Women's health
Menopause: what helps, and what to ask
A great many women spend years assuming that what they are experiencing is stress, ageing or something they should simply get on with. Quite often it is perimenopause, and quite often something can be done.
The short version
- Perimenopause can begin in the early forties, and periods often continue throughout it.
- Symptoms go well beyond hot flushes — sleep, mood, memory, joints, libido and urinary symptoms are all common.
- Menopausal hormone therapy is an option for many women, and the understanding of its risks and benefits has changed substantially.
- Book a long appointment. There is more to cover than fifteen minutes allows.
Menopause is the point twelve months after your last period. Everything leading up to it is perimenopause, and that is where most of the symptoms live — often for several years, and often starting earlier than people expect.
What it can look like
Hot flushes and night sweats are the recognised ones. The list is considerably longer:
- Periods becoming irregular, heavier, lighter, closer together or further apart
- Sleep that breaks up, often waking at 3am for no obvious reason
- Mood changes, irritability, anxiety that is new or worse
- Difficulty concentrating, and word-finding problems that feel alarming
- Joint aches and stiffness, which surprises a great many women
- Vaginal dryness, discomfort with sex, and recurrent urinary symptoms
- Reduced libido
- Weight redistributing around the middle
- Fatigue that rest does not fix
Because these arrive gradually and separately, they are frequently attributed to work, family, ageing or stress. Seeing them listed together is often the moment it clicks.
Do you need a blood test?
Usually not. In women over 45 with typical symptoms, menopause is diagnosed on the history rather than on hormone levels, which fluctuate so much during perimenopause that a single reading is frequently misleading.
Blood tests are more useful in women under 45, where early menopause is a possibility, or to check things that mimic menopause — thyroid problems and low iron in particular.
Menopausal hormone therapy
Formerly called HRT. The understanding of it has changed substantially since the early 2000s, when coverage of one large study led a generation of women to stop or never start treatment.
For many women, particularly those who start it under 60 or within ten years of menopause, the balance of benefit and risk is more favourable than that coverage suggested. It is the most effective treatment for hot flushes and night sweats, and it helps protect bone density.
It is not suitable for everyone, and your own history matters — breast cancer, clots, liver disease, unexplained bleeding and migraine all affect the decision. It comes in several forms, including patches and gels, which carry a different risk profile from tablets.
This is exactly the sort of decision worth a proper conversation rather than a leaflet. Your GP will go through what applies to you specifically.
Vaginal symptoms are worth raising separately. Local vaginal oestrogen is a different treatment from systemic hormone therapy, works well for dryness, discomfort and recurrent urinary symptoms, and is suitable for many women who cannot or prefer not to take systemic treatment. It is one of the most under-used treatments in this area, largely because nobody mentions it.
What else helps
- Strength training. Better evidence than almost anything else for bone, muscle, mood and sleep at this stage of life.
- Sleep routine. Worth attending to properly, since so much else worsens without it.
- Alcohol and caffeine. Both commonly trigger flushes and both fragment sleep.
- Cognitive behavioural therapy. Has genuine evidence for hot flushes as well as for mood, which surprises people.
- Non-hormonal medication. Several options exist for women who cannot or do not want to take hormones.
Be cautious about supplements marketed for menopause. Some have little evidence, some interact with other medicines, and "natural" is not the same as safe. Bring anything you are taking or considering to your appointment.
Getting the most from the appointment
Ask for a long appointment. Write down your symptoms, when they started, and which one bothers you most — that last one shapes the plan more than anything else. Bring a note of your periods if they are still happening, and your family history of breast cancer, heart disease and osteoporosis.
You can ask for a female GP when you book, and reception will arrange it without asking why.
Bleeding after menopause is never normal. Any bleeding twelve months or more after your last period needs assessing promptly, regardless of how light it is or whether you are on hormone therapy. Book an appointment.
Questions we get asked
How do I know if I'm perimenopausal?
Usually from the pattern of symptoms and changes to your cycle rather than from a blood test. In women over 45 the diagnosis is made on history, because hormone levels fluctuate too much during perimenopause to be reliable.
Is hormone therapy safe?
For many women, particularly those starting under 60 or within ten years of menopause, the balance of benefit and risk is favourable. It is not suitable for everyone, and your own history matters. It is a decision to make with your GP based on your specific circumstances.
How long do symptoms last?
It varies enormously. Some women have a year or two of symptoms, others considerably longer. That uncertainty is one of the reasons treatment is worth discussing rather than simply waiting it out.
General information only. This article is general health information for people in the Port Stephens area. It is not advice about your individual situation and it does not replace a consultation with a doctor. If you are worried about a symptom, book an appointment or call us on (02) 4008 4400. In an emergency, call 000.
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