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.

Menopause refers to the point in time when you haven’t had a period for 12 consecutive months, which on average is around 51 years old). Perimenopause refers to the years leading up to this when you experience menopausal symptoms due to hormone changes, but still have your period. These symptoms can start a few months or even years before your periods stop, so this would be for most people in their mid 40s and can continue 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.

2. Is there a test to confirm menopause?

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

However, during perimenopause, hormone levels fluctuate throughout the menstrual cycle. You can also be on hormone treatments (such as birth control 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 by looking at your symptoms alone.

3. What are the 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, so when they are fluctuating in the perimenopause, this can cause symptoms all over our body, and may include ones you didn’t realize 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 estrogen, (the main sex hormone needed for normal sexual and reproductive development in women') which happens over perimenopause. You may experience anything from hot flushes and night sweats, to mood changes, difficulty sleeping and lack of interest in sex. Some women experience physical symptoms( joint and muscle pain, ) – as well as later in menopause, vaginal/bladder symptoms (vaginal dryness causing painful sex, soreness and, frequent urine infections).

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 their womb removed from a hysterectomy procedure or because of the birth control they are on. This can make it seem more confusing to judge if you are going through menopause or not.

So if you’re over 45 and getting these symptoms - you’re likely 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 menopause?

If this is all starting to feel a bit overwhelming, remember we are here to help. There are many 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 estrogen levels that naturally fall in menopause. It is the most effective at treating all menopausal symptosm including hot flashes. It also has long term health benefits improving heart and bone health. You can take HRT as tablets or through a patch or gel on your skin. If you still have a womb, you must take ‘combined HRT’ which in addition to estrogen has progestogen to protect your womb lining. If you don't have a womb (you have had a hysterectomy), you need estrogen only.
• Vaginal estrogen preparations are very safe and can be used in anybody who experiences vaginal dryness which can cause painful sex and urine infections
• For those women who choose not to take HRT or cannot take HRT due to medical reasons, there are alternative treatments available too. These may help symptoms but will not have the long term health benefits that HRT offers. We can discuss these with you in an appointment to explore what will be the best option for you.
• Don’t forget about birth control! HRT is not birth control so we recommend using birth control alongside it until you are age 55. If have the hormonal IUD (which contains progesterone) as part of your combined HRT treatment plan, you can use this for HRT and birth control
• It’s important not to forget lifestyle measures. These can include improving your diet, exercising, and making sure your alcohol intake is not too high (14 units per week) - that’s no more than a large glass of wine a night! In fact, for women who take HRT, your mood can improve, your body aches could improve and you may sleep better, which in turn will encourage you 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 complete 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 personalize your care. If you complete the checklist 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 birth control
• 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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