The experience of menopause varies from person to person. Some women have minimal symptoms, with their periods simply ceasing. After 12 months without menstruation, they are considered postmenopausal.

However, the majority of women will experience symptoms, with approximately 80% encountering one or more of them, and around 25% facing severe symptoms. Changes in menstrual patterns often precede the cessation of periods, and symptoms may commence during this time, lasting from months to years, with an average duration of 7-8 years. Some women may continue to experience symptoms for decades.

Oestrogen receptors are present throughout the body. Reduced oestrogen levels that occur post-menopause can lead to a wide range of symptoms, including:

• Anxiety
• Breast tenderness
• Decreased confidence/ imposter feelings
• Dry skin, dry eyes, or dry mouth
• Fatigue
• Hair loss
• Headaches or worsening migraines
• Hot flushes
• Irritability or anger
• Itchy skin
• Low libido
• Low mood
• Muscle and joint pains
• Night sweats
• Pain during intercourse
• Palpitations
• Poor memory
• Sleep disturbances.
• Tearfulness
• Urinary symptoms, such as frequent urination or recurrent urinary tract infections
• Vaginal dryness
• Weight gain

This list is not exhaustive but encompasses the various symptoms that can affect women during menopause.

You can monitor your symptoms using the Menopause Symptom Checker.

For women aged 45 or older with typical symptoms, no blood tests are necessary to diagnose menopause. These women may be advised to undergo blood tests to rule out other common conditions in their age group, such as anemia, underactive thyroid function, or iron deficiency. Blood tests may also be recommended as part of a routine health check to assess cholesterol levels and screen for pre-diabetes.

For women under the age of 45, hormone blood tests are usually suggested, although they can be unreliable during perimenopause.

This is an opportunity to pause and evaluate your lifestyle choices. The decisions you make now will impact your long-term health and your quality of life in the postmenopausal years. Here are some steps you can take:

Diet
Strive to incorporate a variety of colourful foods into your diet. The British Heart Foundation offers guidance on this topic. Additionally, ensure an adequate intake of calcium for bone health, and supplement with a daily dose of 10 micrograms of vitamin D.

Weight Management
Be mindful of weight gain during menopause, as changes in metabolism due to reduced bone and muscle mass are common. Keeping a food diary can help you better understand your eating habits.

Exercise
Aim for at least 150 minutes of moderate-intensity exercise per week, or 75 minutes of vigorous-intensity exercise per week, distributed throughout the week. Include strength-training activities targeting major muscle groups at least twice a week. Regular exercise offers mental health benefits, reduces stress, lowers blood pressure, and lowers the future risk of breast cancer.

Alcohol
Many women find that alcohol can trigger or worsen hot flushes. Limit alcohol intake to government-recommended levels of 14 units per week, with at least two alcohol-free days. Be aware that alcohol contributes to unwanted weight gain.

Smoking
Women who smoke are more likely to experience early menopause and more severe hot flushes and night sweats. Reduce the number of cigarettes smoked and aim to quit completely.

Stress Management
Self-care is crucial during this phase of life. Explore relaxation techniques such as yoga, meditation, nature walks, spending time with loved ones, or any activity that helps you unwind.

Sleep
Address sleep disturbances caused by night sweats, anxiety, itchy skin, vaginal dryness, or the need to urinate. Strive for 7-8 hours of sleep per night, maintain a consistent routine, avoid caffeine and alcohol before bedtime, establish a bedtime routine, and keep electronic devices out of the bedroom.

If you find it challenging to implement these changes, don’t hesitate to seek help. If symptoms are significantly affecting your quality of life, consult a healthcare professional for tailored advice. Every woman’s experience of menopause is unique, and knowledge is key.

In menopause, the ovaries cease to produce hormones, resulting in persistently low hormone levels unless they are replaced. Hormone Replacement Therapy involves the replacement of one or more hormones, including estrogen, progesterone, and testosterone.

Oestrogen
The type of oestrogen used in HRT is 17 beta-estradiol, derived from the yam root. It shares an identical biological structure with naturally produced estrogen and can be administered via patches, gels, sprays, or oral tablets.

Progestogen
Women with a uterus who use oestrogen replacement also require progestogen. When taken alone, estrogen can cause the uterine lining to thicken, increasing the risk of abnormalities and cancer. Progestogen prevents this by keeping the uterine lining thin. Natural progesterone (Utrogestan in the UK) is available as an oral capsule and is derived from the yam root. It is used in Body Identical HRT. The Mirena coil is another option, releasing progestogen into the uterus to prevent uterine lining thickening and can remain in place for 5 years before replacement. Other progestogens are available in combined patches or tablets.

Testosterone
Some women may continue to experience low libido, reduced arousal, and unsatisfactory sexual experiences despite adequate oestrogen replacement. For these women, a trial of testosterone may be beneficial. While there are no testosterone products licensed for use in women in the UK, menopause specialists and some GPs/ ANP’s are willing to prescribe testosterone cream or gel off-label under supervision.

Local vaginal oestrogen
Symptoms like vaginal dryness, pain during intercourse, vulvar and vaginal soreness, recurrent urinary tract infections, and increased urinary frequency can be relieved with local vaginal oestrogen treatment. It can be used alone or in conjunction with HRT, available as a pessary, cream, gel, or a vaginal ring that remains in place for 90 days.