Our ultimate guide to the menopause - symptoms, self-help and treatment

Given the array of symptoms that can be experienced before, during, and after the menopause, from hot flushes and night sweats to heightened anxiety, joint pain and memory loss, it’s little wonder that in a British Menopause Society survey, three quarters of women* in the United Kingdom say that the menopause has caused them to change their life and more than half say it has had a negative impact on their lives, both at home and at work**.¹

So it can be a huge deal and not one that women, their families or their employers can shy away from. But it’s not something to live in fear of either. For those who do experience symptoms (which we’ll come to), while they can be unpleasant at times – there are treatments available, lifestyle changes you can make, and support you can access to help you through it. And if you find you’re really struggling, there’s the knowledge that the menopause is NOT the beginning of the end as was once thought. It’s a life stage that WILL pass and, for most women, give way to many happy and fulfilling years to come.

Here we give you the lowdown on the menopause, from what it means and how it may manifest itself, to the treatments available, plus a whole host of tips to help you through it.

* Either currently experiencing menopausal symptoms OR have experienced menopausal symptoms within the last ten years.

** Those whose menopause symptoms strongly affected their life.

The menopause explained

Menopause refers to the time when a woman’s ovaries are no longer producing eggs and her periods have stopped. Officially it is said to have occurred 12 months after she has had her last period. Women may begin to experience symptoms in the run up to the menopause, during what's known as the perimenopausal period. They are caused by changes to hormone levels, as the ovaries start to produce fewer eggs and secrete fluctuating and lowering amounts of the female sex hormone, oestrogen.

The average age when menopause occurs is around 51 years of age, but it’s worth bearing in mind that the menopause can begin both before and after 51 years, typically at any time between the ages of 45-55. If menopause happens before the age of 45 it’s referred to as an early menopause, and in these scenarios it sometimes needs quite specific management, depending on how young a person is, to help mitigate the loss of oestrogen from the body.

Regardless as to when menopause occurs, the processes involved in the run up to this point, and the symptoms that can be experienced before, during, and after menopause vary dramatically from person to person: they can cause significant emotional and physical upheaval in some women, while others will have very few symptoms at all. 

Menopause signs and symptoms

Listed below are some common symptoms experienced by women during the menopause:

• Hot flushes
• Night sweats
• Sleeplessness
• Vaginal dryness
• Loss of interest in sex
• Mood swings, low mood, anxiety
• Joint pains 
• Memory loss and poor concentration
• Formication - a sensation of itchiness or insects crawling on the skin
• More frequent urinary infections, urinary incontinence.

The number and frequency of symptoms vary hugely amongst women, as does the impact, duration and severity.

All the common symptoms of the menopause are associated with a decrease in the body’s production of oestrogen. Reduced levels of this hormone can affect many parts of the body, including the brain, causing changes in emotional well-being, and the skin, which gets thinner, loses elasticity and, together with your hair, can become dry. Other effects include the drying and thinning of vaginal tissue.

Other health considerations of the menopause

Once the ovaries have stopped producing oestrogen other changes take place, which may have more of an effect on long-term health. Most commonly these changes affect the strength and density of bones, increasing the risk of the bone-thinning disease osteoporosis. The bones of the female skeleton depend on oestrogen to maintain their strength and resistance to fracture. However, while other signs of depleted oestrogen, such as hot flushes or vaginal dryness are apparent, osteoporosis has no obvious symptoms – the first sign is usually the fracture of a bone. It’s for this reason that osteoporosis has been called “the silent epidemic”. Our article on osteoporosis and bone health takes a more in depth look at this common condition and what you can do to help build stronger bones throughout your lifetime.

There is also evidence that oestrogen deficiency is the cause of some chemical changes in the body, which can make post-menopausal women vulnerable to heart disease and stroke as the protective effect of oestrogen is lost.²

Help is available

The good news is that there is help available, and having a chat with your GP or a menopause specialist can be a good first step to take. There are also plenty of things you can do for yourself to help improve your long term future health and quality of life in later years.

A healthy lifestyle can minimise the effects of the menopause, helping to keep the heart and bones strong, and many women feel that this is a good time to review how they look after their health. Here, Nikki shares her tips on how to manage your symptoms and continue to live life to the full, through this transitional period and long after the menopause has become a distant memory!

