Hewlett-Packard

UNDERSTANDING
MENOPAUSE
a practical guide
KARISHMA

15

What the menopause REALLY does to your body and how to

tell when its started: Continuing the ultimate guide to
surviving the change
Some women are only affected by occasional hot
flushes and tiredness
Others suffer from debilitating symptoms, both physical
and psychological
Many women may not even realise their problems are
menopausal
Here, we reveal everything you need to know about
menopause symptoms
For some women the menopause is marked by just the
occasional hot flush and tiredness. For others the change can be
utterly debilitating as they try to deal with a flood of symptoms,
both physical and psychological.
But because many symptoms, such as bad breath, itchy skin and
even irritable bowel syndrome, have no obvious connection to
hormones, women may often not realise their problems are
menopausal.
+9
Some women are only affected by occasional hot flushes and
tiredness during the menopause while others suffer from
debilitating symptoms, both physical and psychological (file
image)
The good news is that simple lifestyle changes can do much to
ease all but the most severe.
But, first, heres a unique guide to your menopause symptoms to
help you understand the often unexpected things that are
happening to your body.

Many women will find they have trouble sleeping and suffer from
night sweats during menopause
BRAIN

Depression, anxiety, mood

swings: Oestrogen helps raise levels of the brain chemicals
serotonin and dopamine, which are responsible for mood
regulation. Low oestrogen can lead to low mood, and affect your
ability to cope with stressful situations, triggering agitation, dry
mouth, hyperventilation, rapid heartbeat and shortness of breath.

Dizziness: This may be caused by anxiety or panic attacks

(erratic breathing and heart rate can reduce the flow of blood and
oxygen to the brain), or is linked to the effect hormones have on
blood vessels, making blood pressure fluctuate.

Sleep problems: These can be triggered by night sweats,

but are also directly linked to oestrogen, which regulates our
magnesium levels. Magnesium helps muscles relax, allowing us
to fall asleep. Lower oestrogen also means the throat muscles
become slack, leading to problems such as snoring.
Poor sleep is linked to lower progesterone, the hormone important
for falling and staying asleep.

Brain fog: Forgetting things, poor concentration and inability

to find the right words can all be linked to the drop in oestrogen.
Not only does the brain need oestrogen to help it function, but it
also encourages blood flow in the brain.
During the menopause forgetting things and poor concentration
can be linked to the drop in oestrogen that happens during the
change

Other menopausal symptoms such as stress, night sweats and

poor sleep can further affect focus. Studies show women may not
be able to learn as well as normal shortly before menopause.
Thankfully, full mental function normally returns after menopause.

Tiredness/fatigue: Hormones help regulate how our

cells use energy, so when levels drop, so, too do energy levels.
Many menopausal women experience persistent feelings of
weakness, tiredness and apathy, even after a good nights sleep.
However, these can also be a sign of thyroid problems or iron
deficiency, so talk to your GP.
HAIR
Thinning hair: The loss of oestrogen leads to a drop in collagen, a
natural protein in hair, so hair becomes more brittle. The natural
rate of hair loss can also speed up (on the head and elsewhere)
the follicles need oestrogen to sustain hair growth.
MOUTH
Bleeding gums and taste changes can also be a side effect of the
menopause .
Bleeding gums and taste changes: Oestrogen is important for the
lubrication of mucous membranes, such as those in the mouth.
Lower levels mean the mouth becomes drier, allowing bacteria to
flourish, causing tooth decay and making your gums bleed.
This can damage the taste buds on your tongue, setting off the
pain nerve cells, causing bad breath, a bad taste or a burning
sensation on the tongue.
HEART
Palpitations: Oestrogen deficiency can effectively over-stimulate
the nervous and circulatory systems, causing a pounding, rapid
and irregular heartbeat. See a GP to rule out a possible heart
problem.
LUNGS

