Published: 4 March 2021. As told to: Marina Gask
From coping with night sweats and hot flushes to the safety of HRT, Kathy Abernethy, Director of Menopause Services at Peppy, tackles all those menopause questions you need answered.
Why is the menopause such a hot topic? What was once a stage of a woman’s life that had to be endured in silence has now thankfully become the subject of support groups, books, celebrity influencers and TV documentaries.
As 59% of women experiencing menopausal symptoms say it negatively affects their work, it really is worth exploring what will help.
We asked Kathy Abernethy, Director of Menopause Services at Peppy – the digital health platform that connects users to menopause practitioners – 10 questions that will help prepare you or someone close for this life stage.
1. When will I start the menopause?
Most women can expect to experience menopause between 45 and 55, with around 1% going through it under the age of 40, and one in 1,000 under the age of 30.
Technically, the menopause simply means when your periods stop, but of course in everyday life it means so much more than that. It’s the whole transition around that time. The perimenopause is the time leading up to your periods stopping, when you often start to have symptoms. When you’ve not had a period for a whole year, then you’re said to be post -menopausal.
2. What are the symptoms of the perimenopause?
Perimenopausal symptoms, such as sleep issues, brain fog, memory changes and extreme tiredness, usually predate your periods changing by a few months or even years. So you don’t have any obvious warning signs to indicate that these are related to your hormones and the menopause.
Many perimenopausal women assume there is something wrong with them, when in fact their symptoms are a precursor to the menopause.
3. What are the symptoms of the menopause?
Hot flushes and night sweats are the most common symptoms of the menopause. Symptoms like tiredness, brain fog, low mood, poor memory, as well as an overactive bladder and heavier periods are also common symptoms as you approach menopause. Some women also experience headaches, vaginal dryness and a lower libido.
4. Will I get hot flushes during the menopause?
Around 75% of women experience hot flushes and many women get them several times a day and during the night. Flushes are an overwhelming feeling of heat arising from your chest that then feels like it’s coming out through your head. Sometimes these flushes are associated with palpitations or sweating.
Researchers have spent years trying to find out why hot flushes happen. It seems that women who experience the biggest hormone fluctuations tend to have the worst symptoms. Hot flushes are partly hormone related but they’re probably also related to the thermostatic control in the brain. Research suggests that decreased oestrogen levels cause your body’s thermostat (hypothalamus) to respond to slight changes in body temperature. If it detects that your body is too warm, it triggers a hot flush that will ultimately cool you down by making you perspire or remove a layer of clothing.
5. Why do women dread the menopause?
The menopause is often a time that women fear, dread or want to ignore, partly because there is a really negative depiction of it. However, some women view the menopause as a liberation from periods, contraception and the mood changes associated with the reproductive cycle.
Once the temporary symptoms have passed, you’re much more likely to get your life back if you’re proactive about tackling longer-term physical changes such as osteoporosis and vaginal dryness.
Help is available for these, but if left untreated they could reduce your quality of life.
6. Is hormone replacement therapy (HRT) dangerous?
Once considered controversial, thanks to medical research we now know a lot more about HRT, the women who should avoid it and the women for whom it is a low-risk treatment. Women can now make an informed choice for themselves, rather than automatically dismissing it as an option in helping them manage menopausal symptoms.
There are a lot of myths about HRT, so get advice from a medical practitioner. HRT is not prescribed to women for whom it’s going to be risky. For most women, it’s very low risk with very definite benefits.
7. Are there permanent health implications of the menopause?
Post-menopausal women lose the protection against heart disease that oestrogen provides, meaning they have an increased risk of heart attacks. To protect the heart, follow a healthy lifestyle, quit smoking, don’t drink alcohol to excess, maintain a healthy weight and exercise regularly. If you are on HRT, an added benefit is that it does help protect the cardiovascular system.
Osteoporosis is the thinning of the bones, which starts at whatever age you go through the menopause. If you have a natural menopause, you may not notice the osteoporosis, and the extent to which it could be a problem for you will depend on your family history and whether your mum broke any bones after her menopause.
To improve bone health, take regular exercise, ensure a calcium-rich diet and consider vitamin D supplements.
8. Does the menopause affect mental health?
Many women find the time around their menopause stressful. Hormonal changes and symptoms such as hot flushes and disrupted sleep can really knock your emotional balance off-kilter, especially when you factor in family, work and personal issues. Some women experience low moods or don’t feel in control of their emotions, and may experience feelings of rage and tearfulness.
It’s hardly surprising that some menopausal women experience depression and/or anxiety, especially if they are already prone to these feelings. If you’ve had clinical depression at other times, particularly hormone-related depression – postnatal or premenstrual – this can lead to clinical depression during the menopause, so do seek help.
Manage your anxiety in exactly the same way you would at any other time, with meditation, a balanced diet, breathing techniques, counselling, mindfulness and medication, if need be.
9. Will I go off sex during the menopuase?
Not necessarily. Freedom from periods and eventually contraception can sometimes have the reverse effect. If you’re in a stable relationship, working things through with your partner may take a little time and patience.
If you experience a loss of desire, it may be because sex has become painful. Over half of post-menopausal women aged 51 to 60 experience vaginal dryness. But there are things that you can do to improve it, so don’t hesitate to ask your GP for help.
10. What can I do to make menopause manageable?
- Download the Peppy app, for menopause support at the touch of a button, including 1-to-1 chat and virtual consultations with menopause practitioners, included in most Vitality Health plans.
- Improve your sleep quality with some useful tips here.
- Next, address what triggers your hot flushes. Reducing your intake of caffeine, alcohol and spicy foods, as well as keeping rooms cool and wearing breathable cotton layers that can quickly be removed, are sometimes enough.
- Try black cohosh or red clover supplements, as there is some evidence of both being effective in reducing hot flushes and night sweats. But if your symptoms are just too extreme, find out if HRT is suitable for you.
- If you’re experiencing vaginal dryness and discomfort, you can buy over-the-counter lubricants or try vaginal oestrogen.
Kathy Abernethy is author of Menopause: The One-Stop Guide (Profile Books)
Read more about the menopause and how it affects the body here
Eligible Vitality Health Members can download the secure Peppy app to sign up and access expert menopause support from Peppy. Find out more here.