Support During the Menopause

The menopause usually occurs between the ages of 45 to 55. For women in the UK, the average age of the menopause is 51, with symptoms starting on average at age 47. This stage is known as the perimenopause.

Approximately one in one hundred women experience menopause before the age of 40. It can sometimes happen earlier naturally, or for reasons such as having surgery to remove the ovaries or the uterus, cancer treatments like chemotherapy, or in some cases there may be a genetic reason. Sometimes the reason is unknown. Daisy Network provide advice and support for anyone going through early menopause, and for further reading about early menopause, please see our knowledge base.

What is the menopause?

The menopause is when a woman’s periods stop due to lower hormone levels. It happens when the ovaries stop producing as much of the hormone oestrogen, and no longer release an egg each month. As you age, your reproductive cycle begins to slow down and prepares to stop. Physical changes can also happen as your body adapts to the change in hormone levels. The symptoms you experience during each stage of the menopause are all part of your body’s adjustment to the changing hormone levels.

Perimenopause is the name for the time before your periods stop but when you will usually experience symptoms. You reach the menopause when you have not had a period for 12 months consecutively.

Natural menopause is the permanent ending of menstruation and happens naturally rather than because of any type of medical treatment.

This process is usually gradual and happens in three stages:

• Perimenopause – the perimenopause can happen as much as 8-10 years before the menopause. During this time your ovaries are gradually producing less oestrogen. The perimenopause continues right up until menopause. In the last couple of years before menopause, the drop in oestrogen levels accelerates. During the perimenopause, you may have all of the symptoms of menopause; however, it is still possible to get pregnant during this time. During this time you will still have periods but they may be irregular.
• Menopause – this is at the point where you will no longer have periods at all. At this stage your ovaries stop releasing eggs. If you have not had a period for 12 consecutive months, at this stage your healthcare provider would consider you menopausal.
• Postmenopause – this is the stage after you have not had a period for 12 consecutive months. During this time, menopausal symptoms should hopefully get better. In some cases, symptoms can continue during this stage. Due to the lower oestrogen levels, women in the postmenopausal phase are at an increased risk for several health conditions, for example osteoporosis and heart disease.

The signs and symptoms that you may be in the perimenopause stage include:

• Hot flashes – this is a sudden feeling of warmth that spreads over your body.
• Night sweats – this can also include cold flashes.
• Difficulty sleeping.
• Fatigue.
• Vaginal dryness.
• Urinary urgency.
• Dry skin or a change in skin type.
• Changes in the digestive system.
• Incontinence.
• Emotional changes – this can include irritability, mood changes or some symptoms of depression or anxiety.
• Light-headedness.
• Breast tenderness.
• Irregular periods.
• Decreased fertility.

Some people may also experience:

• Headaches.
• Hormonal migraines.
• A racing heart.
• Muscle aches.
• Difficulty concentrating or brain fog.
• Hair loss or hair thinning.
• Weight gain.
• Feeling bloated.
• Changes in libido.

These symptoms happen due to the changing hormone levels. Some people experience mild symptoms; however, some people experience extreme symptoms which can affect their quality of life. You can have symptoms of menopause for up to 10 years. However, most people experience symptoms of menopause for less than five years.

After menopause your risk of certain medical conditions increases.

This includes:

• Heart and blood vessel disease – this is due to declining oestrogen levels and is the leading cause of death among women. It is therefore important to get regular exercise, eat a healthy diet and maintain a normal weight.
• Osteoporosis – this condition causes bones to become brittle and weak, leading to an increased risk of fractures.
• Sexual function – vaginal dryness from decreased moisture production and the loss of elasticity can cause discomfort and slight bleeding during sexual intercourse.
• Urinary incontinence – as the tissues of your vagina and urethra lose elasticity, you may experience frequent, sudden, strong urges to urinate, and possibly an involuntary loss of urine. Strengthening your pelvic floor muscles with exercises can help with this.

What kind of support is needed?

Despite menopause affecting around 51% of the population, there is often a lack of awareness or understanding of menopause, even amongst women themselves. When a woman is experiencing symptoms of menopause, the support they may require will vary and will largely depend on the symptoms and severity of these. The support needed may be for physical symptoms or for your mental health.

Support is needed:

• At home
• In the workplace
• In society in general

Why is support needed?

Menopause can be a difficult time for some women due to the physical and emotional changes. As there are a wide range of symptoms, some of which can be severe and can have a significant impact on day-to-day life, it is vital that support is offered and that menopausal women and the people supporting them understand where they can access this support.

Support at home during the menopause

If you know someone who is going through menopause or perimenopause, there are various ways you can offer them your support.

This could include:

• Educating yourself about menopause.
• Learning what the symptoms are.
• Letting them know that you want to support them.
• Learning about what treatment and support is available.
• If they want to talk, listening to them and trying to understand what symptoms they are experiencing and how they are being affected.
• Learning about how they can ease their symptoms, for example living an active, healthy lifestyle including eating a healthy balanced diet and avoiding alcohol.

How can the workplace support someone during the menopause?

The number of women who will experience menopause symptoms while in employment is increasing. Women over the age of 50 were the fastest growing group in the workforce according to government research conducted pre-pandemic. A 2019 survey conducted by the Chartered Institute for Personnel and Development, found that three in five menopausal women were negatively affected at work. BUPA found that almost 900,000 women in the UK had left their jobs because of menopausal symptoms.

