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UNDERSTANDING MENOPAUSEa practical guide

KARISHMA

What the menopause REALLY does to your body and how to tell when it’s started: Continuing the ultimate guide to surviving the change

Some women are only affected by occasional hot flushes and tiredness

Others suffer from debilitating symptoms, both physical and psychological

Many women may not even realise their problems are menopausal 

Here, we reveal everything you need to know about menopause symptoms 

For some women the menopause is marked by just the occasional hot flush and tiredness. For others ‘the change’ can be utterly debilitating as they try to deal with a flood of symptoms, both physical and psychological.But because many symptoms, such as bad breath, itchy skin and even irritable bowel syndrome, have no obvious connection to hormones, women may often not realise their problems are menopausal.

+9Some women are only affected by occasional hot flushes and tiredness during the menopause while others suffer from debilitating symptoms, both physical and psychological (file image) 

The good news is that simple lifestyle changes can do much to ease all but the most severe.

But, first, here’s a unique guide to your menopause symptoms to help you understand the often unexpected things that are happening to your body.

Many women will find they have trouble sleeping and suffer from night sweats during menopause

BRAIN

Depression, anxiety, mood swings: Oestrogen helps raise levels of the brain chemicals serotonin and dopamine, which are responsible for mood regulation. Low oestrogen can lead to low mood, and affect your ability to cope with stressful situations, triggering agitation, dry mouth, hyperventilation, rapid heartbeat and shortness of breath.

Dizziness: This may be caused by anxiety or panic attacks (erratic breathing and heart rate can reduce the flow of blood and oxygen to the brain), or is linked to the effect hormones have on blood vessels, making blood pressure fluctuate.

Sleep problems: These can be triggered by night sweats, but are also directly linked to oestrogen, which regulates our magnesium levels. Magnesium helps muscles relax, allowing us to fall asleep. Lower oestrogen also means the throat muscles become slack, leading to problems such as snoring.Poor sleep is linked to lower progesterone, the hormone important for falling and staying asleep.

Brain fog: Forgetting things, poor concentration and inability to find the right words can all be linked to the drop in oestrogen.Not only does the brain need oestrogen to help it function, but it also encourages blood flow in the brain.

During the menopause forgetting things and poor concentration

can be linked to the drop in oestrogen that happens during the

change

Other menopausal symptoms such as stress, night sweats and poor sleep can further affect focus. Studies show women may not be able to learn as well as normal shortly before menopause.Thankfully, full mental function normally returns after menopause.

Tiredness/fatigue: Hormones help regulate how our cells use energy, so when levels drop, so, too do energy levels. Many menopausal women experience persistent feelings of weakness, tiredness and apathy, even after a good night’s sleep. However, these can also be a sign of thyroid problems or iron deficiency, so talk to your GP.

HAIRThinning hair: The loss of oestrogen leads to a drop in collagen, a natural protein in hair, so hair becomes more brittle. The natural rate of hair loss can also speed up (on the head and elsewhere) — the follicles need oestrogen to sustain hair growth.

MOUTHBleeding gums and taste changes can also be a side effect of the menopause .

Bleeding gums and taste changes: Oestrogen is important for the lubrication of mucous membranes, such as those in the mouth. Lower levels mean the mouth becomes drier, allowing bacteria to flourish, causing tooth decay and making your gums bleed.This can damage the taste buds on your tongue, setting off the pain nerve cells, causing bad breath, a bad taste or a burning sensation on the tongue.HEARTPalpitations: Oestrogen deficiency can effectively over-stimulate the nervous and circulatory systems, causing a pounding, rapid and irregular heartbeat. See a GP to rule out a possible heart problem.LUNGS

Allergies: Hormones and the immune system are inextricably linked, and menopausal changes can lead to allergies becoming worse, or you may develop them for the first time, particularly asthma, hay fever and dermatitis.BREASTSBreast tenderness: Fluctuating hormones can lead to an imbalance where progesterone temporarily dominates; this can trigger fluid retention, causing tenderness.BODY TEMPERATURE

Hot flushes/sweats: As levels of oestrogen drop, the hypothalamus gland — the body’s thermostat — can be fooled into thinking you’re overheating; you sweat and flush to cool down.Sudden heat or redness often starts in the face, neck or chest and then spreads; you will then start to sweat. Your heart rate may increase or you may have palpitations.FIRST AID FOR HOT FLUSHES A growing number of specialists are in favour of early hormone treatment during perimenopause, with low-dose HRT to help with common symptoms such as anxiety, dizziness, breast tenderness and reduced libido.

