Menopause
Menopause is usually described as a single moment, but it is lived as a stretch of years in which the cycle loses its order and the body changes long before…
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Medicines commonly prescribed for Menopause
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: CAPSULE, 90 mgActive substance: duloxetineManufacturer: Esteve Pharmaceuticals S.A.Prescription requiredDosage form: CAPSULE, 30 mgActive substance: duloxetineManufacturer: Laboratorios Cinfa S.A.Prescription requiredDosage form: CAPSULE, 30 mgActive substance: duloxetineManufacturer: Laboratorios Combix S.L.U.Prescription required
Menopause is usually described as a single moment, but it is lived as a stretch of years in which the cycle loses its order and the body changes long before the last period. Most of the difficulty falls into exactly those years, and almost all of it can be managed: some of it with hormones, some with sleep, exercise and conversation, and some simply stops being frightening once you understand where it comes from.
What is actually happening
The store of follicles in the ovaries is spent throughout life, and by the fifties there is almost nothing left. The ovaries respond less and less to signals from the pituitary, and oestrogen production falls not in a smooth line but in jumps. Hence the defining feature of these years: how you feel changes from one day to the next.
Perimenopause is the time when symptoms are already there but periods still come, if no longer to a timetable. It can last several years. Menopause itself is the final period, and it is recognised in hindsight, once twelve months have gone by without bleeding. For most women this falls between the ages of 45 and 55.
Menopause can also be brought on. After the ovaries are removed it arrives at once and is harder to bear, because the hormones vanish in a day rather than over years. Chemotherapy and radiotherapy to the pelvis do the same. Removing the womb alone, with the ovaries left in place, does not cause menopause: periods stop, but the hormones carry on being made.
While periods have not stopped for good, pregnancy is still possible, and at this age the cycle is deceptive. Contraception is continued for a further year after the last period if it came after the age of fifty, and for two years if it came earlier. Combined hormonal pills are usually swapped for another method from the fifties onwards.
What it feels like
The rhythm is usually the first thing to change: the gaps shorten or stretch out, and bleeding turns scanty one month and heavy the next.
- hot flushes, a sudden wave of heat over the face, neck and chest, sometimes with a racing heart and sweating, lasting from seconds to minutes;
- night sweats and broken sleep, followed by daytime exhaustion and short temper;
- anxiety, low mood, abrupt swings of temper, brain fog and forgetfulness;
- aching joints and muscles, and headaches worse than the ones you were used to;
- vaginal dryness and itching, pain with sex, urinary urgency and repeated urine infections;
- dry skin, thinning hair, lower sex drive and a shift in where weight settles.
The mix differs from woman to woman: some notice nothing beyond the periods stopping, others count twenty flushes a day. Flushes and sweats last a few years on average and fade of their own accord. Vaginal dryness and discomfort, by contrast, do not settle on their own and get worse over time without treatment; it is the one group of symptoms there is no point in waiting out.
What must not be put down to menopause
Some things at this age look like menopause without being it, and here a mistake is expensive.
Bleeding after a year with no periods. Any bleeding, even once, even a smear. Until proved otherwise it means cancer of the womb lining has to be ruled out, a disease that is treated well when caught early and badly when caught late. Book an appointment within days rather than putting it off: an ultrasound scan measuring the thickness of the lining, and a biopsy if needed.
Periods stopping before the age of forty. This is premature ovarian insufficiency, and it affects roughly one woman in a hundred. It is always confirmed with blood tests, because losing oestrogen early means not only flushes but faster loss of bone and earlier heart and vessel disease. For these women hormone treatment is not a matter of comfort but replacement of what is missing, at least until the usual age of menopause.
See a doctor soon as well for heavy bleeding with clots, bleeding after sex, bleeding between cycles, or bleeding that returns or refuses to stop while on hormone treatment. Separately and urgently: sudden pain and swelling in one leg, sudden breathlessness or chest pain while taking oestrogen, since that is how a clot announces itself; in that case call an ambulance on the single European number 112.
How it is confirmed
Past the age of forty-five, with a typical picture, no tests are needed at all: the diagnosis rests on age, on the changed cycle and on the symptoms. Hormone levels swing so widely in these years that a single reading means almost nothing and can only mislead.
A blood test for follicle-stimulating hormone is worth doing if periods stopped before forty-five, and is essential if they stopped before forty; in that case it is repeated a few weeks later. Hormonal contraception distorts the picture: with combined preparations the test is meaningless, and the question has to be settled another way.
