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Despite menopause being something that every woman, and person with a uterus, will experience once they reach a certain age, there is still a lack of clarity around its onset, symptoms and how it can be treated.
There is even less clarity, for some, about who to turn to for help and advice, if anyone. This leads to women struggling on their own, experiencing confusion over their symptoms or simply not understanding that these changes are a part of this phase of life.
There are two ‘stages’ of menopause; perimenopause and menopause. While symptoms can overlap, they are different phases and are experienced differently from person to person.
As Dr Gill Jenkins, GP and independent advisor to menopause brand M-Club notes: “Understanding the differences between these stages empowers women to manage symptoms, seek support, and maintain wellness.”
Perimenopause
“Perimenopause refers to the transitional period when ovulation becomes less frequent and the menstrual cycles become less frequent,” says Dr Haitham Hamoda, menopause service lead at King’s College Hospital and British Menopause Society trustee and past chair.
“Menopause and perimenopause are terms often used interchangeably, but they refer to distinct phases in a woman’s reproductive life,” adds Dr Hilary Jones, GP and independent advisor to menopause brand M-Club.
“Both are natural biological processes associated with the end of fertility, yet their experiences, symptoms, and significance differ considerably.”
Perimenopause can start several years before menopause and lasts typically for four years, but this can vary, with some women experiencing this phase for a few months, while for others it can last for 10 years. It begins “usually in a women’s 40s, but sometimes as early as the mid-30s” says Dr Jones.
“Eggs are still being released [during perimenopause], albeit less regularly, and hormones are fluctuating. Consequently, periods can be erratic, unpredictable, less or more frequent, heavier, lighter or less or more uncomfortable,” he says.
It is also not unusual for women experiencing perimenopause to also get hot flushes, night sweats, vaginal dryness, weight changes, fatigue, mood swings, and be more vulnerable to feelings of anxiety and/or depression.
Menopause
Menopause, on the other hand, “is defined as the point after 12 months without menstruation”, says Dr Jones. “Menopause is not a sudden event but rather a milestone that signifies the completion of a long process of hormonal change.”
It is therefore also diagnosed retrospectively, whereas perimenopause is diagnosed while symptoms are being experienced.
Menopause comes about as a result of the ovaries gradually producing less oestrogen and progesterone, the hormones that are key to and work together to ensure the regularity of the menstrual cycle and pregnancy. “[It is] the end of the reproductive life cycle,” says Dr Hamoda.
This is a significant difference between menopause and perimenopause, as while periods may be irregular, an egg is still being released by the ovaries during perimenopause and pregnancy is possible.
While some women may experience similar symptoms during perimenopause and menopause, there is a crucial difference in hormone levels which distinguishes the two phases.
“Many symptoms overlap, but perimenopause is typically associated with greater hormonal variability and more unpredictable symptoms,” says Dr Jones. “The decline in hormone levels affects many bodily systems, leading to a variety of physical changes.”
“The menopause is often discussed in terms of physical symptoms, but its emotional impact can be just as severe, if not more so”
What are the symptoms?
There are many changes a woman can experience during this time in her life. “Once menopause is reached, some symptoms experienced during perimenopause may subside, while others persist or become more pronounced due to the sustained low levels of oestrogen,” says Dr Jenkins. Some symptoms and effects of menopause include:
- Hot flushes and night sweats: these may continue, though often with reduced frequency or intensity
- Trouble sleeping
- Vaginal dryness, thinning of vaginal walls, and increased risk of urinary tract infections are common
- Mood changes: emotional symptoms like low mood, anxiety and depression may continue or stabilize
- Bone density loss: low oestrogen can lead to osteoporosis and increased risk of fractures
- Loss of libido
- Dry eye
- Cardiovascular changes: the risk for heart disease increases after menopause due to changes in cholesterol and blood pressure
- Thinning hair, dry skin, and loss of skin elasticity
- Joint stiffness, aches and pains.
Many of these symptoms are often understood simply as signs of ageing, and therefore, not something to seek treatment for.
Without treatment, these symptoms can negatively impact a woman’s daily routine, hobbies and lifestyle, leading to all sorts of unexpected changes.
Take joint stiffness, for example. “Many women are surprised to discover that joint pain can be linked to menopause, but the connection is very real. As oestrogen levels decline, inflammation increases and the cushioning within our joints begins to wear down, leading to stiffness, aches and pain. It’s not just uncomfortable; it can make exercise difficult, contributing to muscle loss and weight gain,” says Julie Robinson, leading expert in menopause management and founder of MenoHealth.
What are the treatment options
Luckily, there are over-the-counter (OTC) options for relieving symptoms and valuable self care advice that pharmacy teams can share with customers:
- Hormone Replacement Therapy (HRT), some of which are available OTC
- Medicines containing rosehip extract may ease joint pain due to its inflammatory properties
- Vaginal moisturisers to help with vaginal dryness
- St John’s Wort for anxiety and low mood
- Cognitive behavioural therapies for low mood, sleep problems and hot flushes and joint pain
- Avoid caffeine and alcohol near bedtime
- Eat a nutrient dense diet, and if customers are worried about not getting in all the nutrients they need, suggest supplementing their diet with the relevant vitamin(s). For example, vitamin D keeps bones healthy and strong.
Fibroids and menopause
“It is estimated that between 50-80 per cent of women have fibroids,” says Dr Haitham Hamoda, menopause service lead at King’s College Hospital and British Menopause Society trustee and past chair.
