Perimenopause and Menopause

The menopause affects far more than periods and hot flushes, and for many women it lasts longer than they expect. In this video, I'll explain what's happening in your body; how the menopause is diagnosed; which treatments help; and what changes after breast cancer. Perimenopause is the time before your last period, when hormone levels start to change and your cycles become irregular. The menopause itself is only confirmed looking back, once you've gone a full year without a period. In the UK, this happens at around the age of 51 on average. If the menopause happens before the age of 40, hormone replacement is usually the standard advice rather than an optional extra. Losing oestrogen that early can affect the long-term health of your bones, your heart and your memory. Whenever it happens, the best-known symptoms are hot flushes and night sweats, which affect around three in four women. For about half of those who have them frequently, they carry on for more than seven years; so they're often far from a short phase. Flushes are only part of the picture, though, because many women also notice poor sleep, low mood, anxiety or memory lapses. Aching joints and muscles are common but often overlooked. Some feel their heart racing or pounding; while bone loss happens quietly without any symptoms at all. Vaginal dryness, soreness and bladder symptoms are also very common, and unlike hot flushes they don't settle on their own. They usually respond well to treatment, starting with moisturisers and lubricants. Vaginal oestrogen can be continued for as long as it's needed, even alongside HRT. With symptoms this varied, it helps to know how the menopause is diagnosed. If you're over 45, it's usually diagnosed from your symptoms rather than a blood test. Hormone levels swing widely from week to week at this stage, so a single result can easily mislead. In younger women, a blood test for a hormone called FSH can sometimes help, although it isn't reliable on hormonal contraception. Once the menopause is recognised, HRT is the most effective treatment for hot flushes and night sweats. If you still have a womb, you'll need a progestogen alongside the oestrogen to protect its lining. Patches and gels avoid the small increase in clot risk seen with tablets. Because HRT is taken to relieve symptoms rather than to correct a number, it’s usually reviewed every year as your needs change. My video on hormones and breast health explains what HRT means for breast cancer risk in real numbers. HRT isn’t right for everyone, and if you’d rather not take it, there are other options. National guidance recommends cognitive behavioural therapy adapted for the menopause, a talking therapy that can reduce how much flushes bother you and may improve sleep. Some non-hormonal medicines, including certain antidepressants, can also ease hot flushes. Things are different after breast cancer, when treatment can bring on the menopause suddenly and symptoms can feel more severe. HRT that acts on the whole body isn't recommended afterwards, so non-hormonal options come first. Vaginal oestrogen may be considered alongside tamoxifen, but generally not with an aromatase inhibitor, and we'd decide that together. Breast cancer medicines also need care alongside other treatments. If you take tamoxifen, some antidepressants and the herbal remedy black cohosh can interfere with it. Please check any new medicine or supplement with your team first. If you start an aromatase inhibitor, which lowers oestrogen further, a bone density scan is usually recommended at the outset. Whatever stage you’re at, most menopause symptoms are expected, but some changes need checking promptly. These include, bleeding after the menopause; unexpected bleeding on HRT; or a new change in your breast. Please also see your GP promptly about low mood that won't lift; or any thoughts of harming yourself. Beyond your health, the menopause can affect work too, and it's reasonable to ask your employer about adjustments or a menopause policy. Our booklet has more practical tips, and you'll find more about the menopause at work there too. To talk through your own situation, please get in touch with me or my team.