Menopause is commonly used as an umbrella term when we are actually referring to any of the situations detailed below.
Although we use the term women when discussing menopause we acknowledge that some transgender men, non binary people assigned female at birth and some intersex people or those with variations in sex characteristics may also experience menopausal symptoms. We aim to support anyone who is going through menopause, both within the clinic and at our community talks.
Perimenopause
The perimenopause is the time leading up to menopause and can often be the most symptomatic and problematic. It can last many years and as the average age of menopause in the UK is 51 the majority of women aged 45 and over will start to experience symptoms and possible changes to their cycle. The hormones are fluctuating at this time which can mean that some days you may experience a lot of symptoms and yet on others none at all. During this time the ovaries may not release an egg each month. There is a feedback loop between the ovaries and the brain which also contains a hormone known as Follicle Stimulating Hormone or ‘F.S.H.’.
FSH levels rise as the body tries to stimulate the ovaries into ovulating, and a blood test can be done to check this level. This blood test is often cited as a way of diagnosing menopause however, as FSH levels are fluctuating in perimenopause, and therefore the blood test can often be normal. The NICE Guidelines therefore do not suggest blood tests as a way of diagnosing menopause, especially in women over the age of 45. We tend to find that monitoring symptoms and changes in menstrual cycles much more useful.
Menopause
Menopause originates from the Greek words ‘menos’ (month) and ‘pause’ (stop). It is 12 months after your periods naturally stop. If you are on hormonal contraception including the Mirena coil then you may not be able to determine this and symptom monitoring is more useful.
Post-menopause
Anything after menopause is termed ‘post-menopausal’. During this stage the ovarian function is at its quietest and symptoms may not fluctuate as significantly. This does not mean that they will disappear and some women will experience significant symptoms for years. Even if you are not symptomatic a decrease in hormones has a potential impact on your future health and this is something that should be considered and addressed. It is a great time to have really good look at potential treatments and lifestyle measures to keep you strong, healthy and the best version of you.
Early menopause
Early menopause is natural menopause that occurs between the ages of 40 and 45. It is more common than you may think and happens to approximately 1 in 20 women. This means that they may experience perimenopausal symptoms in their 30s.
Premature Ovarian Insufficiency (P.O.I)
This is menopause that occurs below the age of 40. It occurs in 1 in 100 women. It can also occur at a younger age than this and the incidence is about 1 in 1000 below the age of 30 and 1 in 10000 below the age of 20. The cause of this is often unknown (the medical word for this is ‘idiopathic’) although it is sometimes linked to autoimmune conditions such as coeliac disease and autoimmune thyroid disease. It also be due to certain genetic conditions and there is more research currently underway into this field.
Surgery involving the female reproductive tract or treatments that shut down the ovaries including GnRH analogues, chemo or radiotherapy treatments can also cause P.O.I.
If you have P.O.I the ovaries do not ovulate regularly. This means that your body does not produce the normal level of sex steroid hormines (oestrogen, progesterone and testosterone). Fertility can be affected and although some women with P.O.I will conceive naturally, others may need to consider options such as egg donation.
Premature Ovarian Insufficiency can feel like an overwhelming diagnosis. It can feel very lonely and the organisation The Daisy Network www.daisynetwork.org is an amazing resource which aims to provide evidence based information and links/events to connect and support those with this diagnosis.
Guidelines indicate that where possible, hormones should be replaced until at least the average age of menopause (51). Many people then decide to keep taking Hormone Replacement Therapy for symtoms control and the benefits for future health.
Surgical menopause
If you have surgery to remove your ovaries for any reason then you will go straight into surgical menopause. This is a sudden transition and can be problematic for this reason. We still speak to far too many women who haven’t been counselled about this prior to their surgery or given adequate doses of replacement hormones following surgery and are very symptomatic. Diane Danzebrink talks about her journey following surgical menopause on the website www.menopausesupport.co.uk
Medical/Induced menopause
Medical treatments for certain gynaecological conditions such as endometriosis may shut down ovarian function.
Many women who have had either chemotherapy or radiotherapy for cancer may also have been forced into menopause with these treatments. This is often not spoken about during the treatment as the focus is understandably on treating the underlying cancer. We speak to many who feel very isolated and haven't known who to turn to for help.
With certain types of cancer such as oestrogen receptor positive breast cancer, the guidelines indicate that Hormone Replacement Therapy should not be considered first line. This does not mean that symptoms can not be addressed with options such as other medications or lifestyle adjustments. Depending on the severity of symptoms, Hormone Replacement Therapy can sometimes be considered in this group with individualised discussion and where possible, liaison with your Oncologist.
There are many factors that influence the way that you will experience menopause and these are just a few. Whatever your circumstance, we aim to spend the time to truly listen to you, work with you to empower and support you and to come up with the best management plan for YOU.