Lifestyle tips – self help for menopause

1. Consider your diet. The fall in oestrogen levels that accompanies the menopause can increase the risk of heart disease and osteoporosis. A healthy diet is essential at this stage: try to keep it low in saturated fat and salt to reduce blood pressure, and rich in calcium and vitamin D to strengthen bones. Some women take dietary supplements to help get the balance right. Our article on Women’s vitamins, minerals and supplements may help you decide is this is something for you to consider.
   
   
2. Stay active. Some women experience increased anxiety during the menopause. Regular exercise helps to convert stress into positive energy, while guarding against heart disease. It also helps us to maintain bone mass. A regular, varied programme is best: try cycling, swimming, strength training, running or aerobics. Take a look at our article on fitting change into your lifestyle for help getting started, or why not have a browse through our exercise and fitness hub for lots more information, tips and inspiration to get you moving more, and keep you motivated along the way.
   
   
3. Stop smoking. Smoking has been shown to lead to an earlier menopause and trigger hot flushes. If you smoke you also run a higher risk of developing osteoporosis and coronary heart disease (CHD), which is a leading cause of death in women.  See our article on quitting smoking for more information and support, should you choose to give up.
   
   
4. Limit alcohol. Alcohol increases hot flushes and is associated with an increased risk of breast cancer, so try not to drink more than 2 to 3 units of alcohol per day, and keep at least one day a week alcohol-free. Our article How much is too much alcohol contains some practical tips to help you cut down.
   
   
5. Make use of health screening services. Studies have shown that a late menopause (menopause that occurs after the age of around 55) can lead to an increased risk of breast cancer. The NHS offers screening, but you should also keep a check on any changes in your breasts, and seek advice if here’s anything that concerns you. Our article, Breast cancer symptoms and signs, explains what to look out for and how to check yourself.
   
   AXA Health membership includes FREE fast track access to cancer screening and diagnostic services for breast and other common cancers without the need to visit your GP, provided certain criteria are met. So if you’re worried, simply call our customer service centre on 0800 132 203 to check your eligibility and you could be seen within a matter of days. Non-members can pay to access the same screening services by going direct to Breast Health UK, part of the Check4Cancer group.
   
   
6. Find ways to calm the mind and remain positive. Hormone imbalance during the menopause can result in added stress and even depression. Relaxation techniques, such as mindfulness, and counselling can be very helpful in coping with anxiety and try to make time to do something you enjoy, this is a time when it’s particularly important to practice self-care. For more ways to de-stress, manage anxiety and generally look after your mental health, visit our mental health hub.

It’s good to talk

If you’re an AXA Health member you can speak to one of our nurses, pharmacists or counsellors, all with experience in supporting individuals through this period, via our telephone information and support service, Health at Hand. Nurses and counsellors are available around the clock, 365 days a year so there’s always someone at the end of the phone if you need to talk. Pharmacists are available 8am–8pm Monday to Friday, 8am-4pm Saturdays and 8am-12pm Sundays if you’d like help with medication. Non-healthcare members can also access support though our Ask the Expert service – simply submit your query online and an appropriate member of the team will respond when they become available.

Menopause treatments

Hormone Replacement Therapy

Hormone replacement therapy (HRT) is the most effective and widely used treatment for menopausal symptoms. As its name suggests, it’s simply a way of replacing the hormone oestrogen that’s lost during the menopause.

HRT aims to relieve those symptoms related to oestrogen deficiency, such as hot flushes, vaginal dryness and osteoporosis. The benefits of HRT as a remedy for hot flushes, sleep disturbances, vaginal symptoms and some mood disorders have been proved. Some women experience unwanted side effects when taking HRT for the first time. These may include breast tenderness, leg cramps, nausea, bloating, irritability and depression. Usually these symptoms resolve after a few months, but a change in route/type (oral/tablet, transdermal/patch or gel) or dose of HRT may be required to find a combination that’s right for you.

Although there have been concerns raised about HRT and the potential risks to various aspects of women’s health, the latest evidence – as reflected in current clinical guidelines – shows that although not entirely risk-free, HRT remains the most effective solution for the relief of menopausal symptoms and is also effective for the prevention of osteoporosis. It may also provide protection against heart disease in certain age groups.⁴

For anyone thinking about starting HRT, the recommendation is to discuss the benefits and risks of HRT with your GP on an individual basis. Overall, the balance of benefit to harm always needs to be assessed, but appears to have shifted favourably for HRT as we gather more evidence. Women using or hoping to use HRT can usually be reassured, provided:

• HRT is taken for the correct reasons, i.e. to alleviate the symptoms of the menopause. 
• HRT is taken for only as long as necessary - usually up to five years is considered safest at the lowest effective dose.
• HRT users are assessed by their GP at least once a year.

