What is Menopause?

The term menopause – derived from the Greek ‘men’ which means month or monthly and ‘pausis’ which means end or stop – translates literally as the ending of your monthly menstrual cycle. It is a completely natural and normal stage of life that all women will go through and leading up to this point, you will probably have (knowingly or not) gone through perimenopause, the time before your periods stop (and when your ovaries are beginning to slow down, and your sex hormone levels begin to fall) before transitioning fully into menopause.

If this all sounds straightforward enough, unfortunately, menopause isn’t something that can be neatly boxed up and put away the day after your periods stop. This marks just one day in your menopause journey – a transitional time that usually builds over months and years which is generally accompanied by a range of physical and psychological symptoms that can last for years after you stop menstruating.

Menopause is not an illness or disease but that doesn’t mean it is necessarily easy to live with. An estimated 6,000 women in the US reach menopause every day[1] and more than one million will go through it each year.[2] Menopause can have a huge impact on your life so it is important to take action and try to manage it, 10% of women leave their job because of their symptoms and one in four consider quitting according to our research.[3] Ultimately, your experience will not be the same as other women who are the same age as you or who are experiencing menopause at the same time, and for this reason there is no one size fits all solution as to how to manage it. That said, arming yourself with all the latest research and information can help you to understand what is happening, what you can do about it and what practical help is available.

What age does menopause begin?

For most women, menopause starts between the ages of 45 and 55, with the average age (in the US) being 51. Five per cent of women experience it after the age of 55 – sometimes referred to as late onset menopause – and around 1 in 100 women experience it under 40 which is defined as premature menopause.[4]

Early menopause is when your periods stop before the age of 45. This can be caused by cancer treatments, if you’ve had a hysterectomy, the result of some autoimmune diseases and infections, or sometimes it just occurs naturally.

No one can precisely predict when you will go through menopause but research shows there are a range of factors which can affect its onset. These include:

The age your mother went through it (both early and late menopause appear to run in families)[5]
The age you started your periods (starting them young has been linked to early menopause)[6]
How many children you have had (giving birth to three children is associated with a later onset menopause; having no children or never getting pregnant is linked to going through it earlier)[7]
Your weight (research suggests overweight and obese women have a 50 per cent higher risk of having a late menopause and underweight women are more likely to have an early one)[8]
Whether you smoke (many studies have shown that women who smoke enter menopause earlier than those who don’t).[9]
According to research African, Asian and Latino decent women are also, on average, more likely to begin menopause earlier than white women and may have a longer transition time into menopause and experience worse symptoms.[10]

How do you know menopause is happening?

The simple answer is you are experiencing the effects of menopause and it has been 12 months since your last period.

What happens to your hormones in menopause?

As you approach menopause, your ovaries begin to slow down and with it your production of the sex hormones estrogen, progesterone, and testosterone. Estrogen levels affect your reproductive (period) cycle, but also your sleep, weight, energy levels, temperature regulation, skin, soft tissues, and mood. Changing levels of testosterone can affect your sex drive. In short, it’s a time of extreme hormonal fluctuations – leading some experts to suggest menopause should be renamed ‘Female Hormone Deficiency’.[11]

If you want to get a more informed picture of what is going on with your erratic hormones at this time there is a test that measures your Follicle Stimulating Hormone (FSH), one of the most important hormones involved in regulating your reproductive system and menstrual cycle. A single FSH test might not conclusively confirm if you are in menopause – as levels of it can rise and fall – but it can help to give you a bit more information about your hormone status, if you feel it would be helpful. If you haven’t had a period for 12 months and your FSH levels are consistently elevated to 30 lU/L you are almost certainly in menopause.

Menopause symptoms

Lower levels of estrogen are thought to drive almost all menopause-related symptoms (there are estrogen receptors all over the body, including within the brain). This is the case for psychological symptoms as well as the physical ones. However, often symptoms are inter-linked. For example, regularly not sleeping (and this is the number one complaint from women going through menopause according to recent Health & Her research) is likely to lead to feelings of low energy/lethargy, which can lead to reduced motivation to do things and enjoying them less, as well as perhaps a lowering of mood generally. Similarly, worrying about experiencing brain fog or hot flashes whilst at work can contribute to increased anxiety, stress and/or loss of confidence.

There is evidence to show that around 75 per cent of all women will experience menopausal symptoms, and for around a quarter of these they will be severe.[12] Given that for many women these will last for around seven years, and up to 15 years in 20 per cent of cases, you can see why it becomes so important to 1. be able to recognise them 2. understand why and how they might impact on your body and brain and 3. learn what can alleviate them. Again, every woman’s experience will be slightly different – including length, severity, and symptoms experienced.

