At Private GP Services, we take hormonal changes in a woman very seriously and our GPs are trained to support women through this period of their lives. It is important to stress that many women go through this period without any problems at all. Quite rightly the subject of menopause and HRT is now being discussed more openly in the media, in government and there is a lot of legislation being introduced to support women at work going through this period of their lives.
There are several phases to the “change”, which we will discuss below.
If a woman’s menstrual cycle stops before the age of 40, this is considered early menopause, or premature menopause. They may experience a number of symptoms from a younger age and this is more common in those who have family members who have been through early menopause. This can happen naturally and it is also sometimes called premature ovarian failure.
Premature ovarian failure can be caused by:
- Surgery to remove the ovaries including a Hysterectomy or Oophorectomy
- Autoimmune disease
- Cancer treatment such as radiotherapy and chemotherapy can cause premature menopause
How do I know if I have early menopause?
You might experience some of the following symptoms, but it’s important to check with your doctor to ensure there are no other alternative causes:
- Hot flushes
- Night sweats
- Intimate dryness
- Discomfort during sex
- Difficulty sleeping
- Low mood
- Anxiety and depression
- Reduced sex drive
- Problems with concentration and memory (brain fog)
Treatment for early menopause
Doctors may prescribe a combined contraceptive pill or HRT to manage the effects of early menopause. It is likely you will be recommended to take the treatment until the natural menopause age. Those who have had certain types of cancer may not be able to have hormonal treatment but your GP can advise on this after further detailed discussion.
What is Perimenopause?
Perimenopause is the period when the body begins to transition into menopause. It marks the end of the reproductive years and does not have a fixed age when it begins. Everyone is different, so it is important to make a note of any changes to discuss with your doctor. Some people can experience menopause symptoms as early as their thirties, most will be in their 40s.
During the transition to menopause, your body will change and there are a number of changes you may notice:
- Irregular periods, or changes in menstrual loss
- Mood changes and changes in mental health eg increase in anxiety
- Hot flushes and/or night sweats
- Sleep disturbance
- Recurrent cystitis (UTIs), thrush or BV infections
- Reduced or loss of libido
- Brain fog
- Increase or onset of migraines
- And much more
On discussion with your GP, HRT can be prescribed even if still having periods. Areas to discuss will include contraceptive needs, family history, past medical history, smoking and alcohol habits. If there are no contra-indications; HRT will help and some women may benefit from additional vaginal oestrogen too.
For women where HRT is contra-indicated, then other things to consider include keeping active with regular exercise, a consistent sleep schedule, reducing caffeine and alcohol intake, practising mindfulness and stress reduction and maintaining a healthy diet.
Some may even benefit from supplements, antidepressants or gabapentin (all licensed for use in menopause)
Menopause and post menopause
What is it?
Following perimenopause, your periods will stop, often between the ages of 45 and 55. Post-menopause is when you have not had a period in 12 months or more, signalling the end of ovulation. There are a range of symptoms that are most common, however, every individual is unique, so your symptoms may differ.
Mental Health Symptoms
- Low mood, anxiety and self-esteem problems
- Memory and concentration might become more common also known as brain fog
- Hot and cold flushes
- Trouble sleeping
- Heart palpitations
- Headaches or migraines
- Muscles and joint aches
- Dry and itchy or oily skin
- Body shape and weight changes esp around the waist
- Vaginal dryness, pain, itching or discomfort during sex
- Recurrent UTIs and possible stress incontinence
How long do symptoms last?
Everyone is different and symptoms can last anywhere from a number of months, with the average menopausal transition lasting for around 7 years. Symptoms can last for up to 14 years, depending on lifestyle factors. Symptoms can alter in severity as time goes on, with some long-term symptoms levelling out and others continuing throughout the entire transition.
Primary Management Through HRT
Evidence overwhelmingly is in favour of prescribing oestrogen transdermally, through patches or gel or spray. If progesterone is needed then this can be prescribed as a patch, as a tablet or as a Mirena coil.
- Reduce alcohol intake
- Stop smoking
- Rest and keep a routine
- Eat a healthy diet
- Include calcium-rich foods
- Weight-bearing exercise
- Speak to others including support groups
- Speak to a doctor about supplements and medicines
Managing hot flushes
- Wear light cotton clothing
- Keep your bedroom cool at night
- Drink plenty of water
- Try to manage stress
- Avoid triggers such as spicy food and smoking
- Manage your weight
- Cognitive behavioural therapy
Managing bone health
Managing intimate dryness
- Over-the-counter moisturisers and lubricants e.g. Sylk, Replens or KY
- Doctor prescribed hormone replacement therapy
- Oestrogen Pessaries, gel and vaginal rings are available on prescription but now Gina is available over the counter.
Management with HRT
HRT uses two hormones; Oestrogen to manage the symptoms of menopause and is available as skin patches, gel or spray for skin, implants and tablets. Progesterone is also offered, if a woman has a womb, as a (combined) patch, coil (Mirena) or tablets.
HRT has been shown to reduce the risk of
- heart disease
- type 2 diabetes
- brittle bones
- bowel cancer
Women can now remain on HRT indefinitely but would be advised to see their doctor each year for review. Need to check the suitability of dose, suitability of regime, any concerns, and check up to date with a mammogram.
During post-menopause, your symptoms should subside significantly. Some people will continue to experience symptoms for longer, but they should be more manageable.
Post-menopause health risks
Post-menopause brings about an increased risk of health conditions including heart disease, weak bones and urinary tract infections.
Important changes to make
- Diet is critical to keep your body healthy and functioning correctly
- Keep active and maintain muscle strength and a healthy weight
- Regular cancer screenings for breast and cervix
- Speak to your doctor about calcium and vitamin D supplements
- Reduce alcohol consumption
- Drink plenty of water and use the restroom whenever you need to
- Manage your weight to reduce stress on your muscles and bones
What about incontinence?
You may experience loss of urine when coughing, laughing or lifting, which can be frustrating, but there are preventative measures to try:
- Pelvic floor exercises can help strengthen the muscles
- Oestrogen preparations are used to improve vaginal thinning
Menopause in trans men, trans women and non-binary people
It’s not just cisgender people who experience menopause. A person who is undergoing transition has previously undergone transition or simply has an ovarian system, will go through menopause symptoms at some point in their life. The information on menopause in trans and nonbinary people is less prevalent, however, it is important to remember everyone has a right to discuss their menopause concerns with a GP and receive relevant treatment.
Menopause in trans women
If a trans woman chooses to stop hormone therapy, they may experience menopausal symptoms. This is due to the same effects triggered by menopause, a sudden drop in oestrogen. They will experience symptoms typical of menopause, although the cause is different.
As a trans woman ages, they might choose to lower their oestrogen dose, which can also result in menopausal symptoms, however, they may be less severe as their body will still produce testosterone.
Menopause in trans men
If a trans man chooses not to undergo a hysterectomy as part of their transition, they will experience the symptoms of menopause. Additionally, if a trans man pauses or is unable to access their testosterone supply, they would begin to experience menopause symptoms.
Menopause in non-binary people
A person who has an ovarian system will experience menopause, this includes nonbinary people, alongside cis women and trans men and women. All of these people can experience menopause and will be able to access support in finding management techniques through the help of a GP.
Private GP Services – Menopause Services
At Private GP Services, we offer menopause advice and support within a 30-minute appointment as part of our women’s health service, with the option to speak to our GPs through an in-person appointment or via video consultation. Where appropriate we can provide options and access to hormone replacement therapy (HRT).
For more information visit: https://privategpservices.co.uk/services/womens-health/