You asked, we answered: Your most asked questions about menopause

What is menopause?

An individual is considered to have reached menopause 12 months after their last menstrual period. Menopause is a natural part of ageing, and although there is no "normal" age of menopause, it typically occurs between 45 and 55 years of age, as oestrogen levels decline.

When does menopause start?

In the UK, the average age for menopause to begin is 51, although anywhere between 45 and 55 is completely natural. During the 'natural menopause', an individual's menstrual cycle will stop due to hormonal changes inside the body, most significantly a drop in oestrogen (or estrogen) levels as well as other hormone levels.

The hormone oestrogen is predominantly made in the ovaries and affects each of the key processes involved in a woman's reproductive and sexual health journey. For example, oestrogen levels rise during puberty, peak in the days preceding ovulation to help facilitate pregnancy, and finally drop to trigger the end of a woman's menstrual cycle.

Although rare, 5% of women do undergo natural menopause before the age of 45, known as early menopause, and for 1% of women this will happen before they reach the age of 40. This is known as premature menopause. Early or premature menopause usually occurs when the ovaries underproduce certain hormones, particularly oestrogen.

Can you test to find out if you're going through menopause?

Testing for menopause typically involves assessing hormone levels, specifically follicle-stimulating hormone (FSH) and oestradiol, through a blood test. FSH level testing is generally recommended for younger women experiencing menopausal symptoms to rule out other possible causes, as women approaching the natural menopause age of around 45 are already highly likely to be in the perimenopausal phase. Therefore, menopause is more often confirmed through a woman's age and symptoms, rather than through a blood test.

Early or premature menopause and how do you know if you have it 

How long does menopause usually last?

Menopause symptoms typically last between four and five years, although this does vary. While some women may only have menopausal symptoms for a matter of months, others can continue to experience them for as long as 14 years after menopause begins. Menopausal symptoms during the menopausal transition can vary in severity but often have an impact on an individual's daily life.

Some can have a big impact on a person's quality of life too. Several lifestyle factors, including smoking, race, ethnicity, family history (for example, your mother's age at menopause), and the age at which it began can determine the length of a woman's menopause. Any time after menopause is known as post-menopause. Remember, there are lots of treatment options available for people going through menopause.

What are the symptoms of menopause?

Usually, the first signs of menopause are changes to a person's normal menstrual bleeding pattern. This change represents any sudden shift in a woman's monthly cycle; namely irregular periods (they become more or less frequent) and unusually light or heavy periods, known as irregular bleeding. 

It's important to note that although women can expect changes in their cycles during perimenopause, any vaginal bleeding that occurs after menopause, which is defined as 12 consecutive months without a period, is not a normal symptom. Postmenopausal women experiencing bleeding should contact a healthcare professional to rule out any serious causes.

As well as changes to a woman's monthly periods, there are some common and completely normal perimenopause symptoms that can affect daily life. Remember, there isn't one unifying symptom - each person will experience menopause in their own unique way.

- Changes in skin condition, oiliness or the development of acne

- Hair loss or thinning

- Headaches and migraines

- Joint stiffness, aches, and pains

- Vaginal dryness and astrophic vaginitis (thinning and inflammation of the vaginal wall)

- Recurrent Urinary Tract Infections (UTIs) and urinary incontinence

- Heart palpitations

- Hot flashes or hot flushes (a sudden feeling of heat)

- Night sweats

- Pain during sexual intercourse

- Memory loss

- Brain fog

- Weight gain

- Dry skin and dry mouth

- Joint pain

- Bone loss or loss of bone density

- Sleep disturbances or sleep issues

- High blood pressure

- Reduced blood flow to the genitals

- Breast tenderness

- Racing heart

Emotional symptoms are also common. Increased anxiety, low mood, irritability, reduced sex drive (libido), mood swings or feeling a loss of self are all associated with the menopause.

During menopause, hormonal changes can lead to an increase in body fat, particularly around the abdomen area, as the increase in oestrogen levels can impact metabolism and redistribute fat storage in women. One of the main reasons for this change is that body fat serves as a source of oestrogen production in post-menopausal women. Extra oestrogen can help protect bone health long term, as well as provide many other health benefits.

Each person's experience of menopause will be unique to them. Some will experience severe symptoms, whereas others won't even notice they're going through it. Some people will have some of the more mild symptoms.

The symptoms of menopause and what to expect 

What is a 'hot flush' or 'hot flash' and how to manage them?

Symptoms like hot flushes are very normal to experience at some point during your menopausal period. They are reported to impact 70-80% of people going through menopause.