The top 9 symptoms of menopause

New research from Health & Her[13] reveals women are having to contend with an average of 9 symptoms during their menopause with the most common ones cited (in order of prevalence) as:

Sleeping problems – stress, low mood, anxiety and depression can all potentially lead to problems with getting to sleep as your brain finds it difficult to switch off. This is very likely to be accompanied by night sweats which not only wake you up but also make it difficult for you to get back to sleep.
Weight gain – we tend to gain weight as we age as our metabolism slows down and we might find it harder to find time to exercise. On average menopausal women gain around 5lb.[14] The hormonal changes during menopause can also affect the way you store fat so that it becomes distributed differently around your body. You are more likely to gain weight around your middle – often dubbed the meno-belly, the meno-pot or meno-middle.
Low energy – decreasing hormone levels can cause tiredness and fatigue during menopause and this can be exacerbated by sleep issues, stress, mood swings and low mood – all of which can lead to you feeling generally ‘flat’ and unmotivated.
Joint aches and pains – estrogen plays a key role in helping to decrease inflammation in the body and keep joints naturally lubricated. Losing estrogen as you head into menopause will not only reduce natural bone density but can also affect your joints and cartilage (the connective tissue which cushions your joints) – often resulting in stiffness, pain and muscle aches.
Night sweats – These often accompany hot flashes and are similarly caused by an inability to control your temperature at night. Night sweats should always be discussed with your physician as there are other, non-menopausal causes of these, and in rare cases these can be serious.
Brain fog – this is the term used to describe the forgetfulness, confusion and inability to remember words and retain information during perimenopause and menopause. Many women describe it as their brain feeling like bubble wrap and whilst it might be the butt of many a joke it can be seriously disconcerting for many women. Dr Anne Henderson discusses the subject more in Menopause mood changes and brain fog.
Stress and worry – Mood swings, anxiety and depressive symptoms are common during menopause. You might also feel angry, less confident, more forgetful and have difficulty concentrating or finding words that you know (typical symptoms of brain fog). These feelings can be quite pronounced and may appear to come out of the blue making them particularly hard to deal with. Menopause experts point out that it is these psychological symptoms which tend to floor women more than the physical ones like hot flashes – with many women worrying that they might be experiencing early signs of dementia.
Low mood – estrogen is hugely significant for brain function and mood and diminishing levels of it can potentially result in you feeling a pretty constant flat, low feeling and a general loss of interest in things that normally bring you pleasure. This low mood is often accompanied by debilitating tiredness.
Trouble concentrating – when hormone levels are lowered brain function can be affected in subtle ways including your ability to concentrate. Whether at work or at home this can be hugely frustrating, and is likely to be compounded by the fact you are not sleeping well so making it even harder to focus.

The top 9 symptoms vary for women in perimenopause and menopause – the perimenopause stage is explained more in What is Perimenopause?

Symptoms associated with the vaginal area are typically reported as having a big impact on quality of life. These symptoms include:

Vaginal dryness and discomfort during sex – Lower levels of estrogen can affect your urogenital tissues – the areas around the vagina, the vulva, the bladder and urethra (the tube that takes pee from the bladder to the outside of the body). The estrogen deficiency that occurs during the perimenopause and menopause can cause urogenital atrophy, where the tissues become thinner and drier. This can lead to vulva (the vulva is the area outside the vagina) or vaginal dryness, soreness, and/or irritation/itch. These symptoms can, understandably, make sex painful. Bladder-wise this can cause abnormally high urinary frequency, waking frequently overnight to have a pee, an unusual urgency to pee, and a propensity to urinary tract infections like cystitis. It should be pointed out that while other menopause symptoms tend to subside, these ones might not. As Dr Rebeccah Tomlinson M.D., a physician with a special interest in menopause explains, ‘Whilst we learn to manage and adapt the other menopause symptoms that all tend to lessen over time, the vaginal atrophy is persistent and will not resolve or improve without ongoing treatment.’
Low libido – Lower levels of estrogen can dampen your desire for intimacy and sex plus the fact it may be uncomfortable (see above) can make it a double turn off.

To discover more symptom specific advice and expert content, visit our easy-to-use symptom checker which is based on the British Menopause Society’s most common symptoms.

