Video: How do you know you're going through the menopause?

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How do you know you are going through the menopause?

Dr Sarah Jarvis MBE, FRCGP

01:04

How do you know you are going through the menopause?

Dr. Sarah Jarvis MBE, FRCGP

01:12

What is perimenopause?

Dr. Sarah Jarvis MBE, FRCGP

00:50

Do I need a blood test to diagnose menopause?

Dr. Sarah Jarvis MBE, FRCGP

01:10

Does menopause affect your sex life?

Dr. Sarah Jarvis MBE, FRCGP

01:20

Is it safe to take HRT?

Dr. Sarah Jarvis MBE, FRCGP

How do you know you are going through the menopause?

The word for menopause comes from the Greek Menos Pausos or periods have paused or rather stopped. So the last day of your last period is the day technically you go through the menopause. But of course you don't know until a year later that was your last period. In the years coming up to the menopause you can start getting more irregular periods and you can start getting the symptoms of the menopause.

So hot flashes, mood swings, sometimes low mood even depression, vaginal dryness and so on. Some women go through all these without even noticing; they sail through it- menopause. For some women those menopausal symptoms can be really debilitating. The answer is technically you won't know until a year after your period stopped that you are menopausal because until then we say that it will be normal for you to have another period. But those hot flashes might give you a very good idea.

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What is perimenopause?

Every woman knows about the menopause but most women assume it just sort of happens. In fact sometimes it can creep up on you and sometimes it can reach up and start grabbing you. The perimenopause is the years running up to the menopause. The menopause technically is the day of your last period although we don't know that that's happened until a year later. The average age of menopause is about 52 and the perimenopause lasts about 4 years on average.

So most women start going through it in about their late forties, however, it can last up to a decade. What's happening around the perimenopause is the oestrogen levels are gradually dropping. So, your periods become less regular, they may become more erratic, and they may well become heavier. You may start to get hot flashes and night sweats, you may get vaginal dryness, mood swings and depressed mood. A small proportion of women in their perimenopause get really bad symptoms, so bad that they need, for instance, HRT to relieve their symptoms. The good news is, it doesn't go on forever.

Do I need a blood test to diagnose menopause?

NICE-The National Institute for Health and Care Excellence says that if you are over 45 and you have menopausal symptoms including your periods stopping then your doctor can diagnose menopause without needing to do any blood tests at all.

If you are under the age of 40 and your periods stop, especially, if you have hot flashes and so on as well then your doctor should be doing 2 FSH blood tests separated in time, that's Follicle Simulating Hormone, to see if you are going through the menopause. Between the ages of 40 and 45, it slightly depends on your personal circumstances. But there is no point in doing that blood test if you are taking the combined oral contraceptive pill or a high dose progesterone contraception.

Does menopause affect your sex life?

There are lots of ways in which the menopause could have an impact on your sex life. First of all, you could suffer from vaginal dryness that’s caused by low estrogen levels can cause soreness, pain during sex as well as urine infections and vaginal infections.

Secondly, you can get a lot of hot flashes during the menopause which may interfere with your sleep, especially, if you are having night sweats too and being tired is never a great recipe for wanting to get cosy.

Thirdly, menopause can have an impact to your mood; you can get mood swings and possibly depression as a result of the menopause. And finally, yes, we think that the menopause or the changes in the hormones around the menopause may have a direct effect on your sex drive as well. However, if you talk to your doctor about how you can improve things say, if you got vaginal dryness and say you couldn’t stop yourself from suffering some of the physical consequences of menopause you may be able to get on track.

Is it safe to take HRT?

Very much depends on what you mean by safe. Doctors don’t talk about safe, we talk about relative risks and benefits. Now we know on the one hand that the HRT is the most effective way of relieving hot flashes which can have a terrible impact on some women’s life around the menopause. But we also know it can increase your risk of breast cancer. However, we know lots more than we did few years ago.

So, for instance, taking HRT does not increase your risk of heart attacks, especially, if you take it around the time of the menopause. It can protect you against osteoporosis or thinning of the bones in later life. There may be an increased risk of ovarian cancer but it’s a very small increase in real terms. Taking oestrogen only HRT which only women who have had hysterectomy can take results in little or no increased risk of breast cancer but there is an increased risk of breast cancer if you take combined HRT.

However, that depends on the type of HRT and how long you take it for and once you’ve stopped taking it your risk does return back to normal. So, the evidence is there, it’s up to you to weigh up the risks and the benefits.