WONDERING IF MENOPAUSE SYMPTOMS WILL EVER END?

You’re never too old – or too young – to have menopause symptoms as hidden hormone havoc can go on for years. But there are helpful steps you can take whatever stage you’re at

Steps to take when hormones wreak havoc

Aall women go through the menopause, but we won’t all experience it equally. The reality is that for every one of us who sails through unscathed, there’ll be four others who find themselves in a world of hot flushes, aching joints, disturbed sleep, foggy brain and mood swings.

Several studies have shown that, for some, menopausal symptoms can continue for a decade or more after their last period. A recent US study of 3,000 women found that, although symptoms in those who had frequent hot flushes and night sweats persisted on average for more than four years after their last period, it was women who had symptoms premenopausally that were still suffering nearly 12 years after menopause. According to Dr Shahzadi Harper a GP and menopause doctor (theharperclinic.com), it’s not just hot flushes – low moods, loss of confidence, foggy brain, loss of libido and poor sleep can all persist.

EARLY SYMPTOMS

Some women experience years of symptoms before they reach their final period. Although many still think of menopause as something that happens in your 50s (51 is the average age for women to have their last period), for many, symptoms start in their mid or even early 40s, says Dr Harper. ‘I often describe perimenopause as the brackets around the menopause,’ she explains. ‘Symptoms can last for as long as 10 years before and 10 years after your final period. It’s easy to miss the early symptoms when you’re busy and tired, especially as they can be quite subtle,’ she adds. The first signs you may notice, apart from small changes in your periods – they may be a bit shorter, longer, be a little more or less frequent – are joint pains, hot flushes or night sweats, disturbed sleep, anxiety, irritability and low mood. Later symptoms include vaginal dryness, needing the loo more often and urinary tract infections. All these are the result of the reduction in your body’s production of oestrogen, which starts to decline rapidly from the age of 40. There are oestrogen receptors in organs all over your body, so when oestrogen production declines it can have a wide-reaching impact.

WHO IS MOST AT RISK?

Some women are particularly vulnerable to having more severe and long-lasting menopausal symptoms. ‘Women who have suffered from post-natal depression or bad PMS often have more severe symptoms, which tend to last longer post menopause,’ says Dr Harper. ‘These women seem to be more sensitive to hormonal imbalances, although symptoms can also vary according to other factors, such as environment and life stresses, as well as the physical changes that are happening in the body.’ A 2015 US study found that women who experienced long-term symptoms tended to be younger and have greater levels of stress, anxiety and depression.

KNOWLEDGE IS POWER

What seems clear is how unprepared many women still are for menopause and the fact that symptoms may develop early and persist for years. A 2017 survey of 3,275 women aged 40-65 by Nuffield

Health found that, despite symptoms such as joint and muscle ache, hot flushes, irregular periods, night sweats, mood swings and poor memory, 45% of the women didn’t recognise they could be experiencing menopausal symptoms, with just under half (42%) mistakenly believing they were either too young or too old for symptoms. A quarter simply put their symptoms down to stress. Just over a third (38%) sought help from a GP; however, a quarter of those who visited their doctor said the possibility of the symptoms being menopause related failed to come up.

Menopause expert and psychotherapist Diane Danzebrink says we shouldn’t blame GPS, as many of them receive little training in menopause. Since Diane, 53, experienced a surgical menopause after a hysterectomy eight years ago, she has become a passionate campaigner for better information and GP training on the

‘I thought I was going insane, which made me scared to go to the doctor’

menopause. ‘No one explained just how critical oestrogen was,’ she says. ‘They just suggested I discuss HRT with my GP. But because I had heard horror stories, I chose not to, which was a mistake. Three months on,

I was having palpitations, I felt heavy and fatigued, I had panic attacks and couldn’t stop crying. I thought I was going insane, which made me even more scared of going to the doctor,’ says Diane. ‘It was only when I was close to driving my car in front of a lorry that I went to see my GP. They explained why I was feeling the way I was, that oestrogen deprivation was affecting my body, my brain, my cognition and my emotions. It was an enormous relief to discover this and, within a few weeks of starting HRT, the world stopped being so dark; the chinks of light came back.’ As Diane explains, ‘When I started researching, I found there were thousands of women suffering from undiagnosed and untreated menopausal symptoms, often for many years.’

STARTING THE CONVERSATION

Diane’s personal experiences led her to set up Menopause Support (menopausesupport.co.uk), which provides information for women, their families and employers.

She is also campaigning to make menopause training mandatory for GPS, to provide menopause guidance in every workplace and to include menopause in the new sex education curriculum in secondary schools, which is happening from September.

Like Diane, Dr Harper meets many women who have struggled for years with menopausal symptoms.

‘I get older women coming to see me,’ she explains, ‘who feel they’ve missed the boat for treatment, and I see many women from diverse and different ethnic backgrounds. These women have often reached a tipping point because they have been putting up with symptoms for so many years – they are struggling at work, they are having relationship problems and their anxiety levels are so high they feel they are going crazy; hot flushes and sleep problems are also the big issues.’

NEXT STEPS

 Be informed and make contact with others At long last the menopause has come out of the shadows and women are talking about it. Check out menopausematters.co.uk, an online forum; womens-health-concern.org has lots of clear, current information and daisynetwork.org offers support for women going through early menopause.  Read the guidelines by the National Institute for Health and Care Excellence (nice.org.uk), which give information on treatments for menopausal symptoms.  Make lifestyle changes that can help

These include steering clear of foods that trigger hot flushes, typically coffee, tea, alcohol and spicy foods. Follow a balanced diet with oats, wholegrain rice, pulses, oily fish, seeds and leafy green vegetables, and also maintain a healthy weight. Research from the North American Menopause Society found that hot flushes are associated with a higher BMI and symptoms, such as joint and muscular pain and urinary problems are more prevalent in those who are obese. Relieve stress with regular exercise, which helps balance hormones and can boost your mood with the release of endorphins.

FIND YOUR TREATMENT HRT

 For women suffering from severe hot flushes, low mood and anxiety, HRT is the most effective treatment and, for the majority, the benefits outweigh the risks. ‘It’s safe for most women under 60 and you can start taking it when you are still having periods,’ explains Dr Harper. ‘Although it may take some tweaking to find the right dose and HRT for you, it can be very effective.’ The British Menopause Society says that when combined HRT is taken by women under 60 and for less than five years, the risk of breast cancer is low, less than that associated with being overweight, over 50 or drinking two units of alcohol a day.  Cognitive behavioural therapy This is recommended by NICE as there is good evidence it can improve hot flush perception and reduce stress and sleep problems. Women’s Health Concern (womens-health-concern.org) offers a self-help factsheet on CBT.

ALTERNATIVE OPTIONS

Some 95% of women say they would try alternative treatments before taking HRT. Some worth considering are...

 St John’s wort can help relieve hot flushes, may be helpful with mild depression and may also help boost libido. Be aware, though, that it interacts with tamoxifen and a number of other drugs, so can’t be taken by women with breast cancer.

 Black cohosh may help with hot flushes, but it can also interact with other medicines. Women’s Health Concern says that with all herbal products you should look for the THR (traditional herbal registration) logo, which shows the product has been approved.

 Foods containing phytoestrogens, such as flaxseed, lentils, chickpeas and soya are claimed to help balance hormones by mimicking oestrogen. The results of studies are variable, but some women find them helpful. If you have breast cancer, speak to your specialist.