Allergies: Hormones and the immune system are inextricably

linked, and menopausal changes can lead to allergies becoming
worse, or you may develop them for the first time, particularly
asthma, hay fever and dermatitis.
BREASTS
Breast tenderness: Fluctuating hormones can lead to an
imbalance where progesterone temporarily dominates; this can
trigger fluid retention, causing tenderness.
BODY TEMPERATURE
Hot flushes/sweats: As levels of oestrogen drop, the
hypothalamus gland the bodys thermostat can be fooled
into thinking youre overheating; you sweat and flush to cool
down.
Sudden heat or redness often starts in the face, neck or chest and
then spreads; you will then start to sweat. Your heart rate may
increase or you may have palpitations.FIRST AID FOR HOT
FLUSHES
A growing number of specialists are in favour of early hormone
treatment during perimenopause, with low-dose HRT to help with
common symptoms such as anxiety, dizziness, breast tenderness
and reduced libido.
+9
Between 70 and 90 per cent of menopausal women suffer from
hot flushes
This will also improve thinning hair, brittle nails, so-called brain
fog, dry and itchy skin and mood swings.
Many women also respond well to herbal remedies
Hot flushes: But when it comes to hot flushes, there are some
more immediate steps you can try.
Between 70 and 90 per cent of menopausal women suffer from
them theyre most common in the year after periods stop.

You move from having a finely tuned system which gradually

adjusts itself to changes in temperature to an on/off switch,
explains Eddie Morris, a consultant gynaecologist at the Norwich
and Norfolk and chair of the British Menopause Society.
Cutting down on alcohol may help, he says, as can avoiding spicy
food and hot drinks.
Another option may be a form of counselling: cognitive
behavioural therapy. CBT teaches you how to replace negative
thoughts, such as I cant cope with this hot flush, with ones such
as I know this will pass.
A trial at Kings College, London in 2013 found that just four
sessions were enough to significantly reduce the number and
severity of flushes. Losing weight also appears to help, as do low
doses of antidepressants known as selective serotonin reuptake
inhibitors.
memory problems: Another symptom is memory problems. Many
women may struggle to find the correct word, or forget names and
appointments.
Menopause specialist Dr Jane Woyka says: I regularly see
women in tears because they wrongly believe they are developing
dementia.
Doctors call this condition nominal aphasia a temporary state
caused by receptors in the brain being deprived of oestrogen.
Most women report their memory returns to normal once
fluctuating oestrogen levels have settled. Lifestyle changes to
improve sleep and reduce stress can help.
Mindfulness a simple form of meditation may also be of use.
A recent U.S. study found that just two weeks of mindfulness
training was enough to improve cognitive performance.

ABDOMEN/GUT
Weight gain: You may struggle to keep the weight off, as the body
strives to retain fat cells, especially on the abdomen, as fat
produces oestrogen.
As your testosterone levels drop, your metabolic rate slows so
women need fewer calories if they want to avoid gaining weight.
The stress linked to menopause raises levels of cortisol, which
encourages fat deposits around the abdomen.
Bloating: Oestrogen is important for maintaining the correct
amount of water and bile in your body. As levels begin to change,
you tend to store more water, making you feel bloated. Because
your body produces less bile, you dont digest fats as well, leading
to flatulence+9
Bloating during the menopause is a common side effect, as are
cramps and weight gain
Other changes in the gut mean food passes through more slowly,
resulting in a build-up of gas as the undigested food ferments.
Bloating at menopause is more common in women who have
experienced it as part of pre-menstrual syndrome (PMS), possibly
indicating an increased sensitivity to hormonal fluctuations.

Irritable bowel syndrome: The muscles of the gut

have oestrogen receptors, so the drop in oestrogen can reduce
muscle tone, slowing transit time and triggering indigestion,
nausea, diarrhoea or constipation. The stress of menopause can
also affect the gut.

Cramps: Conflicting messages being sent by erratic

hormones can lead to period-type pain in the lower abdomen.

SKIN/NAILS

Itchy skin: The body needs oestrogen to produce collagen

(a fibrous protein that keeps skin plump) and for lubrication. So a
drop in levels can mean the skin becomes dry, flaky and itchy;
dryness can also lead to formication, a sensation like crawling
insects.
The lack of natural lubrication during the menopause means that
fingernails can become dry and brittle and will be prone to splitting
The skin also becomes thinner and less dewy-looking. Collagen
loss tends to be most rapid at the beginning of menopause.