+9Between 70 and 90 per cent of menopausal women suffer from hot flushes This will also improve thinning hair, brittle nails, so-called brain fog, dry and itchy skin and mood swings.Many women also respond well to herbal remedies

Hot flushes: But when it comes to hot flushes, there are some more immediate steps you can try.Between 70 and 90 per cent of menopausal women suffer from them — they’re most common in the year after periods stop.

‘You move from having a finely tuned system which gradually adjusts itself to changes in temperature to an on/off switch,’ explains Eddie Morris, a consultant gynaecologist at the Norwich and Norfolk and chair of the British Menopause Society.Cutting down on alcohol may help, he says, as can avoiding spicy food and hot drinks.

Another option may be a form of counselling: cognitive behavioural therapy. CBT teaches you how to replace negative thoughts, such as ‘I can’t cope with this hot flush’, with ones such as ‘I know this will pass’.

A trial at King’s College, London in 2013 found that just four sessions were enough to significantly reduce the number and severity of flushes. Losing weight also appears to help, as do low doses of antidepressants known as selective serotonin reuptake inhibitors.memory problems: Another symptom is memory problems. Many women may struggle to find the correct word, or forget names and appointments.

Menopause specialist Dr Jane Woyka says: ‘I regularly see women in tears because they wrongly believe they are developing dementia.’

Doctors call this condition nominal aphasia — a temporary state caused by receptors in the brain being deprived of oestrogen.Most women report their memory returns to normal once fluctuating oestrogen levels have settled. Lifestyle changes to improve sleep and reduce stress can help.

Mindfulness — a simple form of meditation — may also be of use.A recent U.S. study found that just two weeks of mindfulness training was enough to improve cognitive performance.

ABDOMEN/GUTWeight gain: You may struggle to keep the weight off, as the body strives to retain fat cells, especially on the abdomen, as fat produces oestrogen.

As your testosterone levels drop, your metabolic rate slows — so women need fewer calories if they want to avoid gaining weight.The stress linked to menopause raises levels of cortisol, which encourages fat deposits around the abdomen.

Bloating: Oestrogen is important for maintaining the correct amount of water and bile in your body. As levels begin to change, you tend to store more water, making you feel bloated. Because your body produces less bile, you don’t digest fats as well, leading to flatulence+9Bloating during the menopause is a common side effect, as are cramps and weight gain Other changes in the gut mean food passes through more slowly, resulting in a build-up of gas as the undigested food ferments.Bloating at menopause is more common in women who have experienced it as part of pre-menstrual syndrome (PMS), possibly indicating an increased sensitivity to hormonal fluctuations.

Irritable bowel syndrome: The muscles of the gut have oestrogen receptors, so the drop in oestrogen can reduce muscle tone, slowing transit time and triggering indigestion, nausea, diarrhoea or constipation. The stress of menopause can also affect the gut.

Cramps: Conflicting messages being sent by erratic hormones can lead to period-type pain in the lower abdomen.

SKIN/NAILS

Itchy skin: The body needs oestrogen to produce collagen (a fibrous protein that keeps skin plump) and for lubrication. So a drop in levels can mean the skin becomes dry, flaky and itchy; dryness can also lead to formication, a sensation like crawling insects.

The lack of natural lubrication during the menopause means that

fingernails can become dry and brittle and will be prone to splitting The skin also becomes thinner and less dewy-looking. Collagen loss tends to be most rapid at the beginning of menopause.

Brittle nails: The lack of natural lubrication also makes nails prone to splitting.

