A doctor’s guide to menopause: what you need to know.

50% of us go through it, yet why can menopause feel like such a mystery?

We asked Dr Elise Dallas, our Women’s Health Lead GP, what women want to know about menopause and what we can do about it.

1. How do I know if I am perimenopausal or menopausal?

This is a question we get asked all the time.

Despite menopause being a natural event that every woman will go through, perimenopause is a gradual transition so it is sometimes difficult to work out whether you are ‘starting the change’ or not.

Symptoms can start a few months or even years before your periods stop and can persist for some time afterwards, lasting on average 7 years!

Your doctor will be able to tell if you are in perimenopause or menopause based on your age, symptoms and how often you have periods. Did you know that you can still have regular periods or no periods at all and still be in perimenopause?

2. Is there a test to confirm the menopause?

A hormone called FSH (follicle-stimulating hormone) can be found in higher levels in menopause.

However, during perimenopause, hormone levels fluctuate throughout the menstrual cycle. You can also be on hormone treatments (such as contraception or treatment for heavy periods) which make it more difficult to interpret these levels accurately. This means a one-size-fits-all hormone test for all women is not necessarily helpful for confirming menopause.

In women over 45, a diagnosis of menopause can be reached on symptoms alone.

You may be offered a blood test but only if:

• you are between 40 and 45 and have menopausal symptoms, including changes in your menstrual cycle (how often you have periods)

• you are under 40 and we suspect you are in menopause (also see premature menopause)

Some contraceptives can affect your natural FSH levels. If you are on one of these and need an FSH blood test, this can make this process a bit longer. For example, If you are taking a contraceptive containing oestrogen and progestogen (combined pill/ring/patch) we will ask you to stop the contraceptive for 6 weeks before we take the test to make sure the reading is accurate.

Don’t worry, your doctor will be able to talk you through this if it applies to you.

3. What are these symptoms I should be looking out for?

Menopause affects every woman differently.

You may have no symptoms at all, or they might be brief and short-lived. For some women they are severe and distressing. Hormones affect every cell in our body. When they are fluctuating in the perimenopause, this can cause symptoms all over our body, and may include ones you didn’t realise might be due to your hormones, until now.

Have you seen the Babylon Menopause Symptoms Checklist ? This is a great and simple way to measure and track your symptoms.

Lots of these symptoms are a result of falling oestrogen levels in your body which happens over perimenopause. You may experience anything from vasomotor symptoms (hot flushes, night sweats), to psychological changes (mood disturbances, difficulty sleeping, lack of interest in sex). Some women experience physical symptoms( joint and muscle pain, vaginal dryness) as well as vaginal/bladder symptoms (dry vagina, frequent urine infections).

Did you know that you can still get menopause symptoms if you have had a hysterectomy (an operation to remove your womb)?

4. I don’t get periods, how do I know I am perimenopausal?

You may think that you’ll know you’re going through perimenopause if your periods become less frequent or even stop entirely.

However, some women don’t get periods in the first place. This may be because they have had a hysterectomy or because of the contraception they are on. This can make it seem more confusing to judge if you are going through menopause or not.

Let’s take an example, if you have a mirena coil in, you may stop having periods. This coil contains progesterone only. Therefore you’d still experience the symptoms which come from having a lack of oestrogen which comes with perimenopause, such as the hot flushes but not necessarily any change in the bleeds you were having.

So if you’re over 45 and getting these symptoms - you’re perimenopausal.

This is why being familiar with the symptoms of menopause can be even more helpful, especially the ones you didn’t necessarily know about.

5. How do you treat the menopause?

If this is all starting to feel a bit overwhelming, remember we are here to help. There are lots of ways we can support you through your menopause.

• HRT (hormone replacement therapy) is the most commonly prescribed treatment to help women through menopause. HRT is a safe treatment which helps to relieve symptoms by replacing oestrogen levels that naturally fall in menopause. You can take HRT as tablets or through a patch or gel on your skin. If you still have a womb, you take ‘combined HRT’ which contains oestrogen and progesterone. If you have had a hysterectomy, you just need to take the oestrogen.
• For those women who choose not to take HRT or cannot take HRT due to medical reasons, there are alternative treatments available too. We can discuss these with you in an appointment to explore what will be the best option for you.
• Don’t forget about contraception! All women can stop contraception at the age of 55 but before that, we need to consider contraception when you are sexually active. HRT, like many forms of contraception, contains hormones. However, this does not mean that your HRT can act as a contraceptive in all forms.
  • For example, if you have the mirena coil (which contains progesterone)as part of your combined HRT regime, you can use this for HRT and contraception..
  • However, for other forms of progesterone, we would need to make sure you are using contraception as well. Again, this can be something you discuss in your menopause appointment with your doctor but it’s a handy thing to know about before.
• It’s important not to forget lifestyle measures. These can include optimising your diet, exercise, and making sure your alcohol intake is not too high(14 u/week). In fact, in women who take HRT, you might find you become more mobile and sleep better which will probably make you want to be more active too!

6. Can I speak to my doctor about this?

Yes! It is important that we all talk about menopause more. You will be able to tell your doctor about what you’ve experienced so far and they will work with you to create a holistic menopause management plan specifically for your individual circumstances.

There can be a lot to talk about so here’s our handy guide for preparing for your first consultation so you can get the most out of it:

• Write down your symptoms:

This Babylon Menopause Symptoms Checklist is very helpful for you to complete before your consultation and will help your doctors to personalise your care. If you complete regularly, it can help monitor how your symptoms change with time or with treatments, especially when taking HRT (Hormone Replacement Therapy).

• Bring your menstrual diary:

Recording major changes in your menstrual cycle such as period frequency and flow and any unusual bleeding patterns ahead of your appointment is really helpful in guiding us to whether you are in your perimenopause or your menopause.

• Your most recent blood pressure (you can check with a calibrated home monitor or pharmacy)
• Your height and weight so we can calculate your Body Mass Index (BMI)
• Any HRT or other treatments you have taken
• Your medical history with medications you are taking, including contraception
• A brief family history of medical problems – especially breast and ovarian cancer, heart disease, stroke, blood clots, and osteoporosis

We are here to help. Menopause may feel like a great unknown but with support, knowledge and treatment which works for you, it can be part of a whole new chapter of your life. We look forward to helping you through this journey.

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