What you need to know about menopause and its symptoms
As part of our regular Lunch & Learn webinar series, Henpicked was joined by Dr Dawn Harper, an NHS GP who many of us know from the Channel 4 programme Embarrassing Bodies. We asked her some of the most common questions women ask us about menopause, and her answers were fascinating and informative.
Menopause and its symptoms
Henpicked: When it comes to menopausal symptoms, everyone recognises hot flushes. But it’s much more than that, isn’t it?
Dr Dawn Harper: Absolutely. And you’re completely right. If I walked down a street and asked the first 100 people I met what they thought the symptoms of menopause were, the majority would come up with hot flushes, night sweats and probably mood swings. But menopause is an incredibly personal journey, very different for different women.
I’ve got three children and had three very different experiences of hormonal changes during each pregnancy. In exactly the same way, menopause is very personal. Yes, women can experience things like night sweats, hot flushes, mood and sleep disturbances. But I also see women terribly upset by thinning hair, for example. For many of us, feeling you’re losing your hair can be very distressing.
Henpicked: Interesting that you say that about hair, we’ve had quite a few questions about this lately. Is this something women can speak to their GP about?
Dr Dawn Harper: Women are often really apologetic. They so often say “I shouldn’t bother you about this, it’s silly”, but of course it’s not. It can have a massive impact on self esteem and cause real distress. Knowing you’re not on your own is actually really important.
I love the fact we’re exploring some of the less common symptoms of menopause and I’d like to give women a little tip. I know that sometimes people get offended when a doctor’s receptionist ask why they want to see or speak to the doctor. But they’re not being nosey. They’re trying to make sure you navigate through the practice in the best way and see most appropriate person. By definition as GPs we are generalists but we do have our own areas of expertise. It might mean waiting a few weeks to get an appointment and I get that’s frustrating. Usually by the time a woman is ready to make the appointment, they want it yesterday, they’ve got to crisis point.
And it’s only human nature and the idea of having to wait can be frustrating but it’s probably worth doing.
Henpicked: We tend to wait until we’re absolutely desperate. Lots of women perhaps don’t realise there’s a lot more they can do?
Dr Dawn Harper: Indeed. And a lot of women going through menopause will be going through a time of life full of all sorts of stresses and strains. Perhaps being a parent, holding down a career, looking after their own parents, it’s a lot of juggling. Our needs end up at the bottom of a long list.
I’d like to say to people struggling, it’s not selfish to ask for help. You need some way out, you’ll be a better mum if you are one, a better partner, a better friend, a better colleague. It can have a massive impact on our lives, so it’s not selfish to find a little bit of time to explore how to make things better for you.
Henpicked: When you consider that 3 in 4 women will experience symptoms at some time, 1 in 4 serious symptoms, it’s clear these can have a real impact.
Dr Dawn Harper: Massively and I think some women think they’re going nuts or are becoming depressed, and a lot of this is down to the psychological symptoms.
Henpicked: Is there a way to diagnose menopause?
Dr Dawn Harper: I really understand why women ask this. I see a lot of women who say “I need a blood test to see where I am”. But over the age of 45 a blood test is really unreliable, because the test we do is for something called FSH – Follicle Stimulating Hormone – produced by your brain, that drives your ovaries.
Our reaction to hormones is actually a reaction to changing hormones, and these fluctuate a lot. I could take a blood test from a lady struggling with perimenopausal symptoms four times a day every day for a week, and get 28 different readings. Some of which would make me think you’re going through the change, others wouldn’t. In fact, a blood test is most reliable at telling us you’ve gone through the change.
The average age of menopause in UK is 51. For anyone aged between 45-55 with the kind of symptoms we’ve talked about, a blood test won’t make a difference. In general, if you’re showing menopausal symptoms in those years you’re menopausal until proven otherwise.
Under 45 is early menopause, while under 40 is premature menopause, and we do use blood tests in younger women.
Henpicked: At Henpicked we encourage women to keep a diary of their symptoms, what’s changing in their period, do the reading up and think about what their options might be and what they want to do. Is this something you’d recommend?
Dr Dawn Harper: Yes, I couldn’t recommend that strongly enough. I’ve already said you may have to wait a little longer to see the doctor in the practice with the most experience with this issue. Turn this into a positive. Sit back and have a think. What makes your symptoms worse or better? What’s happening to your periods? Perhaps talk to your family, as when you go through menopause does have a genetic link.