How can you manage your menopause symptoms

There are a whole range of treatments, remedies and lifestyle habits that can help relieve your symptoms – although it should be said what works for one woman might not for another so it can be a matter of trial and error working out the right plan of action for you. Practical strategies that can help include:

Tracking symptoms

The Health & Her Menopause App, for example, can help you make note of your triggers, log down the severity and regularity of symptoms, and help provide some exercises to manage them. Documenting and monitoring symptoms can improve knowledge and it can be helpful if they are getting in the way of your quality of life. 78% of women who used the Health & Her app every week for 2 months reported improvements in symptoms.[15] Having this information can also be useful to take to an appointment with your physician so you get the most out of the time you have with them.

Recognize your particular triggers: The top 10 menopause triggers

What appears to make symptoms worse? The Health & Her findings show the top 10 triggers likely to inflame and exacerbate menopause symptoms for thousands of women are:

Worry at work
A stressful event
Alcohol
Sugar
Caffeine
Fatty food
Hot weather
Spicy food
Cold weather
Changes to your diet

There are a variety of treatment routes to consider depending on how the menopause affects you. Knowing what is available can help you make more informed choices and give you the practical tools to make your menopause easier.

Medical treatments for menopause

The most common medical treatment for menopause is hormone therapy (HRT) which according to the National Institute for Health and Care Excellence (NICE) is statistically the most successful one for relieving symptoms in otherwise healthy women. Hormone therapy works by replacing the estrogen and progesterone hormones that deplete during menopause. It is usually prescribed by your physician (although you can now buy vaginal estrogen from your pharmacist to help relieve vaginal dryness) and it comes in several forms, including tablets, skin patches, gels, implants, creams or pessaries. To determine if it is the right option for you, speak to your doctor to discuss the risks and benefits.

Exercise

Regular exercise can be key to helping you through menopause symptoms. It can boost your ‘feel-good’ endorphin levels and help manage anxiety and depression whilst keeping you physically fitter and more likely to maintain a healthy weight. It can help you build muscle mass and protect your bones,[16] generally help you to stay more flexible and reduce your risk of heart disease (keeping your weight down and improving cholesterol levels).[17] It can also lead to better sleep.[18] On top of all this, there is also evidence to show that women who exercise regularly have less severe hot flashes than women who don’t.[19] Exercising also increases blood flow to the brain and can help reduce brain fog. Significantly, it has also been shown to improve self-worth and quality of life in post-menopausal women.[20]

Diet and lifestyle

Ensuring you have a diet that helps you have a healthier, happier menopause. This should be a diet rich in nutrients, vitamins and minerals can have a huge impact in helping to provide you with the energy you need and improving your mental health. Cutting down on certain foods that may make you feel lethargic or tired, and incorporating more protein and foods rich in fiber into your diet can make a real difference.

Supplements for menopause

Supplements during menopause can help support your body as it goes through this life stage. Those containing natural phytoestrogens – including plants like Red Clover that help mimic the action of estrogen in the body – can help balance your hormones. Health & Her’s menopause supplement range is a natural and medical support for your unique menopause journey.

Building positive lifestyle habits

There are lots of small daily changes you can do that can lead to long-lasting results:

Cognitive behavioral therapy (CBT) exercises for hot flashes, night sweats and low mood
Guided imagery meditation can help towards a better night’s sleep
Pelvic training is good for sensitive bladders
Deep breathing exercises to help with your stress & anxiety

The Health & Her Menopause App’s symptom toolkit includes all of the above, it is the first personal trainer for your menopause with a selection of evidence-based exercises, tools and reminders to support your symptoms.

Talk about it

Thankfully, the days when the subject of the menopause was brushed under the carpet and/or talked about in hushed tones as ‘women’s troubles’ are over, but that said many of us can still feel uncomfortable talking about it even with people we love and trust. No-one should feel pressured into talking about it, but it can help the people around you to empathize and understand why you might be behaving slightly out of character. Broaching it with your close family or colleagues can be a bit of a minefield but there are ways and means as Menopause Coach Ruth Devlin explains in How to Talk to Your Teenagers and How to explain menopause to a man . Similarly, if you’re struggling to find the right words to speak to your physician about your symptoms, there is helpful information in Here is how best to broach intimate topics with your health professional.

