everything you need to know, from hot flushes to HRT


Plus the top skincare products and supplements we recommend.

If you’re part of the 85 per cent of women who experience symptoms around the menopause, it’s likely you have lots of questions: Like how do you know if you *actually* have it? What are most common symptoms? And should you try HRT?

The menopause is something you can’t ignore. It’s unavoidable. It’s inevitable. And it can be daunting.

Luckily, there’s a wealth of information out there. From frank (and frankly necessary) discussions on what is perimenopause? to game-changing new insights into female hormones and early menopause, the M word is slowly losing its stigma. But that doesn’t mean that we’re fully there yet – and many would argue that we still have a long way to go in order to smash the taboo around the common yet not so commonly discussed topic. 

We caught up with three women who are trying to encourage greater conversation around the change, so that those going through it don’t feel so isolated and alone. Sara Matthews is a consultant gynaecologist, Dr Jan Toledano specialises in women’s hormones at the London Hormone Clinic, and Jackie McCusker is a registered Nutritional Therapist.

Drawing on expert insight and their own lived experience, they share everything you need to know about the menopause – bringing you the answers to all those questions, from the average age of menopause to how your skin changes during menopause, too. 

The menopause: your complete guide

First: what is the menopause? 

“It’s the age at which a woman has her last period,” explains Matthews. “Which for UK women is around 51. At which point there are no functioning eggs left in her ovaries.”

So, technically, when a woman has been without a period for twelve months, it can be referred to as the menopause – but not before that point. “In the Western world one year after your last period is when we’re officially diagnosed as going through the menopause, but up until that point we’re in the peri-menopause and that’s the stage when our oestrogen and progesterone levels are beginning to drop,” adds Jackie McCusker, who experienced early menopause symptoms in her 30s.

What is the difference between menopause and perimenopause?

Put simply, the menopause is when your periods stop, while the perimenopause is the months (or years) before your period stops when hormones change and you start to have menopausal symptoms (like hot flushes – but more on that later).

Matthews goes on, “the perimenopause can pre-date the menopause by up to ten years when periods are still regular and hormone levels are normal. The ability to conceive was also lost approximately two years prior to the last period.”

The perimenopause continues until you are considered “post-menopausal” (one year after your period stops). Perimenopause can last a long time, with some women saying they feel the menopausal changes in their late 30s. It’s important to remember that not all women will have the same ‘experience’ of the menopause. Some will experience the menopause suddenly or early, as a result of surgery or treatment for cancer. Some might not get symptoms at all. 

What are some of the tell-tale menopause symptoms?

You start to experience symptoms in the perimenopausal stage, which can occur at different times for each individual and it’s all down to the changes in your hormones. “Progesterone will have already been depleted over the previous decade, so many women will have already gone through heavier periods and worse PMS symptoms,” explains Dr Toledano.

“Then the ovaries stop producing oestrogen – the hormone that controls many functions of a woman’s body – and that’s when women experience things like hot flushes, low mood, vaginal dryness, poor memory and headaches. On top of that, testosterone also declines, which causes poor energy, lower libido and less muscle strength and lower confidence.”

What are common symptoms of menopause and perimenopause?

There are a whole host of symptoms that occur when you’re at this point, some more common than others. According to Matthews, around 88% of women in the perimenopausal stage will experience hot flushes (or vasomotor symptoms, to give them the correct medical name). Women describe these flushes as an “intense heat”, commonly on the upper part of the body – the neck, face and shoulders. Sometimes you might look a little pink in the cheeks and sweat, sometimes you don’t. They can last just a moment or a few minutes.

  • skin dryness
  • vaginal dryness
  • hot flushes
  • forgetfulness
  • depression
  • low moods
  • night sweats
  • irregular periods
  • anxiety
  • heart palpitations
  • panic attacks
  • decreased libido
  • joint paints
  • brain fog
  • skin rashes
  • allergic reactions
  • weight gain
  • hair loss
  • brittle nails
  • needing to go to the loo more often
  • increased urine leakage
  • migraines or other types of headache
  • acne
  • breast tenderness
  • difficulty coping at work
  • relationship difficulties
  • sleep deprivation
  • exhaustion

“We have completely individual biochemistries,” explains McCusker. “So, one person’s menopause isn’t going to be the same as another person’s menopause. It’s genetics, diet, the amount of stress we’ve had in our lives, cultural differences, etc.”

Dr Toledano agrees, saying, “All women experience the change in hormones differently. Some are debilitated and feel unable to function properly, while others barely notice this change at all.”

“There is an idea that women must carry on through menopause with little complaining,” says Dr Taledano. “These changes however can be devastating and often happen at a time of life when there are other changes too, such as children growing up and leaving home. It’s important to know that all the symptoms are preventable and physical changes reversible.”

How long do symptoms last?

This is not a straightforward question to answer, because the menopause is defined by the day 12 months after your last period. However, the length of time a woman experiences the perimenopause, or symptoms of the menopause will vary considerably. Unfortunately, there is nothing set in stone. “There is no test that can indicate how long,” says Matthews. “Women can start symptoms up to 10 years before the periods’ stop, but recent research suggests that symptoms after the last period last an average time of 7.4 years.”