Brittle nails: The lack of natural lubrication also makes

nails prone to splitting.
MUSCLES/JOINTS

Muscle pain and weakness: Oestrogen has a

calming effect on the body; as levels drop, the stress hormone
cortisol can dominate, causing the muscles to tighten and tire. All
muscles have oestrogen receptors, so falling levels can trigger
pain and affect muscle tone.

Joint pain: Oestrogen also has an effect on your joints

low levels during menopause can lead to increased joint pain or
trigger it for the first time, known as menopausal arthritis.
WOMB/BLADDER+9
Hormonal imbalances can mean that periods may become
heavier or lighter than before

Heavy bleeding: The hormonal imbalance can lead to

changes in flow (periods may be heavier or lighter than before,

and there may be clots) and frequency (with longer, shorter, or

irregular cycles).
Oestrogen normally thickens the womb lining, and the egg thats
released produces progesterone, which reduces that thickening
effect. However, if no egg is produced (egg production becomes
erratic during the lead-up to the menopause), the thicker lining is
shed as a heavy period.
Incontinence: The loss of collagen linked to lower
oestrogen levels can mean the tissues around the bladder
become thinner and less elastic.
The surrounding pelvic muscles may weaken, too, causing urine
to leak when you cough, laugh or sneeze, or trigger a sensitive
bladder (characterised by a constant need to urinate) or frequent
bladder infections.
SEX
Low libido: Reduced oestrogen levels can affect the sense of
sensation and the ability to orgasm. Falling progesterone levels
lead to lower libido progesterone stimulates testosterone
production, and testosterone is key to sex drive.
Vaginal dryness: The mucous membranes of the vaginal walls
can become dry, triggering itching, stinging or burning, and
possibly pain during intercourse.
SHOULD YOU TAKE A TEST TO TELL IF IT'S BEGUN?
There is no definitive test that can tell if youre menopausal, says
Dr Jane Woyka, a GP from London and a specialist at Northwick
Park Hospitals Menopause Clinic.
Its like putting a jigsaw together. As well as your age, your GP
will ask about your period pattern and any symptoms such as
mood swings, vaginal dryness, night sweats or hot flushes.

+9
There is no test that can tell if youre menopausal, it's a
combination of factors. There are blood tests that may show if you
are heading that way.
The main test checks for follicle stimulating hormone (FSH),
which the body produces to stimulate ovaries to produce an egg.
As the ovaries stop functioning properly, the body pumps out
increasing amounts of FSH to try to prompt them into action. FSH
levels can fluctuate from one month to another so the test is
given twice, six weeks apart.
Two FSH readings above 25 (4.7 to 21.5 is considered normal)
would suggest its the menopause.
Some doctors may also offer a blood test to determine oestrogen
levels. A normal reading is between 30 and 400; under 30
suggests the menopause.
Another test looks at levels of Anti-Mullerian hormone (AMH) and
can give an estimate of how many eggs are left.
Patients might also be offered a test to check thyroid function, as
problems in this area can cause menopause-like symptoms such
as palpitations, mood swings and lethargy.
DIY TESTS
You can buy home-testing kits. These consist of paper strips or
wands that measure levels of FSH in the urine.
As with a pregnancy test, you get a positive or negative result.

All a positive result means is that your FSH levels are 25 or

above, says Dr Woyka.
The trouble is that its not set in stone that 25 means the
menopause. The FSH levels are just one indicator.
These levels also fluctuate from cycle to cycle, within the cycle
and between individual women, so you can have an FSH reading
of 25 and still be ten years off your menopause, or have a very
high reading one month and a normal one the next.
In hospitals and general practice, we use FSH blood tests that
give you a precise number reading rather than a crude
positive/negative result, says Dr Woyka.
Some of the home kit tests claims to be 99 per cent accurate.
But all this means is they are 99 per cent accurate at detecting
FSH levels of 25 or above. In my opinion, these tests are a waste
of money.
EVEN A LITTLE EXERCISE CAN MAKE DIFFERENCE
Being active really can help menopausal symptoms whether
you exercise a lot or a little. Research has shown that women
who exercise have fewer and milder flushes, night sweats and
sleep disturbances.
Meanwhile, the endorphins feel-good chemicals released
during exercise can lift menopausal low moods and ease
depression.
One of the latest studies, published by the University of Applied
Sciences in Tampere, Finland in January this year, found that 49-