If you’re thinking of starting HRT and you still have your uterus you will be given progesterone alongside your oestrogen therapy to prevent the lining of your uterus from thickening and potentially becoming malignant. By adding progesterone this risk is negated. The progesterone can be given either continuously or cyclically. 

If women start HRT around the time of menopause the associated risks are very small, however there is only limited data for continued usage beyond the age of 60. It is not usually appropriate for women over 60 to be starting HRT. As a large Womens Health Initiative study showed, the risks are increased, but this does not mean that women who started HRT earlier should have to stop it on reaching 60.⁴ 

Bio-identical HRT

In recent years, practitioners in some areas have begun to prescribe bio-identical hormones for relief of menopausal symptoms. These are man-made hormones, usually of plant origin and designed to be identical to those produced naturally by the body. They are available as creams, lozenges, gels and vaginal preparations. They frequently contain a mix of several differing types of oestrogen, progesterone and other sex hormones produced by the body, however there are currently no long-term studies that have been performed on these preparations to look at efficacy and risk. They are not regulated by the MHRA and are marketed as natural products. This means they haven’t been through the rigorous process of drug development, which conventional medicines and products usually undergo and therefore haven’t been scientifically evaluated in clinical trials for effectiveness and safety.

Complementary and alternative therapies

These have become a popular choice and many women use them, although limited scientific research has been done to support their effect or safety. They may sometimes help with troublesome symptoms, but are unlikely to have a significant impact on bone strength, the heart or blood vessels.

Choosing a complementary or alternative therapy can be a challenge as there are so many. Acupuncture, aromatherapy, herbal treatments, homeopathy, hypnotherapy, yoga and reflexology have all been reported as being helpful during menopause. Use of vaginal lubricants can also help to overcome vaginal dryness and soreness in some women.

Black cohosh and red clover extract have been found to be effective in helping to relieve certain menopausal symptoms and unlike some other supplements, have been subjected to research trials.⁶ In the case of red clover extract, it does need to be taken for six to nine months before it’s full effectiveness can be felt, so you need to be patient, but it can be worthwhile persisting with.

As with any dietary supplements, you should always consult your GP before taking them to make sure they’re safe for you.

Key takeaways

• Menopausal women may feel overwhelmed with the type of symptoms they experience leading up to and during the menopause, but it’s also a time that can inspire us to make positive changes for a healthy and productive future.  If you’re going through the menopause, take time to do something that makes you happy every day, even if it’s only for ten minutes. Read, dance, listen to your favourite music, speak to a friend or go for a run – whatever it is that lifts your mood, make sure to schedule it in.
• If your you-time involves getting active, try to also factor in time out for relaxation, whatever form it takes - yoga, meditation, walking in the countryside or taking a relaxing bath, these all help to reinforce your mental health.
• Nutrition: revisit your dietary habits. Try to eat a low saturated fat, low salt diet and plan on incorporating healthy foods, such as fresh fruit and vegetables, lean fish, poultry and meat, seeds, nuts and healthy fibre. Make sure to include extra vitamin D, found in oily and fatty fish, cheese, egg yolks and foods fortified with vitamin D. Also include foods rich in calcium to help maintain healthy bones. These include dairy products, green leafy vegetables, soy beans and tofu. The last two foods are also phytoestrogens, which are plants that have some oestrogenic effects in the body.
• Exercise: aim to have at least 150 minutes of aerobic exercise a week. This could include swimming, cycling, running, dancing or an exercise class. Remember that it’s important to find an activity you enjoy so it doesn’t feel like a chore. And also try to incorporate weekly strength training into your activity, to help build bone strength and keep muscles healthy.
• If you’re battling with your symptoms, start to keep a symptom diary and make a note each day of how you’re feeling, scoring any symptoms according to how bad you’re finding them. This can help form the basis of a chat with your GP or menopause specialist to discuss your symptoms and look at ways these can be managed and treated.
• Although mood changes are common with the menopause, if you find that the self-care techniques discussed in this article aren’t enough to lift your mood or help manage your anxiety and you prefer not to, or aren’t able to take HRT, don’t be afraid to ask for help through counselling or therapy and also from your GP.
• Read up about the menopause and its management as much as possible. Being well-informed helps put you in control of what’s happening to you, and speak to your GP about any symptoms that are affecting you badly.
• If hot flushes are a particular problem, try to keep cool sheets on the bed with a blanket to hand for when the flush has stopped. Wearing natural fibres, like linen and cotton, can help you stay cool. Hand held and desk fans in your environment can also be invaluable, as can carrying a cooling facial mist spray when you’re out and about.
• Energy can dip at this time, due to sleeplessness resulting from menopause symptoms, as well as other changes caused by the menopause itself. Take time for a nap when you can andtry to build in time to relax and recharge if possible. Our article on how to fight fatigue and boost your energy contains more information and tips you may find useful.
• Skin: you may notice your skin becoming drier and thinner during and after the menopause - this is usually due to a loss of elasticity and collagen, caused by low oestrogen levels. Try to treat your skin to daily moisturising face and body creams or lotions, to help nourish and support your skin’s elasticity and reduce dryness.
• Above all else don’t be afraid to talk about what is happening to you, whether it’s with your partner, your GP, employer, a trusted friend or a group of friends, or via the online resources and forums available to you, including your EAP (Employee Assistance Programme), if you have one. Asking for support and sharing your experience with others can be powerful steps towards managing your symptoms and coming out the other side stronger, healthier, more positive and better equipped to live your life to the full, for many more years to come. 

