart disease, compared to women who have yet to reach the menopause stage in the same age range .

Menopause symptoms: relief around the corner

care-iconMenopause is part of the natural course of every woman’s life, but that doesn’t mean that you should go through it without help. The symptoms of menopause can be frustrating and uncomfortable, but don't worry — thousands of women find effective relief from their symptoms in the form of safe and effective HRT every year.

If you're wondering whether HRT could be right for you, or which form of it you should take, talk to a clinician. They'll be able to point you in the right direction.

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This page was medically reviewed by Dr Daniel Atkinson, GP Clinical Lead on August 02, 2022. Next review due on August 01, 2024.

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When we present you with stats, data, opinion or a consensus, we’ll tell you where this came from. And we’ll only present data as clinically reliable if it’s come from a reputable source, such as a state or government-funded health body, a peer-reviewed medical journal, or a recognised analytics or data body. Read more in our editorial policy.

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