DEMYSTIFYING THE MENOPAUSE & HRT – Part 1

October 7, 2022


This month, to support World Menopause Day we will be talking all things Menopause. We are thrilled to have menopause expert and Women’s Health & Safeguarding Lead GP; Dr Elise Dallas join us to share her knowledge on this important subject. As this is such a huge conversation, we are breaking it down into two parts. In the first part Elise will be answering the most frequently asked questions about the menopause and explaining how to find out if you are perimenopausal and what steps you can take to alleviate any symptoms you may be suffering from. 


How do I know if I am perimenopausal or menopausal?

This is a question I get asked all the time. Despite menopause being a natural event that every woman will go through, perimenopause is a gradual transition, so it is sometimes difficult to work out whether you are ‘starting the change’ or not.

Menopause happens on average at 51, but symptoms can start years before often in your mid 40’s and this is your perimenopause. Your periods may or may not be regular but can often be heavier as this is when your progesterone levels start to fall.


Is there a test to confirm the menopause?

It would be nice if there was a simple blood test that would confirm if you were perimenopausal, but there isn’t because leading up to the menopause hormones are fluctuating, so the hormone called FSH (follicle-stimulating hormone) which can be found in higher levels in menopause, will show varying levels on different days.

Therefore, in women over 45, a diagnosis of menopause can often be reached on symptoms alone without the need for a blood test. 


If I don’t get periods, how do I know I am perimenopausal?

You may think that you’ll know you’re going through perimenopause if your periods become less frequent or even stop entirely. However, some women don’t get periods because they have had a hysterectomy or because of their contraception and this can make it more confusing to judge if you are going through menopause or not. However, if you are perimenopausal you may still experience the symptoms which come from a lack of estrogen, such as hot flushes. So if you’re over 45 and getting these symptoms - you’re perimenopausal. 

What are these symptoms I should be looking out for?

Menopause affects every woman differently. You may have no symptoms at all, or they might be brief and short-lived. However, for some women they are severe and distressing. Estrogen affects every cell in our body so when levels are fluctuating during the perimenopause, this can cause symptoms all over our body, and may include ones you didn’t realise might be due to your hormones. You may experience anything from vasomotor symptoms (hot flushes, night sweats) to psychological changes (mood disturbances, difficulty sleeping, lack of interest in sex). Some women experience physical symptoms (joint and muscle aches), as well as vaginal/bladder symptoms (dry vagina, frequent urine infections).

The hidden symptoms of perimenopause? 

Hot flushes are synonymous with perimenopause, but some symptoms are not so obvious. Insomnia, brain fog and crippling anxiety are the most common symptoms that I see, and these are often the most distressing. They can impact relationships and work - did you know 25% women leave their workplace due to perimenopausal symptoms!? Sometimes it can be difficult to disentangle these feelings and emotions from the ‘normal’ everyday stresses of being the sandwich generation, with older parents and younger kids to worry about, combined with busy careers. I would say if you were feeling unable to cope and you are in your mid-40s it is most likely due to your hormones and worth speaking to a doctor. 


How does menopause affect your health? 

Bone health:

The drop in estrogen significantly speeds bone loss and increases the risk of osteoporosis.  Half of postmenopausal women will have osteoporosis, and most will suffer a fracture during their lifetime.  Fractures (broken bones) cause pain, decreased mobility, and function. Fractures are associated with decreased quality of life with 80% losing their independence and a 4 times higher chance of dying.


Heart health:

Heart disease is the commonest cause of death in women worldwide and a drop in oestrogen causes increased blood pressure, body fat, type 2 diabetes, cholesterol and decreased insulin sensitivity. 

Therefore heart disease increases significantly after the menopause with a woman 5 times more likely to have a heart attack than before!


What happens to testosterone during menopause?

Premenopausal women produce both testosterone and estrogen and this is essential for the development and maintenance of our sexual libido, as well as in the metabolic functions related to muscle and bone strength and mood and cognitive ability. Current guidance states that women can be given additional testosterone if they are having problems with low sexual desire when other factors have been ruled out. However, if you are suffering from the symptoms above before being considered for testosterone your doctor will check if you are being adequately oestronised (taking enough estrogen), as adequate estrogen can alleviate these symptoms too. Those that continue to suffer with these symptoms despite adequate estrogen will be considered on a trial of testosterone to see if this improves matters. My patients who are taking testosterone generally report back that their energy levels are increased, and their exercise endurance improves. Plus, they feel mentally more alert, with better concentration and that their well-being is enhanced. 

 If I think I might be in perimenopause, what are the steps I should take?

Make an appointment with your GP and take with you the following things:

  • A list of your symptoms. It is really useful to be able to monitor how your symptoms change with time or with treatments, especially when taking HRT (Hormone Replacement Therapy).
  • Make note of any major changes in your menstrual cycle, such as period frequency and flow and any unusual bleeding patterns. 
  • Record your medical history, including medications like contraception and HRT.
  • Make a brief family history of medical problems – especially breast and ovarian cancer, heart disease, stroke, blood clots, and osteoporosis

Your GP will see if you are a suitable candidate for HRT which is the most effective management in the short and long term and discuss how you can make changes in your lifestyle. 


In Part two of our Menopause series Dr Elise Dallas will be talking to us about why you shouldn’t be afraid of HRT, what taking it involves and what lifestyle changes you can make to optimise your health and wellbeing during the menopause. 

We hope you have found part 1 helpful? If you have any questions, don’t hesitate to drop me a note (sally@sallygunnell.com) and we’ll do our best to get an answer for you?

Take care

Sally & Jon

xx