Hot flushes. Wrinkles and pimples. Brain fog. Mood swings.
“I was angry all the time, tearful and wanting to hit people or scream at them,” shares one woman on Reddit’s menopause forums. “Getting hot flushes was like being plugged into an electrical outlet – you heat up slowly in one point and then the discomfort of the heat spreads through to your arms, head and chest until you practically tear off your clothes,” says another. “It’s like going through puberty again but worse, with raging hormones, sleep problems and acne.”
As doctors and nurses shared with us, menopause can indeed be a challenging time for many women, especially as they see their bodies and moods change significantly. But help is at hand.
Here, we present your Menopause 101 guide, filled with useful information and advice from doctors – answering common questions such as: Which age does menopause start at? What are the three stages of menopause? “What exactly happens during menopause and how long does it last for? Most importantly, we share what you can do today to make your journey through menopause a much smoother – and even rewarding – one.
What is Menopause?
Menopause is diagnosed after a woman has gone for 12 months without a menstrual period. It is a natural part of the ageing process that marks the end of a woman’s reproductive life.
When does Menopause start?
Most women begin menopause in their 40s and 50s, with many starting to experience symptoms between 45-55 years old.
Some describe the process as the three stages of menopause. Perimenopause usually happens about three to five years before full menopause. Periods may become irregular, with the onset of menopause symptoms such as night sweats or restless sleep. Menopause begins a year after the last menstrual period. And postmenopause describes the years after full menopause.
What exactly happens during Menopause?
While each woman may experience different symptoms (and to different degrees), these are some of the most common symptoms of menopause, according to doctors.
“The most common complaint I hear is the dreaded hot flushes,” says Dr Julia Sen, a Consultant Ophthalmic Plastic, Reconstructive & Cosmetic Surgeon. “These typically arrive suddenly and unexpectedly, and the fear of embarrassing yourself – especially at work – can cause further anxiety,” adds Dr Sen. “Hot flushes can also disturb sleep, both for the person experiencing them and their spouse – which can make everyone sleep-deprived and irritable.”
According to Dr Sen, menopause causes testosterone levels to fall (yes, women produce this androgenic hormone too) and the different menopausal hormone changes can wreak havoc on your mood. “One client said she started Hormone Replacement Therapy (HRT) because otherwise she risked "murdering someone" and confessed she sought help because she was involved in a road rage incident that was highly uncharacteristic for her,” adds Dr Sen. “Other patients have reported volatile emotions such as feeling very tearful.”
Impacts on Hair and Skin
Your hair can start to thin and become grey, says Dr Sen. Julia Ogilvie, Non-Medical Independent Nurse Prescriber, says hair can also become drier and brittle, with thinning leading to bald spots.
Skin too, can become thinner, with reduced oil production leading to drying and increased sensitivity. For some, the change in their skin barrier can result in unexpected – and unwanted – breakouts of adult acne, adds Dr Sen. “The fat pads in the face also tend to shrink and descend, leading to sagging jowls and the appearance of bags or dark circles around lower eyelids, hooding of upper eyelids and deepening of facial wrinkles.” “Women may notice dry, dull skin, with increased skin laxity,” says Ogilvie, “as during menopause women lose approximately 40% of their skin’s collagen and elastin content per year.”
Impacts on Body
Dr Sen shares that women going through menopause may notice their breasts may “deflate” while simultaneously gaining weight, especially around their midsections. Ogilvie adds that like facial skin, the body’s skin may also become somewhat loose and saggy, with changes observed in the appearance of the vaginal area as well.
Other unexpected bodily changes may also occur, says Dr Unnati Desai, founder of the Urban Aesthetix Clinic in St John's Wood. For example, one of her menopausal patients suffered from Lichen sclerosus (a chronic skin condition that causes the skin to become thin, white and wrinkly) for years. “I’ve definitely noticed less itching in the vulva area since using CALECIM® Multi-Action Cream (a stem-cell-based anti-aging cream), which means I don’t need to use steroid ointments as frequently,” shares the patient.