MUSCLES/JOINTS

Muscle pain and weakness: Oestrogen has a calming effect on the body; as levels drop, the stress hormone cortisol can dominate, causing the muscles to tighten and tire. All muscles have oestrogen receptors, so falling levels can trigger pain and affect muscle tone.

Joint pain: Oestrogen also has an effect on your joints — low levels during menopause can lead to increased joint pain or trigger it for the first time, known as menopausal arthritis.

WOMB/BLADDER+9Hormonal imbalances can mean that periods may become heavier or lighter than before

Heavy bleeding: The hormonal imbalance can lead to changes in flow (periods may be heavier or lighter than before,

and there may be clots) and frequency (with longer, shorter, or irregular cycles).Oestrogen normally thickens the womb lining, and the egg that’s released produces progesterone, which reduces that thickening effect. However, if no egg is produced (egg production becomes erratic during the lead-up to the menopause), the thicker lining is shed as a heavy period.

Incontinence: The loss of collagen linked to lower oestrogen levels can mean the tissues around the bladder become thinner and less elastic.The surrounding pelvic muscles may weaken, too, causing urine to leak when you cough, laugh or sneeze, or trigger a sensitive bladder (characterised by a constant need to urinate) or frequent bladder infections.

SEXLow libido: Reduced oestrogen levels can affect the sense of sensation and the ability to orgasm. Falling progesterone levels lead to lower libido — progesterone stimulates testosterone production, and testosterone is key to sex drive.Vaginal dryness: The mucous membranes of the vaginal walls can become dry, triggering itching, stinging or burning, and possibly pain during intercourse.

SHOULD YOU TAKE A TEST TO TELL IF IT'S BEGUN?There is no definitive test that can tell if you’re menopausal, says Dr Jane Woyka, a GP from London and a specialist at Northwick Park Hospital’s Menopause Clinic.

‘It’s like putting a jigsaw together. As well as your age, your GP will ask about your period pattern and any symptoms such as mood swings, vaginal dryness, night sweats or hot flushes.’

+9There is no test that can tell if you’re menopausal, it's a combination of factors. There are blood tests that may show if you are heading that way.

The main test checks for follicle stimulating hormone (FSH), which the body produces to stimulate ovaries to produce an egg.

As the ovaries stop functioning properly, the body pumps out increasing amounts of FSH to try to prompt them into action. FSH levels can fluctuate from one month to another — so the test is given twice, six weeks apart.

Two FSH readings above 25 (4.7 to 21.5 is considered normal) would suggest it’s the menopause.

Some doctors may also offer a blood test to determine oestrogen levels. A normal reading is between 30 and 400; under 30 suggests the menopause.

Another test looks at levels of Anti-Mullerian hormone (AMH) and can give an estimate of how many eggs are left.

Patients might also be offered a test to check thyroid function, as problems in this area can cause menopause-like symptoms such as palpitations, mood swings and lethargy.

DIY TESTS

You can buy home-testing kits. These consist of paper strips or wands that measure levels of FSH in the urine.

As with a pregnancy test, you get a positive or negative result.

‘All a “positive” result means is that your FSH levels are 25 or above,’ says Dr Woyka.

‘The trouble is that it’s not set in stone that 25 means the menopause. The FSH levels are just one indicator.’

These levels also fluctuate from cycle to cycle, within the cycle and between individual women, so you can have an FSH reading of 25 and still be ten years off your menopause, or have a very high reading one month and a normal one the next.

‘In hospitals and general practice, we use FSH blood tests that give you a precise number reading rather than a crude positive/negative result,’ says Dr Woyka.

‘Some of the home kit tests claims to be “99 per cent accurate”. But all this means is they are 99 per cent accurate at detecting FSH levels of 25 or above. In my opinion, these tests are a waste of money.’

EVEN A LITTLE EXERCISE CAN MAKE  DIFFERENCE 

Being active really can help menopausal symptoms — whether you exercise a lot or a little. Research has shown that women who exercise have fewer and milder flushes, night sweats and sleep disturbances.