Menopause can affect a woman’s experience at work due to:

• Problematic symptoms affecting their ability to carry out their role.
• Lack of support.
• Discrimination due to the stigma associated with menopause.
• Absence from work/reducing working hours due to symptoms.

There are a number of ways a workplace can support women who are going through the menopause.

These include:

• Practical adjustments.
• Having a specific workplace policy addressing how employees will be supported.
• Menopause induction processes, making it clear that menopause is seen as a health issue which the company will provide support with.
• Discussing menopause openly, for example at company events.
• Creating a supportive environment.
• Education in the workplace.
• Separate training sessions for those who may not be aware of the impact of menopause, for example men and younger workers.
• Detail how the organisation maintains confidentiality and how it will comply with data protection law when dealing with menopause information.
• Managing sickness absence and job performance sensitively.
• Having menopause and wellbeing champions.

Importantly, employers must not discriminate against someone because of their menopause symptoms.

It’s also important to remember that some women may feel that menopause is a private matter and therefore may not wish to be asked directly about it by those they work with. Ensuring that all employees are aware of the support available to them and discussing the subject openly and collectively with employees is often the best option.

UK employment court cases involving menopause are increasing, with workers challenging employers more than ever before. Employment tribunals involving menopause increased by 44% in 2021, with 23 cases referencing it compared to 16 in the previous year; this is according to court data.

This included 16 tribunals claiming disability discrimination, 14 claiming unfair dismissal and 10 claiming sex discrimination. The word menopause was found to have been mentioned 207 times in tribunal documents in 2021; this is an increase of 75% from the 118 mentions the previous year. For further reading about menopause and the law, please see our knowledge base.

If you are an employer and want to find out more about supporting your employees through the menopause at work, acas provide a helpful guide in relation to this.

Support available

If you are having menopause or perimenopause symptoms which are affecting your day-to-day life, you can speak to your healthcare provider who will be able to give you advice and support. There are also menopause specialists within the NHS who have experience in supporting anyone going through perimenopause and menopause.

If you are having symptoms before the age of 45, your healthcare provider may offer you a blood test to check your hormone levels. A diagnosis of perimenopause or menopause can be made by discussing your symptoms.

The main prescription treatment for symptoms of the menopause and perimenopause is hormone replacement therapy (HRT). HRT relieves symptoms of the menopause and works by replacing the hormones which are at lower levels. It can also help prevent weakening of the bones, which is more common after the menopause. Some types of HRT can increase your risk of breast cancer. The benefits of HRT are generally believed to outweigh the risks.

There are many benefits of hormone replacement therapy, which include:

• Better quality sleep.
• Vaginal lubrication.
• Reduced risk of dementia.
• Less painful intercourse.
• Reduced hot flashes and night sweats.
• Reduced risk of heart disease.

Your healthcare provider will be able to advise you if you have any concerns about taking HRT. You can usually begin taking HRT as soon as you begin experiencing symptoms. A low dose is usually recommended to begin with and this can be increased at a later date. Your GP can explain the different types of HRT available and help you choose one that’s suitable for your symptoms. Most women can take HRT if they are experiencing the menopause; however, some women may be unsuitable for HRT.

You may be unsuitable for HRT if you:

• Have a history of blood clots.
• Have high blood pressure which is not being treated.
• Have liver disease.
• Have a history of some types of cancers.
• Are pregnant.

You can take HRT in various ways including in tablet form, as skin patches, gels, vaginal cream, pessaries or rings.

HRT can cause some side effects; however, these should usually pass within three months.

Side effects can include:

• Headaches
• Breast tenderness
• Stomach aches
• Nausea
• Feeling sick
• Vaginal bleeding

If you do not wish to take HRT to manage your symptoms, there are other things you can consider which may help.

These include:

• Exercise regularly.
• Eat a healthy, balanced diet.
• Limit alcohol use.
• Stop smoking.
• Limit caffeine.
• Try to stay cool at night.
• Avoid the triggers for hot flashes.
• Try to reduce stress levels.
• Vaginal lubricant or moisturiser.
• Antidepressants.
• Tibolone – this is a medicine similar to combined HRT but may not be as effective.
• Clonidine – this is a non-hormonal medicine that may help to reduce hot flashes and night sweats in some women, although any benefits are likely to be small.

Sometimes complementary therapies are suggested to help with menopause symptoms. Complementary and alternative medicine is treatment that falls outside of mainstream healthcare. This ranges from acupuncture and homeopathy, to aromatherapy, meditation and colonic irrigation.

Some examples of complementary therapy that are suggested for menopause symptoms include:

• Evening primrose oil
• Black cohosh
• Red clover
• Sage
• St John’s Wort
• Agnus castus
• Ginkgo biloba

There is evidence to suggest that some of these remedies, including black cohosh and St John’s wort, may help in reducing hot flashes; however, many complementary therapies are not supported by scientific evidence. There is uncertainty about the right doses to use and whether the health benefits last in the long term. Some of these remedies may also cause serious side effects if they are taken with other medicines.

You should always consult with your GP or pharmacist for advice if you are thinking about using a complementary therapy.

Talking therapies like counselling or cognitive behavioural therapy (CBT) can help with symptoms of menopause and perimenopause. It is possible to access NHS talking therapies without seeing a GP first as long as you are registered with a GP.

If you are experiencing symptoms of perimenopause or menopause, there are some charities who can offer helpful advice and support.

 These include:

• Menopause Matters
• Women’s Health Concern
• Menopause Cafe