You may have heard hot flushes described as hot flashes - they're both the same thing and can be used interchangeably.

Hot flushes are brief, periodic increases in body temperature, often described as a sudden unpleasant sensation of intense heat or feeling of warmth. They can occur for many reasons, and are not solely ascribed to menopause. Their exact cause is not fully understood, however they are thought to come on due to changes in the hypothalamus

Your hypothalamus, a structure deep in your brain, acts as your body's smart control coordinating centre. Its main function is to keep your body in a stable state called homeostasis. It does its job by directly influencing your autonomic nervous system or by managing hormones. During perimenopause, it becomes more sensitive to temperature changes due to hormonal fluctuations, causing the dilation of blood vessels and sweating that characterises hot flushes.

Read our guide to hot flushes here

What's the best support and treatment for menopause symptoms?

If your company does not have a menopause policy in place or menopause support through us at Fertifa , we would recommend speaking to your GP about getting treatment and support to help with the symptoms.

Alternatively, talking therapy such as counselling, CBT or even menopause cafes provide a safe space to share menopause experiences, and can be hugely beneficial to mental health at a time when lots of people struggle with their mental health.

Hormone replacement therapy (HRT) is a perfectly safe and effective hormonal treatment which can be used to relieve menopause symptoms. Common menopause symptoms such hot flushes, low libido and night sweats are unpleasant, however HRT can offer both short-term relief and prevent longer -term medical conditions, for example by lowering the risk of osteoporosis.

HRT is available in various forms, including oral tablets, skin patches, gels, creams, and vaginal preparations, offering women different options for managing menopausal symptoms and hormonal imbalances. If you are considering menopausal hormone therapy, please talk to your GP or a health professional.

If you're a Fertifa patient looking to understand more about HRT, get in touch via the app. Our doctors, nurses and menopause specialists can talk you through HRT and give you the necessary medical advice or a prescription if they agree it's suitable for your menopause symptoms. 

By minimising the weakening of bones and stabilising emotions, vitamin D supplements also help relieve symptoms caused by declining oestrogen levels. If you are particularly suffering from urinary incontinence and/or pain during sex, practising Kegel exercises will help strengthen your pelvic floor muscles and can help tackle these symptoms.

According to NHS guidance and the guidance of our in-house clinical team (led by Dr. Gidon Lieberman), the risks of Hormone Therapy are minimal, with a minor increase to the risk of breast cancer, blood clots or heart disease (cardiovascular disease) following hormone therapy. If there is a history of breast cancer in your family and you are concerned, be sure to speak to your doctor for reassurance and next steps.

You can read our guide to HRT here.

Alternative therapies, or non-hormonal treatments, for menopause can also be used to alleviate symptoms like hot flushes and night sweats.

Herbal remedies like black cohosh or St. John's wort are great, as well as daily vitamin supplements such as vitamin D. By minimising the weakening of bones and stabilising emotions, vitamin D supplements help relieve symptoms caused by declining oestrogen levels.

These are all over-the-counter medications meaning you don't need a prescription - they can be purchased straight away from your local pharmacy. If you are particularly suffering from urinary incontinence and/or pain during sex, practising Kegel exercises will help strengthen your pelvic floor muscles and can help tackle these symptoms.

Monitoring alcohol consumption is another important way to minimise perimenopausal symptoms. Alcohol can disrupt hormone balance, potentially worsening menopausal symptoms such as hot flushes and mood swings. Excessive alcohol consumption can affect bone health and increase the risk of fracture. Menopausal women often struggle with sleep disturbances, and alcohol can worsen this issue. While alcohol consumption may help some individuals fall asleep initially, it can disrupt the later stages of sleep and lead to more awakenings during the night, impacting overall sleep quality.

Maintaining a healthy lifestyle during menopause is crucial for managing symptoms, supporting overall health, and reducing the risk of age-related conditions.

Here are the key factors to consider:

- Maintaining a healthy diet (see here for advice on how to maintain a balanced diet) specifically focusing on phytoestrogen-rich foods. Foods like soy, flaxseeds, chickpeas, and lentils can offer potential relief of menopausal symptoms.

- Regular exercise and physical activity - Moderate caffeine and alcohol consumption

Every person's menopause journey will be different, but with the right knowledge and support people can navigate this transition with confidence. It's time to talk about it openly and break down those barriers. Through Fertifa's in-house clinical team, we support your employees with ongoing care throughout their menopause and perimenopause journeys.

If you want to know more about the different ways Fertifa can provide menopause support to employees, please don't hesitate to book in a call with our team below 💜