Meanwhile, the endorphins — feel-good chemicals — released during exercise can lift menopausal low moods and ease depression.

One of the latest studies, published by the University of Applied Sciences in Tampere, Finland in January this year, found that 49-

year-old women who exercised regularly had a better quality of life and reduced menopausal symptoms.

The women who did 2½ hours of fast walking or 1¼ hours jogging or running a week, plus strength or balance training, such as yoga, twice a week, were less likely to report anxiety, depression, memory and concentration problems and hot flushes.

Exercise will also help you control your weight at a time when hormones are conspiring to pile the fat around your middle.This is all the more important because being overweight can exacerbate menopausal symptoms.

+9Staying active can really help menopausal symptoms with research showing that women who exercise have fewer hot flushes, night sweat and sleep disturbances.

So what kind of exercise should you be doing? The Royal College of Obstetricians and Gynaecologists recommends regular aerobic exercise (such as cycling, walking or swimming) rather than infrequent bursts of high-impact exercise (running, intensive aerobics) as these can make symptoms worse.

Low-intensity exercise such as yoga may also help hot flushes and general well-being, it says.

Even a little bit of activity can have an impact. Researchers from Australia found that women who do less than the recommended levels of exercise still experience benefits.

Even if you’re not troubled by menopausal symptoms, exercise has significant long-term benefits, reducing your risk of heart

disease and osteoporosis (which rises significantly once the protective effect of oestrogen is lost).

One U.S. study showed that healthy menopausal women who walked for three hours a week or exercised vigorously for an hour and a half a week had a 30 to 40 per cent lower risk of heart disease than inactive women.

And it’s never too late to start. Women who become active only in mid or late-adulthood still had a reduced risk of heart disease compared with their inactive peers.

Meanwhile weight-bearing exercise — walking, jogging, dancing and aerobics — can prevent or reverse bone loss by 1 to 3 per cent a year in post menopausal women (the stress stimulates bone growth).

Exercise can also keep you slim, reducing your risk of type 2 diabetes and some cancers.

More active post-menopausal women have smaller waists and less body fat, researchers have found.

YOU CAN CONQUER THOSE MIGRAINESHeadaches affect more than 90 per cent of women going through the menopause, and some start suffering from migraines for the first time.‘The main reason for this is the fluctuation of oestrogen,’ says Professor Anne MacGregor, a migraine specialist.‘Falling oestrogen levels can trigger chemical changes in the brain, causing a migraine.’Meanwhile, nearly half of those who already suffer from migraines may find they get worse (though 15 per cent see an improvement), and some women find their attacks continue to follow a cyclical pattern years after the menopause.

Headaches affect more than 90 per cent of women going through the menopause.

‘This is possibly because though your periods have stopped, your ovaries haven’t, and some hormone activity can last two to four years after the last period,’ says Professor MacGregor, author of Understanding The Menopause & HRT.

The most effective treatment is 900 to 1,000mg of aspirin in a soluble or effervescent form for speed of absorption, she says.

You can take this up to four times in 24 hours (though always check with your doctor that there are no health reasons for you to avoid aspirin). But avoid painkillers containing codeine, which can aggravate migraine and nausea.

If aspirin doesn’t work, another option is a triptan drug, available over the counter.

This works by constricting the widened blood vessels in the brain and stabilising changes in brain chemicals.

For a more immediate remedy, place a covered hot water bottle or ice pack on the back of the neck or most painful point for a short time. And have a nap.

‘Clinical trials have shown that even a short doze can help treatment work more effectively,’ says Professor MacGregor.

‘Hormonal changes can be difficult to control, but attacks can be helped by eating small, frequent meals, avoiding sugary snacks and alcohol and getting adequate sleep in the week or ten days before your period.’

When there are other menopause symptoms, such as hot flushes or sweats, HRT can ease migraines — but not the tablet form, ‘as these cause hormones to fluctuate even more’.

Instead, oestrogen gel rubbed onto the skin or oestrogen patches cause fewer spikes and dips in hormone levels, says Professor MacGregor.