Expect the unexpected: An expert guide to the menopause

Experiences which vary from person to person along with embarrassment about discussing symptoms can mean that women yet to go through the menopause are unsure of what to expect. In this expert look at the menopause, highly esteemed consultant gynaecologist and fertility specialist Mr Gidon Lieberman discusses common symptoms and the causes behind them. The leading specialist also outlines the relationship between weight gain and the menopause.

What can women expect from the menopause?

No two women will have the same symptoms during the menopause and their experience is affected by lots of factors including internal changes, relating to a fall in hormone levels, as well as external pressures.

The journey through menopause is shaped by internal changes but also by the wider world: work, families, friendships can all make a difference to how you feel. We also know that different societies and cultures view menopause differently so women’s’ experiences vary widely.

Relating to symptoms, some women will not have any particular issues whilst others will have their lives devastated by the menopause. Time and time again, I hear how the menopause can have a profound change to a women’s quality of life, impacting heavily on themselves, families and careers.

Why does a fall in hormones cause symptoms?

Hormones are biological emails that go from one organ to another. Without the email service, many bodily functions don’t work as they should and so lead to symptoms.

The fact that there are so many symptoms associated with the menopause shows that these hormones have an impact on many locations in the body. Bones, blood vessels, skin and the brain are only some of the tissues that interact with hormones.

What are the typical symptoms of the menopause and how do they affect women?

The lack of hormonal messaging leads to all of the biological menopausal symptoms women experience - from hot flushes to bone weakness and so on. Hot flushes can be at the very least uncomfortable and embarrassing while night heat and sweats can lead to sleeplessness and brain fog and concentration issues which can have a disastrous knock on effect on family life and the working day.

Headaches and the recurrence of migraines are also frequent. Many women who have menopause associated headaches will have also experienced headaches during their periods when they were younger. Oestrogen receptors are present in the brain, so we should not be surprised that brain fog and concentration problems occur.

It is unclear why these higher function problems are more common in some women than others. However, it is evident that the financial cost of brain fog and concentration problems is high and I will often hear that HRT, or hormone replacement therapy, is a necessity for some women to continue working. Without hormonal support, many women feel unable to work to the same level as they did before their symptoms started.

Skin and hair condition is not improved by the menopause and joint aches and pains are also frequently voiced concerns. Joint discomfort can occur quite early on in the menopause and thankfully is not necessarily an indication of bone weakening.

The vulva, vaginal walls, bladder and urethra (the pipe which takes urine from the bladder) are known as the lower genital tract. These structures, together with their supporting tissues, are very sensitive to oestrogen and so it is not surprising that problems begin in this area with the fall in hormones that accompany the menopause.

Bladder issues and vaginal dryness are very frequent although they are not widely discussed. Vaginal dryness leads to discomfort during sex. This can lead to issues in relationships which are often already a little strained during the menopause. Fortunately, vaginal dryness can be treated with vaginal creams or pessaries to good effect. Bladder problems can be trickier to treat but can definitely be improved by a combination of lifestyle changes, pelvic floor exercises and in some cases, medication.

Additionally, loss of libido often comes hand in hand with the menopause. There are many reasons for this including a fall in hormone levels and changes in relationships and within families. Although testosterone medication can help, we believe that psychological support is just as vital in addressing problems with intimacy and sex.

What is the relationship between the menopause and weight gain?

One symptom of the menopause which is very common is changes in weight and body shape. Additionally, many women are worried about weight gain if they start HRT. It seems to be a no-win situation, in that women are aware of increasing weight during the menopause and HRT causing further weight issues seems to add insult to injury.

Nobody (including myself!) really likes to take on a couple of home-truths about weight change and body shape, but we have to accept them. If we eat more energy than we burn (through daily activities and exercise) then the body will store the energy as fat. Also, as we get older our bodies change shape. It's not nice to hear, but it’s true.

Although it’s true that falls in hormone levels affect our weight, they are only part of the picture. Rather than attributing all of the blame for weight gain to hormones, it's important to look at your life as a whole.

If you are struggling with symptoms of the menopause and wish to discuss your treatment options, don’t hesitate to book a consultation with Mr Lieberman by visiting his Top Doctors profile.