In an appointment, there’s not a lot of time for you to explain everything. Write everything down, including any questions you’d like to ask. Your GP might have to ask you what’s the priority for you now, and book you in to deal with the rest another time. Also, you can take somebody with you if you want to. All sorts of studies have shown that most of us retain about 20% of information we’re given in an appointment.
So basically if you take somebody else, maybe they can make notes, or they might remember a different 20%. More often than not, the other person will say now “come on, you’re putting a brave face on it and it’s much worse!”
Henpicked: Another big question, when do symptoms start and when do they end?
Dr Dawn Harper: Strictly speaking menopause means meno – periods, pause – stop. So if we’re being scientific about it menopause can only be diagnosed retrospectively. What usually happens is periods become lighter, heavier, go a bit awol. The average age for periods to stop completely is 51. The symptoms we’re talking about here are the perimenopause, the run up to menopause.
Another thing to flag up is that sometimes we have to remove women’s ovaries for clinical reasons, and this plunges you straight into surgical menopause. If you have your womb removed – a hysterectomy – a lot of women will opt to keep their ovaries. There’s good evidence that those who opt to do this tend to have an earlier menopause than those who have still got their womb intact.
I can’t say it enough. Women’s experience of menopause is incredibly individual, so duration of symptoms is very variable. I see women who are symptomatic then they get bit better, then out of the blue they get symptoms again. Some suffer for weeks and months, others for several years, others not at all.
Henpicked: Given that many of us have seen you on Embarrassing Bodies, what symptoms would you say women are most embarrassed about?
Dr Dawn Harper: There’s no doubt that women are getting much better at talking about their symptoms. But the two which they don’t tend to like discussing are vaginal dryness and incontinence. Around half of menopausal or post menopausal women suffer from dryness.
I’ve seen relationships fall apart as women are avoiding sex because it’s painful, and then avoiding intimacy in case it leads to sex. But these are relatively easy symptoms to treat. Please don’t suffer in silence. And please don’t be embarrassed. Your GP has seen everything and more!
Henpicked: There’s a general ‘dryness’ theme to questions we’re often asked – dry mouth, skin, eyes. What can women do?
Dr Dawn Harper: A dry mouth is very unpleasant. There are artificial saliva sprays to try. Also, as saliva is produced by chewing, chewing sugar free gum can help saliva production. If you’re on any medicines have a chat with your GP, as several prescription medicines can dry the mouth. Please don’t just stop taking anything.
And I’m a huge fan of our pharmacists. Most have a private consulting room, they’re open longer hours than your GP and you don’t need an appointment. They’re hugely knowledgable individuals.
Indeed, for symptoms of dryness your pharmacist might be a better first port of call than a GP and easier and more accessible to see.
Henpicked: Lots of women don’t know if they should go onto HRT. What would you tell them?
Dr Dawn Harper: Scary and inaccurate headlines put many women off HRT. Like any medicine it has risks and benefits. My overriding message is pick up the phone, ask in the practice who you should see and have the conversation. There are lots of types of HRT. I liken it to choosing a little black dress. What is going to look a million dollars on one won’t cut it on another. HRT is very personal and I’m a firm believer it should be an informed and joint decision made between you and your GP.
Henpicked: Sleep is something we also hear affects a lot of women.
Dr Dawn Harper: HRT can sometimes help with sleep issues. Even if you decide against HRT there are lots of things you can do. Definitely cotton sheets, make sure your room isn’t overheated, wear layers you can remove. Also, avoid caffeine after midday. People often avoid it after 6pm, but it takes eight hours for half the caffeine to leave your body so if you’re having coffee at 4pm you’ll still have half in your body at midnight.
Don’t rely on alcohol. It’s easy to have a glass of wine or two to help you sleep, but this interrupts your natural sleep rhythms. Avoid phones in your rooms. Instead, take a pad and pen upstairs and write down anything that’s buzzing through your brain. This helps get it out of your mental in-tray.
Exposure to light tells the brain to get awake but often the last thing we do is go into neon-lit bathroom! Go for low lighting in your bathroom, and if you can, invest in blackout curtains and blinds.