year-old women who exercised regularly had a better quality of

life and reduced menopausal symptoms.
The women who did 2 hours of fast walking or 1 hours jogging
or running a week, plus strength or balance training, such as
yoga, twice a week, were less likely to report anxiety, depression,
memory and concentration problems and hot flushes.
Exercise will also help you control your weight at a time when
hormones are conspiring to pile the fat around your middle.
This is all the more important because being overweight can
exacerbate menopausal symptoms.
+9
Staying active can really help menopausal symptoms with
research showing that women who exercise have fewer hot
flushes, night sweat and sleep disturbances.
So what kind of exercise should you be doing? The Royal College
of Obstetricians and Gynaecologists recommends regular aerobic
exercise (such as cycling, walking or swimming) rather than
infrequent bursts of high-impact exercise (running, intensive
aerobics) as these can make symptoms worse.
Low-intensity exercise such as yoga may also help hot flushes
and general well-being, it says.
Even a little bit of activity can have an impact. Researchers from
Australia found that women who do less than the recommended
levels of exercise still experience benefits.
Even if youre not troubled by menopausal symptoms, exercise
has significant long-term benefits, reducing your risk of heart

disease and osteoporosis (which rises significantly once the

protective effect of oestrogen is lost).
One U.S. study showed that healthy menopausal women who
walked for three hours a week or exercised vigorously for an hour
and a half a week had a 30 to 40 per cent lower risk of heart
disease than inactive women.
And its never too late to start. Women who become active only in
mid or late-adulthood still had a reduced risk of heart disease
compared with their inactive peers.
Meanwhile weight-bearing exercise walking, jogging, dancing
and aerobics can prevent or reverse bone loss by 1 to 3 per
cent a year in post menopausal women (the stress stimulates
bone growth).
Exercise can also keep you slim, reducing your risk of type 2
diabetes and some cancers.
More active post-menopausal women have smaller waists and
less body fat, researchers have found.
YOU CAN CONQUER THOSE MIGRAINES
Headaches affect more than 90 per cent of women going through
the menopause, and some start suffering from migraines for the
first time.
The main reason for this is the fluctuation of oestrogen, says
Professor Anne MacGregor, a migraine specialist.
Falling oestrogen levels can trigger chemical changes in the
brain, causing a migraine.
Meanwhile, nearly half of those who already suffer from migraines
may find they get worse (though 15 per cent see an
improvement), and some women find their attacks continue to
follow a cyclical pattern years after the menopause.

Headaches affect more than 90 per cent of women going through

the menopause.
This is possibly because though your periods have stopped, your
ovaries havent, and some hormone activity can last two to four
years after the last period, says Professor MacGregor, author of
Understanding The Menopause & HRT.
The most effective treatment is 900 to 1,000mg of aspirin in a
soluble or effervescent form for speed of absorption, she says.
You can take this up to four times in 24 hours (though always
check with your doctor that there are no health reasons for you to
avoid aspirin). But avoid painkillers containing codeine, which can
aggravate migraine and nausea.
If aspirin doesnt work, another option is a triptan drug, available
over the counter.
This works by constricting the widened blood vessels in the brain
and stabilising changes in brain chemicals.
For a more immediate remedy, place a covered hot water bottle or
ice pack on the back of the neck or most painful point for a short
time. And have a nap.
Clinical trials have shown that even a short doze can help
treatment work more effectively, says Professor MacGregor.
Hormonal changes can be difficult to control, but attacks can be
helped by eating small, frequent meals, avoiding sugary snacks
and alcohol and getting adequate sleep in the week or ten days
before your period.

When there are other menopause symptoms, such as hot flushes

or sweats, HRT can ease migraines but not the tablet form, as
these cause hormones to fluctuate even more.
Instead, oestrogen gel rubbed onto the skin or oestrogen patches
cause fewer spikes and dips in hormone levels, says Professor
MacGregor.