Fibroids – non-cancerous growths which develop in or around the uterus – are common and can cause women to experience heavy and/or painful periods as well as abdomen, back and leg pain, constipation and the need to urinate frequently.
As their prevalence is linked to oestrogen and is mainly felt during menstruation, many women will want to know how this may impact their experience of peri- and menopause.
HRT
“Fibroids are strongly influenced by the female sex hormones. So, at the time of the menopause, they tend to shrink away as the hormone levels fall, and the fibroids are no longer stimulated by them,” says Dr Hilary Jones, GP and independent advisor to menopause brand M-Club.
“Consequently, heavy periods can become lighter again and any pelvic discomfort associated with them may ease. Any symptoms of pressure exerted on the bladder or bowel may also diminish.”
While these symptoms may subside, fibroids very rarely disappear altogether, and can be influenced by the use of Hormone Replacement Therapy (HRT), which replaces the progesterone and oestrogen no longer present in the body.
“The effect of HRT on fibroids is likely to be minimal and a history of fibroids should not be viewed as a reason for women not to take HRT. Women are exposed to hormones from the ovaries for a number of decades and a significant portion of women do not have fibroids or continue to have small fibroids despite this hormonal exposure,” says Dr Hamoda.
“[HRT] is essentially a lower dose of what woman may be exposed to from their own ovaries and overall is unlikely to have a significant effect on the growth of fibroids.”
As always, it is important to remember that everyone’s experience is different. Anyone with a history of fibroids taking HRT should keep an eye out for symptoms and consult their healthcare team if they are getting worse.
“Not everyone with fibroids will have problems with HRT, especially if they are small, but even then, regular monitoring of symptoms, together with regular pelvic examinations or ultrasounds to check their size is recommended so that alternatives can be found if problems arise,” says Dr Jones.
“Alternatives might include low-dose or non-oral preparations such as patches or vagina creams, a milder a form of HRT called tibolone or even simple self care lifestyle modifications.”
The emotional toll
A recent survey commissioned by pharmaceutical company GR Lanes Health looked at the link between menopause and emotional distress.
The survey interviewed 1,000 perimenopausal and menopausal women and found a strong correlation between the two, with 72 per cent of respondents saying they struggled with their emotional wellbeing.
The survey also found that:
- One in four (25 per cent) experience stress and anxiety daily, with over a third (38 per cent) saying these struggles have strained their relationships
- 70 per cent of women rarely get more than six hours of uninterrupted sleep a night, and for more than two-thirds (68 per cent) this lack of rest worsens stress and anxiety
- Over half (58 per cent) frequently feel burnt out, as if they have little left to give, physically or emotionally
- 62 per cent feel moments of sadness and hopelessness.
“The menopause is often discussed in terms of physical symptoms, but its emotional impact can be just as severe, if not more so. As oestrogen levels fluctuate and then gradually decrease, the body also produces less progesterone,” says Dr Rosie Khan, GP and menopause specialist.
“Both hormones influence serotonin, a neurotransmitter that regulates mood, also known as the ‘happy hormone’. On top of that, dealing with physical symptoms, like hot flushes and joint pain, can leave women feeling worn out, frustrated and anxious.”
Finding the right treatment option
There are a few options when it comes to dealing with the emotional effects of menopause, but it is key for women to make the connection in order to help them understand why they may be feeling the way they are. Thereafter, they can purposefully engage in self care practices.
“Yoga, meditation, tai chi and mindfulness are all good for reducing anxiety and lifting mood. Social connection with friends and family is vital and the M-Club can be wonderfully supportive too as many people will find themselves in the same boat as you. And a problem shared is a problem halved… in this case many times over,” says Dr Hilary Jones, GP and independent advisor to menopause brand M-Club.
Dr Jones also encourages people to “take up creative activities to such as journalling, art and music which can be emotionally purging and uplifting”.
Other changes that can positively impact mental wellbeing include eating a healthy balanced diet based on fruit and vegetables, whole grains, lean protein and healthy fats, regular exercise to promote endorphins, and creating a relaxing environment in the bedroom to promote good sleep – an essential for good mental wellbeing.
This can look like ensuring the room is a cool temperature, limiting the use of smart phones and screens at night and using breathable bedding to better cope with night sweats and avoid sleep disturbances.
There are also online and in-person community support groups that connect women going through perimenopause and menopause, providing a space for them to discuss their experience with others who can relate.
A tailored approach
“Prioritising self care is essential – focusing on good sleep, staying active in a way that feels right and nourishing your body can all have a positive impact,” says Dr Khan.
However, if implementing these practices is not helping, struggling customers should consider seeing a doctor to discuss other options.
“Leaning on friends and family for support is invaluable, but if symptoms persist or become distressing, seeking professional help can make a real difference.”
There are also some over-the-counter options that may help with easing symptoms of stress and anxiety.
“There is some evidence to suggest that herbal options, such as valerian root for relaxation and sleep, pharmaceutical-grade lavender oil for anxiety, and Rhodiola rosea for fatigue and mood support, may be beneficial for certain women during the peri/menopause,” says Dr Khan.
In some cases, customers can be referred to their GP or a mental health specialist where they may consider treatments like antidepressants, talking therapies and anxiolytics.
These options may be necessary for some customers, but your role in making customers aware of medicated and non-medicated choices is invaluable.
Pharmacy team members are often the first point of contact for women who have questions around their symptoms and treatment options.
In Conditions