Think about the positives

As always there is no one size fits all or ‘right’ response to discovering you are going through the menopause. You will probably feel a mixture of emotions but it’s worth thinking about what the potential benefits can be including:

No more periods. No more worries about your period suddenly starting when you are on vacation or flooding during a meeting or an important event. Added to this, no more shelling out for sanitary napkins or tampons and no more PMS, period pain or menstrual headaches. Plus, you can confidently wear white trousers again.
No more birth control. Once you are postmenopausal (generally meaning two full years after your last period) and/or over 55 you should be able to safely stop whatever form of birth control you have been using and not have to worry about getting pregnant. Dr Kate Burns M.D., a doctor with a special interest in menopause, discusses this more in Menopause contraception.
A time to re-appraise your life. The time around menopause can be a time for taking stock of your life generally, focusing more on what you want and need and how to make the most of your fifties and beyond. One of the more surprising things about menopause is that it’s linked to a reduction in the hormone oxytocin.[21] Commonly dubbed the ‘love/cuddle hormone’, oxytocin is associated with caring/mothering and is thought to be one reason why women tend to look after everyone else’s needs before their own. It has been suggested that a decrease in this hormone can allow you to take more time for yourself and may make you slightly more detached.
Focus on healthcare and habits. The typical age of menopause is also a time when many women start to reassess their habits and healthcare generally – many are likely to take up some form of exercise (it has been noted that there has been a big rise in fifty-something runners attempting marathons)[22] and often re-appraise their diet or lifestyle habits – aiming to cut down on sugar or unhealthy fats or stop drinking, for example. Given that menopause can put you at increased risk of conditions like osteoporosis[23] and heart disease,[24] regular exercise and improving your diet can help reduce your risk.
Increased self-assurance and optimism. After 40 or 50 years of life experience, you are generally more likely to have greater self-assurance and the confidence to go after what you want and ask for your needs to be met. As you get your menopause symptoms under control you should also feel calmer and more even tempered. Research also suggests your levels of optimism peak in your mid-fifties.[25]

Sources and references:

[1] https://www.nia.nih.gov/news/research-explores-impact-menopause-womens-health-and-aging#:~:text=More%20than%201%20million%20women,of%20this%20natural%20biological%20occurrence.

[2] https://www.mayoclinic.org/diseases-conditions/menopause/symptoms-causes/syc-20353397#:~:text=Overview,51%20in%20the%20United%20States.

[3] https://www.hrreview.co.uk/hr-news/10-of-women-leave-the-workforce-due-to-menopause/142016

[4] https://www.nhs.uk/conditions/menopause/

[5] https://www.reuters.com/article/idINIndia-57288820110526

[6] https://www.npr.org/sections/health-shots/2017/01/25/511588083/an-early-first-menstrual-period-may-lead-to-premature-menopause#:~:text=An%20Early%20First%20Menstrual%20Period%20May%20Lead%20To%20Premature%20Menopause&text=Getty%20Images-,Data%20from%20four%20countries%20suggests%20a%20link%20between%20starting,age%2011%20and%20earlier%20menopause.&text=Women%20who%20get%20their%20first,of%2040%2C%20a%20study%20finds.

[7] https://academic.oup.com/humrep/article/37/2/333/6427299

[8] https://public-health.uq.edu.au/article/2018/03/weight-plays-role-menopause-age#:~:text=%E2%80%9COverweight%20and%20obese%20women%20had,to%20the%20onset%20of%20menopause.%E2%80%9D

[9] https://pubmed.ncbi.nlm.nih.gov/23788671/

[10] https://www.swanstudy.org/

[11] https://www.themenopausecharity.org/2021/05/05/rebranding-the-menopause-as-a-female-hormone-deficiency/

[12] https://thebms.org.uk/2021/08/the-british-menopause-society-response-to-the-department-of-health-and-social-cares-call-for-evidence-to-help-inform-the-development-of-the-governments-womens-health-strateg/

[13] Health & Her research conducted Oct 2020 – Sept 2020

[14] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6483504/

[15] Data based on 289 women using Health and Her app users for2 months any time between October 2020 and September 2022

[16] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6429007/

[17] https://www.frontiersin.org/articles/10.3389/fragi.2021.667519/full

[18] https://sleepeducation.org/increasing-physical-activity-improve-sleep-menopausal-women/

[19] http://edition.cnn.com/2016/01/27/health/menopause-hot-flashes-exercise/

[20] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2728615/

[21] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6257199/

[22] https://www.theguardian.com/sport/2022/sep/30/a-sea-of-positivity-older-women-boost-london-marathon-numbers

[23] https://www.healthline.com/health/menopause/osteoporosis

[24] https://www.bhf.org.uk/informationsupport/support/women-with-a-heart-condition/menopause-and-heart-disease#:~:text=Before%20the%20menopause%2C%20women%20in,the%20menopause%2C%20your%20risk%20increases.

[25] https://spsp.org/news-center/character-context-blog/look-sunny-side-optimism-increases-people-get-older