It is interesting to reflect that in the 1850s the average age of the menopause was 45 years, and life expectancy for women was also 45 years. Now the average age of the menopause is 51 but women can expect to live well into their 80s meaning that for most women around half of their life comes after the perimenopause.
Menopause is the permanent end of menstrual periods caused by loss of ovarian hormonal activity. This is usually as part of a natural ageing process, with periods changing for a few years before stopping. The average age of the menopause is 51, but the age range of 45-55 years is seen to be the normal range. In a natural menopause it is almost impossible to know which the last period will be so menopause is then taken as a point in time 12 months after the last bleed
Menopause can also be ‘induced’ – a sudden process caused by surgical removal of the ovaries or medical treatment that affects hormone levels (chemotherapy, radiotherapy or hormone manipulation for certain conditions such as endometriosis).
An early menopause occurs between 40 and 45 years of age. Menopause before the age of 40 years is Premature Ovarian Insufficiency (POI) and occurs in around 1/100 women, sometimes as early as the teenage years. If you have an early menopause or POI HRT is recommended as soon as possible to protect the bones and cardiovascular system from the effects of early loss of oestrogen and reduce future risks of brittle bones (osteoporosis) and heart disease.
which lasts for years or even up to a decade, is the time leading up to the last menstrual period when a woman may get symptoms related to changes in her hormones. A common misconception is that women struggle with menopausal symptoms when their periods stop around the age of 50. In fact it is in the perimenopause that symtpoms tend to be worse, affecting younger women who are still having periods.
This refers to the time after the last period, whether this was natural or ‘induced’
The reality is that perimenopause can cause just about any symptom. We have got oestrogen receptors literally all over our bodies, every organ contains them. So the fluctuations and then reduction in hormones in the perimenopause and menopause can cause a myriad of symptoms. For ease these can be divided into symptom groups list below.
All of these symptoms can be variable in severity and duration, some lucky women ‘sail through’ while others may be debilitated for years or even decades.
VASOMOTOR– hot flushes and night sweats. These are extremely common, and probably the symptom most people think of when menopause is mentioned. 80% of women suffer with these to some extent. and slight fluctuations in temp trigger flushing or shivering.
PHYSICAL – change in bowel habit, bloating, palpitations, headaches, flare in asthma are just a few and insomnia and fatigue are very common. Poor sleep in someone that has previously slept well is often reported and might be the first symptom a woman notices.
GENITOURINARY – the genital tract and bladder are full of oestrogen receptors. Itch, burning, soreness in the vulva and vagina, and urinary frequency and urgency or recurrent infections are all common. symptoms do improve in the years after periods finish.
PSYCHOLOGICAL – this is a HUGE group of symptoms, sadly often not recognised as being hormonally driven. Low mood, anxiety, panic, poor self esteem, and also memory problems are all very common. Busy successful women who are used to multitasking may suddenly feel overwhelmed and that they just can’t cope.
Perimenopause and menopause are usually clinical diagnoses ; no tests are usually needed. If you are over 45 and have perimenopausal symptoms in combination with a change to your periods then the diagnosis is straight forward and a blood test is not helpful. If you are younger then blood tests can sometimes be used to support the diagnoses and we will talk you through whether they might be helpful in your individual case.