Other conditions can imitate menopause, so with an atypical picture the thyroid, the haemoglobin and the blood glucose are checked, and pregnancy is excluded if it remains possible. Anxiety and depression produce the same insomnia and the same scattered attention and need treatment of their own.
Along the way it is worth recording what is better known in advance: blood pressure, the lipid profile, weight and, where there are risk factors, bone density. After menopause the risk of fractures and of heart and vessel events goes up.
What helps without a prescription
Simple measures do not replace medicines, but a fair number of women need nothing more.
- layered clothing, a cool bedroom, cold water and a fan within reach when a flush arrives;
- working out your own triggers, most often alcohol, coffee, spicy food, hot drinks and stuffy rooms;
- regular exercise: walking, running or dancing for the bones, plus resistance work for muscle, which also improves sleep and mood;
- a fixed bedtime, with no screens and no alcohol before it;
- enough calcium in the diet and vitamin D, particularly where there is little sun;
- stopping smoking, which brings menopause forward and makes flushes worse;
- vaginal moisturisers used on a regular schedule and a lubricant for sex; with condoms, water-based products only.
Cognitive behavioural therapy has proven value against flushes, insomnia and anxiety: it does not stop the wave of heat, but it markedly reduces how much that wave interferes with life. Herbal remedies do little: red clover has no convincing evidence behind it, and black cohosh has rare reports of liver injury. So-called bioidentical hormones made to order by a compounding pharmacy are not recommended at all, because nobody checks their content or their doses.
Hormone treatment
This is the most effective thing there is for flushes and sweats, which usually ease within a few weeks. Sleep, mood and joint aching improve alongside, and the bones gain protection against thinning.
The backbone is oestrogen as a patch, gel, spray or tablet. If the womb is still in place a progestogen is always added, otherwise the lining of the womb overgrows. The progestogen comes as tablets, as part of a combined patch, or as an intrauterine system, which settles contraception at the same time.
The route matters: oestrogen through the skin has almost no effect on blood clotting, whereas tablets raise that risk slightly. So with migraine, excess weight, high blood pressure or a family history of clots, skin preparations are usually chosen.
The risks are small, but they are real. Combined treatment taken long term slightly raises the chance of breast cancer, the excess grows with years of use and falls away after stopping. Starting in the first years after menopause is better tolerated than starting a decade later. It is not prescribed after breast cancer, in the face of unexplained bleeding from the womb until the cause is known, during an active clot, or with severe liver disease.
The first review is usually at three months and yearly after that: whether the dose is working, whether there is bleeding or side effects, blood pressure and weight. There is no rigid maximum length of use. And it is worth remembering that hormone treatment is not contraception.
If hormones are not an option
They do not suit everyone, and some women simply do not want them. There are choices in that case too.
Vaginal oestrogen, as pessaries, cream or a ring, stands apart: it works where it is placed, barely enters the bloodstream, and is therefore permitted far more widely than treatment taken by mouth or patch. It clears dryness and pain with sex, helps with urinary urgency and cuts down repeated urine infections. It can be used for years, but the symptoms return once it is stopped.
Against flushes, certain antidepressants help, as does an anticonvulsant from the gabapentinoid group and the old blood pressure drug clonidine; in several countries non-hormonal medicines that act directly on the brain's temperature centre are now available. The choice belongs to a doctor, since tolerance and interactions with other medicines differ from person to person.
Where sex drive stays low and does not recover on oestrogen, a specialist may add testosterone in a small dose. In most countries its use in women falls outside the licensed indications, so it is prescribed by a doctor familiar with the practice; the commonest side effects are acne and unwanted hair growth.
Online consultation
The format suits this subject particularly well: what needs discussing is sleep, mood, sex and bleeding, and there is usually nothing to examine. Before the appointment it helps to prepare a calendar of the last six months of periods, a list of every medicine and contraceptive you use, recent blood pressure readings, and a clear sense of what bothers you most, since the choice of treatment turns on that.
A remote appointment can work out whether the picture fits perimenopause or another cause needs looking for, whether blood tests are worth doing, weigh the benefits and risks of hormone treatment in your particular situation, tell a normal reaction to a new dose from a reason to change it, and set up the measures that need no prescription. The limits are plain: an examination, a scan and a biopsy cannot be done through a screen, and any bleeding after a year without periods calls for a face-to-face appointment within days rather than a conversation.
This material is for information only and does not replace medical advice.
Consult with a doctor about Menopause
Discuss your symptoms and possible next steps with a doctor online.
Online doctors for Menopause
Discuss your symptoms and possible next steps for Menopause with a doctor online.