Sleep is disrupted
Ogilvie says about 60-70% of her menopausal patients experience insomnia, which in turn is correlated with increased risk for heart disease, diabetes and obesity. “To combat this, I typically recommend healthy ways to unwind such as meditation, reducing screen time before bedtime, soothing milky drinks before sleep, walks in fresh air or going for a massage.”
What can I do today to make Menopause easier for myself?
“Walking is a free and very effective exercise that most people find easy to stick to,” says Julia Ogilvie, Nurse Prescribe, who recommends walking 30-45 mins a day, 3-5 times a week.
Eat more of these.
Love your carbs? Ogilvie recommends women eat “good carbohydrates” with low glycemicindex (GI), as these can help control blood sugar and weight gain. Examples include pulses, oats, bread, pasta and wholegrains such as quinoa and brown rice.
She also recommends eating regular meals (to stop cravings) and to “eat more protein to keep you full and improve muscle strength.” It’s best to also consume phytoestrogen-rich foods such as soya milk, yoghurt, chickpeas, butter beans and linseed as they may help to lower cholesterol and reduce sweats. “And everyone – whether they’re menopausal or otherwise – should try to eat their 5 a day (five portions of fruit and vegetables) to help reduce heart disease and cancer”, she adds.
You can also download the “My Fitness Pal” app to track your calories and macronutrients. “It helps keep you on track and also has some great meal menus,” adds Ogilvie.
Drink less of these
“Reduce caffeine to one to two cups a day,” says Ogilvie. “Limit alcohol intake to 14 units per week (about six medium glasses of wine). And preferably choose spirits, not wine, as the latter tends to have a lot of hidden calories.”
Hormone Replacement Therapy
To ease symptoms, Ogilvie encourages women to start on HRT in the perimenopause stage in tandem with the suggested lifestyle changes above.
“I had a patient, a 50-year-old executive who’d lost her confidence as she had become very forgetful, her marriage was on the rocks and she felt like she was constantly battling her children. She couldn’t sleep past 4am and had gained a lot of weight due to her ‘comfort eating’. She even talked about ending her life as she felt so miserable,” says Ogilvie, who arranged blood tests that confirmed the woman was menopausal. “She said it was such a relief to know she wasn’t going mad,” adds Ogilvie who started the patient on BHRT immediately. “She was like a new person within two weeks. We worked on her confidence and relationship but she’s now back to public speaking and sees me just once a year for a full follow up.”
There are upsides to Menopause! Yes, really.
“My menopausal clients do report some positives about this time in their lives,” says Dr Sen. “Clearly the cessation of periods is a plus. And many of the symptoms of menopause can be reduced with HRT and scientific breakthroughs, such as CALECIM®’s innovative cosmeceutical skin products. These rejuvenate the skin and stimulate it to behave like younger skin, increasing cell turnover and producing the structural proteins required to restore plumpness and vitality.”
“Many of my clients also share that having spent several decades prioritising the needs of their children, they are now able to invest more of their energy into their own professional and personal development, so menopause can in fact bring about exciting new beginnings for many,” says Dr Sen.
“These women are also more comfortable in their skin, less concerned about the judgement of others and better able to prioritise their lives according to their own personal values, which is a welcome relief after years of pleasing everyone but themselves!”
Ogilvie too, echoes Dr Sen, saying many of her menopausal patients are pleased that they no longer have to deal with periods and use contraception. She also says that menopause is a shared journey that can be made much smoother with the right lifestyle changes and medical support.
“The one piece of advice I’d give all women going on this journey is that you don’t have to do it on your own,” says Ogilvie. “There’s help out there that can change your life – look for an empathetic GP or a private clinic to support you.”
“Ultimately, I consider menopause as a fundamental rite of passage,” says Dr Sen. “Yes, there are some hurdles to negotiate but with the right support and attitude we can conquer it and move forward to become the best-ever version of ourselves.”