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How do you know if you’re going through the menopause?

General Practitioner at Bupa UK
04 November 2020

Menopause experiences vary widely, and that means it can be hard to know if your physical or psychological symptoms are due to the menopause or not. It can be even more confusing if you’re noticing signs of the menopause earlier than you expected. Let’s explore what you might expect and when.

When does the menopause start?

The first phase of the menopause is called perimenopause. This typically occurs in your 40s, and it’s when you’re likely to start noticing symptoms. You are said to have reached the menopause when you haven’t had a period for at least 12 months, and the average age for that is 51.

You’ll probably start having some menopause symptoms whilst still having periods. This earlier stage can last anything from a few months to a few years. Your ovaries will gradually produce less of oestrogen, progesterone and testosterone (hormones), and that decline will accelerate as you head into the menopause.

What are the early signs of menopause?

There are many possible menopause symptoms. Each women’s experience is very personal to her, but typical perimenopause symptoms might include:

  • unusually heavy, light or irregular periods
  • hot flushes in the day
  • night sweats and disturbed sleep
  • difficulty concentrating and remembering things (‘brain fog’)
  • vaginal dryness and discomfort during sex
  • a drop in libido
  • mood swings which could include stress, irritability, anxiety or depression
  • putting on weight
  • joint and muscle aches

Around 1 in every 10 women find their periods stop abruptly without any noticeable changes in their cycle before that point. This might be ideal for some women. However, it’s a problem if you’re trying to get pregnant and don’t realise that you’re going through the menopause.

One in four women will have severe menopause symptoms. This might mean recurrent urinary tract infections (UTIs) caused by vaginal dryness, hot flushes that leave you unable to cope, or unpleasant psychological symptoms. It’s best to see your doctor, because a range of treatments is available.

What about premature or early menopause?

If you’re concerned that you might be having menopause symptoms younger than you expected, this could be either of the following.

  • Early menopause – This affects about 5 in 100 women, and it’s when your periods stop before the age of 45.
  • Premature menopause – Also called premature ovarian insufficiency, this affects about 1 in 100 women and happens under the age of 40. It can even happen as early as the teens or twenties.

  • You might go into premature menopause because you’ve had surgery to remove your uterus and/or ovaries. Or if you’ve had treatments such as chemotherapy or radiotherapy. This can mean that you’re plunged into menopause not only earlier than expected, but also very suddenly. The symptoms can be more severe.

    Is there a menopause test?

    Your GP might suggest a blood test if you’re under 45. This will measure the amount of follicle-stimulating hormone (FSH) in your blood. If you’re over 45, FSH levels become more unpredictable, so a blood test isn’t meaningful. The National Institute for Health and Care Excellence (NICE) suggests that for women over 45, diagnosis should be based on menopause symptoms alone.

    How long do menopause symptoms last?

    One in every 10 women experiences menopause symptoms for up to 12 years. Most menopause symptoms will settle in time, but some may continue to affect you. These can include vaginal dryness, recurrent urinary tract infections (UTIs) and changes in how often you pee. Menopause treatments such as HRT and taking steps to stay healthy may help with ongoing menopause symptoms.

    Can I get pregnant during perimenopause?

    Potentially, yes. If you’re aged over 50, you may be able to get pregnant until a year after your last period. If you’re aged under 50, it may be two years after your last period. So, if you need to use contraception, you should continue using it during this time. However, if you’re taking a hormonal contraceptive, it can be difficult to tell when your last period has happened. If this is the case for you, you’ll need to use contraception until the age of 55. Your GP can give you advice about different contraception options. They can also help you with any of the menopause symptoms I’ve outlined here – I do encourage you to talk to them.

    Dr Samantha Wild
    General Practitioner at Bupa UK

      • Menopause. NICE Clinical Knowledge Summaries.cks.nice.org.uk, last revised March 2017
      • Menopause and its management. Patient. patient.info/doctor, last edited January 2018
      • Menopause. History and exam. BMJ Best Practice. bestpractice.bmj.com, last updated August 2020
      • Dongshan Z, Chung HF, Dobson A, et al. Age at natural menopause and risk of incident cardiovascular disease: a pooled analysis of individual patient data. Lancet 2019; 4(11): E553-564. doi.org/10.1016/S2468-2667(19)30155-0
      • Premature Ovarian Insufficiency. Patient. patient.info, last edited September 2020
      • Early menopause. Cancer Research UK. cancerresearchuk.org, last reviewed July 2018
      • Avis NE, Crawford SL, Greendale G, et al. Duration of Menopausal Vasomotor Symptoms Over the Menopause Transition. JAMA Intern Med. 2015;175(4):531–539. doi:10.1001/jamainternmed.2014.8063
      • The Faculty of Sexual and Reproductive Healthcare of the Royal College of Obstetricians and Gynaecologists. FSRH clinical guideline: contraception for women aged over 40 years. fsrh.org, amended September 2017

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