Menopause

What is the menopause?

Menopause is a natural phase of ageing for women, usually between the ages of 45–55. Some women may experience menopausal symptoms earlier than this for a variety of reasons. Early menopause is defined as occurring between the ages of 40–45, and premature ovarian insufficiency (POI) is defined as going through the menopause before 40. 

Menopause is triggered by a reduction in the number of eggs stored in the ovaries, which prevents ovulation and subsequently reduces the production of oestrogen. This is generally a gradual process, but for some women periods can stop suddenly. 

You are considered post-menopausal when your periods have stopped for 12 months. If you are experiencing symptoms but still have periods, this is known as the perimenopause, which typically lasts around 3–4 years. Menopause affects women differently.

Our specialists provide individualised care at Guy’s Hospital and St Thomas’ Hospital, including a wide variety of treatment options to support you and help manage your symptoms. 

Symptoms of the menopause

The severity of menopause symptoms can vary for each person, these sometimes can be mistaken for other conditions, especially those associated with ageing. It’s important to fully understand the cause of your symptoms so you receive the right support and treatment. 

Symptoms of menopause can include: 

• aches, muscles and joint pain: although this is associated with ageing, it can worsen during the menopause 
• changes to your periods: during the menopause, it’s likely your periods will become less regular and lighter before gradually stopping. How long this takes, will differ for each woman. If you are experiencing other symptoms but still have periods, this is known as the perimenopause 
• difficulty sleeping: menopause can disrupt your sleep due to night sweats, which may lead to irritably during the day 
• headaches and migraines: if you are prone to headaches and migraines, these can worsen during the menopause  
• heart palpitations: you may experience changes to your heart rhythm or an increased heart rate 
• hot flushes: you may struggle to regulate your temperature with sudden bursts of feeling hot or cold 
• impact on sexual wellbeing: you may find you have a reduced sex drive or may experience vaginal dryness, itching or pain during sex 
• urinary tract infections: you may experience recurring urinary tract infections, that cause burning or discomfort when urinating, and a frequent need to urinate, as well as fevers 
• weight gain: you may find you gain weight or store weight differently 

If you need help with managing your menopause symptoms, contact our team to book an appointment with a specialist. 

Early menopause and premature ovarian insufficiency

If you experience menopause between the ages of 40-45, it is known as early menopause. Women may go through the menopause early for several reasons, including family history, smoking, being underweight, hormonal medication, removal of the ovaries, or undergoing radiotherapy or chemotherapy to treat cancer. 

Premature ovarian insufficiency (POI) occurs in women younger than 40 and can negatively impact your chance of getting pregnant. If you have a family history of early menopause, you may want to consider fertility preservation, which would mean freezing your eggs to use for IVF when you’re ready for a family. You can also use donor eggs to have a family if you have lost ovarian function, if you don’t have many eggs, or if they’re not viable. 

Early menopause and POI can also adversely impact your cardiovascular and bone health. Weight gain is also associated with menopause which can put you at higher risk of cardiovascular complications. 

Women who enter perimenopause at a younger age are more likely to experience heart rhythm problems and conditions such as atrial fibrillation, because they are living with an oestrogen deficiency for a longer period of time. This deficiency can also affect bone health and density, leading to conditions such as osteoporosis, which can impact mobility, joint function, and increase the risk of fractures.  

If you suspect you’re experiencing early menopause, we can support you with a diagnosis. We can also evaluate the cause of your symptoms, assess if they are linked to other complications, and create a personalised treatment plan, such as hormone therapy, to help reduce your risk of complications. 

For support with perimenopause, contact our team to book an appointment with a women’s health specialist. 

Diagnosing menopause

To get an accurate diagnosis of menopause, our women’s health specialists will look at your symptoms and medical history. They may also recommend blood tests to check your hormone levels.

Menopause is usually a clinical diagnosis (in women aged 45-55) based on your history and confirmed once your periods have stopped for 12 months, but other tests can be beneficial to rule out any other causes of your symptoms, especially if you might be experiencing early menopause or POI. 

If you are looking for a quick diagnosis of menopause by one of our consultants, get in touch with our helpful customer service team who can book an appointment for you. 

Menopause management

The treatment and support available for menopause will depend on your symptoms, their severity , and whether they need to be managed over a longer period. 

Our specialists can offer several treatments to manage the symptoms of menopause. 

Hormone replacement therapy

There are several hormone replacement treatments (HRT) that can be used to supplement declining hormones. Replenishing these hormones can help with conditions such as hot flushes, night sweats, vaginal dryness and in the longer term prevent osteoporosis and cardiovascular disease. 

HRT can be prescribed in many different forms including:

• patches
• gels
• tablets
• topically in the form of pessaries, gels or creams

The hormones you need will differ depending on your medical and surgical history – but they will contain either oestrogen and progestogen (combined HRT) or just oestrogen (oestrogen-only HRT). 

Localised vaginal oestrogen preparations such as creams, tablets, pessaries or rings may be recommended if you have mild or common symptoms.  Testosterone can be prescribed if this is contributing to your symptoms, especially for women who have had both of their ovaries removed.  

Beta blockers

If you’re experiencing severe heart palpitations, you may be prescribed beta blockers to help regulate your heartbeat. Heart palpitations are not usually caused by a serious heart condition, but HRT can be used to replenish oestrogen, a deficiency of which can cause other heart conditions. 

Fertility preservation and IVF

Early menopause can reduce your natural fertility, so you may want to investigate preserving your eggs. Find out more about fertility preservation here.

IVF is also an option to help with fertility, as well as donated eggs, surrogacy, and adoption if you plan to have a family. 

Diet and nutrition support

Diet has a large impact on how you feel and how your body functions. Dietary changes during the menopause can support bone health, lower bad cholesterol, and maintain a healthy weight. These include:

• reducing alcohol consumption
• avoiding spicy food
• introducing fibre, vegetables, fruit, calcium, and protein

Guidance from one of our expert dietitians can help support you with this. 

Lifestyle changes

Lifestyle changes such as quitting smoking can help reduce menopause symptoms. It’s not uncommon for people who smoke to experience more intense hot flushes, mood swings, and difficulties sleeping. Smoking can also reduce the production of oestrogen, resulting in premature menopause.

Regular exercise can help manage menopause symptoms such as weight gain and low mood. It can also help maintain healthy bones and muscle density, which can be affected by the reduction of oestrogen. 

Cognitive behavioural therapy for insomnia (CBT-i)

If HRT isn’t effective or doesn’t help with sleep disruption caused by menopause, cognitive behavioural therapy for insomnia may be recommended.

CBT-i can help you address and manage unhelpful habits, such as excessive thoughts or anxiety, that are impacting your sleep. You’ll have the support of one of our sleep specialists who will help you manage symptoms and address these habits.  

If you would like to speak to one of our consultants about treatment options for menopause, please contact our team to book an appointment.