Further information

You may find these articles and other AXA Health resources helpful:

Fit more activity into your lifestyle

How to fight fatigue and boost your energy

Managing the menopause

Osteoporosis and bone health

Mental health hub

The following resources are available for more news, information and support for those experiencing, or affected by, menopause:

Menopause matters – an independent website providing up-to-date, accurate information about the menopause, menopausal symptoms and treatment options. Additional support includes fitness routines, tailored for the menopause. a forum to enable you to connect with others and free quarterly newsletter.

Menopause support – a patient expert led not for profit organisation that aims to provide every woman with access to factual, evidence based, non-biased information, education, advice and emotional support to empower them to take control of their health and well-being during menopause and beyond. 1-2-1 support is also available (at a cost) via telephone and video call, or connect with others through closed Facebook group the Menopause Support Network.

Women’s health concern – this patient arm of the British Menopause Society provides a confidential, independent service to advise, reassure and educate women of all ages about their gynaecological and sexual health, wellbeing and lifestyle concerns, via the website, by telephone/email and in live and online events. 

Diet and the menopause - The Association of UK Dieticians. 

Official guidance on the benefits and risks of HRT - National Institute for Health and Care Excellence (NICE) website.

Content disclaimer

Our health and wellbeing pages are written and regularly reviewed by appropriately qualified medical experts. The content is based on medical evidence and guidelines available at the time of writing.

It is not intended to be a substitute for professional medical advice given in the context of an individual consultation. Nor should it be used to self-diagnose or recommend a course of treatment.

Please also be aware that the inclusion of information on a particular health topic or condition in our health and wellbeing pages does not indicate its eligibility for treatment under the terms of our healthcare plans. For more information please refer to our editorial policy.

References

1. In a 2017 survey on behalf of the British Menopause Society, Edelman Intelligence conducted online interviews with 1,000 adults in the UK (698 women and 302 men) who were aged 45+ and either peri-menopausal, menopausal or post-menopausal or partners of those who are, nationally representative of the online population in terms of regional spread.

2. Ogita H, Node K, Kitakaze M. The role of estrogen and estrogen-related drugs in cardiovascular diseases. Curr Drug Metab. 2003;4(6):497-504. doi:10.2174/1389200033489271.

3. Office for National Statistics. Leading causes of death, UK: 2001 to 2018. Registered leading causes of death by age, sex and country. Last updated: 27 March 2020 [Accessed 20 August 2020].

4. Collaborative Group on Hormonal Factors in Breast Cancer. Type and timing of menopausal hormone therapy and breast cancer risk: individual participant meta-analysis of the worldwide epidemiological evidence. The Lancet, vol 394, issue 10204, p1159-1168, September 28, 2019.

5. Rossouw JE, Anderson GL, Prentice RL, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women's Health Initiative randomized controlled trial. JAMA. 2002;288(3):321-333. doi:10.1001/jama.288.3.321.

6. Geller SE, Studee L. Botanical and dietary supplements for menopausal symptoms: what works, what does not. J Womens Health (Larchmt). 2005;14(7):634-649. doi:10.1089/jwh.2005.14.634