According to the NHS, symptoms can last for months or years, and can change with time. For example, hot flushes and night sweats may improve, and then you may develop low mood and anxiety. Some symptoms, such as joint pain and vaginal dryness, can carry on after your periods stop.

Should you see a doctor to confirm you are going through the menopause?

Matthews recommends that you do. “It is always useful to consult your GP about any symptoms that could relate to the menopause, no matter what age you are. A blood test to check your hormones will indicate whether you are one to two years from your last period, but you can still have symptoms long before that. If your hormone levels are fine and your periods regular, and your GP has ruled out other causes for your symptoms, then it would be useful at that stage to see a menopause specialist,” she says.

Find your nearest NHS or private menopause specialist on the British Menopause Society website (this lists NHS and private specialists).

What’s the best menopause treatment?

“All perimenopausal symptoms will improve with hormone replacement therapy (HRT),” says Matthews. “About ten years ago, HRT received bad press after a study suggested it significantly increased the risk of blood clots and breast cancer. The findings have now been refuted and safer HRT regimes have been developed.”

Dr Toledo agrees with HRT as a treatment, adding, “Topping up the hormones that are low is the best option. The fear instilled by those studies and the subsequent press frenzy still causes confusion for women. There is no increased risk of disease, and in fact, there’s a lower risk of many diseases with certain HRT.”

Ideally, you would get a top-up of both oestrogen and progesterone, as they balance each other out. By replacing oestrogen you are protected against heart disease, strokes, high cholesterol, diabetes and osteoporosis. It also helps to relieve hot flushes. There’s also the option of vaginal oestrogen, which prevents and treats vaginal dryness and urinary symptoms. Matthews recommends it to all of her patients from the menopause onwards, apart from breast cancer patients. Replacing progesterone can stop skin from being and feeling as dry and helps with cognition and sleep.

What are the benefits of HRT?

HRT is proven to be effective, and many say it’s life-changing – it remains the most effective treatment for hot flushes, night sweats, tiredness, insomnia, mood changes and poor memory. 

Women wishing to start HRT should carefully discuss the benefits and risks of treatment with their doctor to see what is right for them, taking into account their age, medical history, risk factors and personal preferences.

Can lifestyle changes help menopause and perimenopause symptoms?

Changes to your lifestyle can also help you manage your symptoms. “A heathy diet and exercise, good sleep and doing things that make you happy all have a positive impact,” says Matthews. “Moderating alcohol intake, stopping smoking, taking control of your health will bring massive benefits. Cognitive behaviour therapy can help along with meditation.”

Dr Toledano couldn’t agree more: “Make healthy lifestyle choices, like a better diet, more exercise (especially weight-bearing exercise to keep your bones healthy), stop smoking, lose excess weight and cut down on alcohol. Meditation or cognitive behaviour therapy can also be really useful.”

Is there a recommended menopause diet?

As a nutritional therapist, McCusker works closely with women to help them rethink their diets to help with the symptoms.

“The female Asian population tend to have a better experience of menopause than us in the western world, and one of the main things is their diet. They have had a very nutritiously dense diet of whole foods, legumes, and traditionally fermented soy, which contain phyto-oestrogens. These are natural plant oestrogens and can emit a mildly oestrogenic effect, when our oestrogen levels are dropping severely during perimenopause.”

So have a look at your diet, look at the composition of your plate and make vegetables your hero. 50% of your plate should be vegetables. There should be good quality fat, no low-fat anything and good quality protein. Things like legumes are really great, tofu, and fermented soy products. Eggs and dairy are great sources of calcium and protein.”

The things to avoid are environmental oestrogens, a.k.a zeno-oestrogens or endocrine-disrupting chemicals. These disrupt your internal hormone system. These come from things like plastic bottles, plastic wrapping and parabens in skincare. McCusker recommends buying organic where possible, “Any livestock or animal products, like eggs because they’re being pumped full of zeno-oestrogen hormones. It’s about making small steps to lower your toxic load. For example, you could change your washing liquids to more natural ones.”

The bottom line: what else should I know about menopause?

“Do not blame yourself for how you feel,” says Dr Toledano. “Get help from your doctor to give you the hormones you need to top up what you are not making and do not use oestrogen if you still have periods (unless this is supervised by a gynaecologist), only use progesterone at this stage.

“Be aware of the symptoms that can arise, seek medical help from your GP and if necessary, a menopause specialist,” Matthews adds. “Don’t suffer in silence! Take a little time out to think about what is happening and how you can adapt your lifestyle to help. Little practical things like layering clothes and having a fan and some water in your handbag, cotton sheets and a cool bedroom can make all the difference.”

“Find a bit of joy every day,” recommends McCusker. “Although life can be really crap and terrible, find time to laugh, find something that makes your heart sing, that lifts you a little bit. Even in the darkest moments.”

If you feel you need more support or information, check out one of the following charities:

8 menopause products that’ll make life a little bit easier

Thankfully, we live in a world where there are brands that aim to help women during this tough time.

Scroll down, for the products that might make your menopausal journey a little bit easier.





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