Menopause, perimenopause and post-menopause – A doctors overview

by Dr Shilpa McQuillan, ⊕ medically reviewed by Dr Rebecca Tomlinson on 5th September, 2022

From the time you start noticing changes and symptoms to beyond your last period, menopause is a time of multiple changes. Many of us feel mystified by what’s going on. So if you’re wondering ‘am I perimenopausal’ or want to understand what’s going on with your hormones, GP Shilpa McQuillan is on the case, explaining what to expect and why.

What is the menopause?

Menopause, or other terms such as ‘the change’, ‘the climacteric’, means to permanently stop having periods. It is diagnosed once a woman has no menstrual periods for 12 months in a row.

When will I experience menopause?

For many women this occurs between the age of 45 and 55 (with the average age in UK being 51). For some women this may occur ‘early’ before the age of 45, or even ‘prematurely’ below the age of 40, known as Premature Ovarian Insufficiency (POI).

For many women, it can be difficult to know if you are going through the menopause, especially if you already have scanty or irregular periods. We often refer to the time that leads up to the menopause – which can be months or years – as ‘perimenopause’.

How to tell if you are perimenopausal or menopausal?

During the perimenopause, some women may continue to have regular periods but experience symptoms of menopause. Others may start to notice changes to their periods – they may become more scanty and lighter, or they may become heavier. A good way to understand if you might be perimenopausal is to observe for other menopause symptoms including hot flushes, anxiety, low mood and sleep problems (more about this later in this article).

Many women may find these symptoms distressing and confusing as they are not aware that you can experience menopausal symptoms whilst still having periods. Speak to your GP if you feel this could be you and you would like more information on how to manage this. Some women also find it helpful to keep a diary of their periods and symptoms they are experiencing. Health & Her have produced a Perimenopause symptom checker which is helpful digital way to track your symptoms.

If you think you might be menopausal, but you aren’t sure, below is some helpful guidance on how to tell whether menopause has begun.

Why does menopause occur?

Oestrogen is a hormone mainly produced in the ovaries and is responsible for controlling many functions in the body including the production of an egg each month (ovulation). As a woman gets older, the store of eggs in their ovaries naturally declines. The menopause occurs when your ovaries stop producing eggs and your body’s oestrogen levels fall. As a result, there are many changes that can occur to the body including the symptoms we associate with menopause, and no longer having periods.

What is early menopause?

Premature or early menopause can occur at any age and sometimes there is no clear reason. However sometimes, there may be a reason women’s ovaries stop working early. For example:

Surgery to remove your ovaries. It is important to discuss this with your doctor as soon as possible as it is likely you will experience menopause symptoms and may need hormone replacement.
Treatment for some cancers may require radiotherapy aimed directly at your ovaries or pelvis. Some medications including chemotherapy may also affect the ovaries. Both of these can result in damage to your ovaries and an early menopause.
There are some medical conditions that can cause early menopause. For example chromosomal abnormalities (such as Turners syndrome), or rarely, infections such as mumps or tuberculosis.
Having a family member with early menopause may increase your chance of an early menopause.

What are ‘the symptoms’?

The key thing to remember is that everyone is different. Some women do not experience any symptoms, but majority of women will, and this can really impact on both physical and mental aspects of your life including relationships, work, and activities.

The symptoms associated with menopause tend to be a result of hormone imbalance and lack of oestrogen. There are over 30 symptoms associated with menopause, but the British Menopause Society list of most commonly experienced symptoms includes:

Some of these symptoms can be common and ‘typical’ of what we associate with menopause, but they might also be vague, and things ‘just do not feel right’.

Also it is worth noting that some other medical conditions have similar signs and symptoms to menopause. It is important to visit your GP to discuss and explore this further.

When should I seek help?

If your symptoms are bothering you then it is worth exploring what options are available. There are many different treatments available depending on your individual symptoms and needs.

If you’re struggling to approach this topic with your healthcare professional, here is some advice on how to talk to your GP about menopause.

Are there any health worries to be aware of around menopause?

Menopause itself is not ‘dangerous’. However, it’s important to be aware that some hormone changes that occur during this period can present some health concerns. For example, low oestrogen can increase your risk of cardiovascular disease (such as heart attacks and strokes), and bone problems such as osteoporosis (brittle bones).

Normally when women go through the ‘natural menopause’ (after the age of 45) the oestrogen stores are enough that just taking care of yourself by following a healthy diet, exercising regularly, not smoking and limiting alcohol intake can reduce these risks and improve your overall health.

However, if you go through an early menopause then your oestrogen and other hormone levels are low from a young age and you may need to top these up to prevent osteoporosis and cardiovascular disease. It is therefore really important you go to your GP if you are below 45 and have symptoms that sound like the menopause.

As well as lifestyle, it is important to make use of the screening services offered by the NHS to keep a check on your health. This includes breast and cervical screening. There are some things you can do at home, for example regularly checking your breasts. You can seek advice from your GP if you are unsure how to do this.

Do I need any tests for Perimenopause?

If you are over the age of 45, diagnosing menopause can be based on symptoms alone.

Below 45, you may need a blood test to confirm menopause. This is because as there are many other reasons your periods can stop before this age and your GP may advise having further tests to investigate this.
If you are showing signs of ‘premature’ menopause, you may also be offered other tests. This is because it can be associated with other medical conditions that may need looking into and treating.

Can I still get pregnant in Perimenopause?

During perimenopause (the lead up to menopause) and even shortly after your periods have stopped you may still be able to get pregnant. If you are using hormonal contraception such as the pill, mini-pill, Mirena coil or subcutaneous implant, this may be masking the fact you could still be having periods.

It is therefore important that you discuss whether you need contraception with your GP.

As a general rule, it is safe to stop using contraception if:

You are not on any hormones and have not had any periods for more than one year and are over the age of 50.
You are not on any hormones and have not had any periods for more than two years and are under the age of 50.

About Dr Shilpa McQuillan

Dr Shilpa McQuillan is a GP with a difference; she brings a wealth of specialist knowledge when it comes to women’s health. Previously a Hospital Registrar in Obstetrics and Gynaecology, Shilpa now works in general practice, providing patients with resident expertise and knowledge on women’s health concerns.

Read Shilpa’s full biography here.