The average age for menopause is 51 years old. We spend a third of our lives in the post-menopausal phase. Menopause and its symptoms can have a huge effect on our lives so it is important to understand what is going on in our bodies and what we can do to help make this transition easier.

What Are The 3 Stages Of Menopause?

A woman is born with a set number of follicles in her ovaries. Follicles are fluid filled sacs that contain an egg; they produce estrogen. When puberty hits, these eggs are released (ovulation) and the monthly cycles (periods) start. Over time, as these follicle numbers decrease, estrogen levels fall until the periods eventually stop. This is a gradual change over many years.

As the levels of estrogen start to fluctuate, symptoms can start to appear. This is perimenopause. The average age for perimenopause is around 47 years old but can start anytime from late 30’s. This stage lasts around 4 years on average. Finally, menopause is when periods stop. We have reached menopause once we have not had a period for 1 year. So, menopause is 1 date in time and is only known 1 year after the date of our last period. Following this date, we are said to be post-menopausal. As previously mentioned, the average age of menopause is 51 years old.

What Are The Physical Changes In The Body During Perimenopause And Menopause?

We have estrogen receptors in all the tissues in our body and so estrogen influences every organ in the body. For example, our skin, hair, nails and even our eyes are influenced by estrogen; dryness is common.

In the brain, oestrogen, along with other hormones, has an influence on temperature control memory and libido. It helps to regulate serotonin (the hormone that makes us “happy”). Thus, low or fluctuating estrogen can cause a variety of symptoms like mood swings, irritability, “brain fog” and memory lapses. A decline in estrogen causes aging of our neurons and aids in the formation of amyloid plaques which can be associated with Alzheimer’s disease.

In the heart, estrogen influences heart rate by a variety of mechanisms. It also influences the lining of our blood vessels. In the liver, estrogen helps with cholesterol regulation and in the nervous system, estrogen aids and influences the transmission of signals. Taking all this into account explains why we have symptoms of hot flashes (hot flushes in the UK), heat intolerance, night sweats and palpitations. The loss of the protective effects of estrogen on the lining of our blood vessels and the poorer cholesterol regulation that comes with lower estrogen means there is a staggering 5 times increased risk of heart disease at menopause (if we do not make changes to our lifestyles).

In the joints and muscles, estrogen has an anti-inflammatory effect and aids muscle strength, flexibility and joint lubrication. Thus, stiff or aching joints or muscles is a common symptom in perimenopause and menopause.

In the bowel, estrogen helps to maintain function and works with our own bacteria in the gut (the gut microbiome). Thus, bloating, constipation and symptoms of irritable bowel syndrome are also common during perimenopause and menopause.

In the bladder, estrogen helps to control bladder function and decreases the risk of infection by various mechanisms. At the vagina, it aids lubrication and reduces bacterial overgrowth. Thus, low estrogen can lead to symptoms such as incontinence (loss of bladder control), recurrent urinary tract infections, and vaginal dryness and soreness.

In our bones, oestrogen supports the cells that build up bone strength. Our bone mass peaks at the age of 30 years; it stays static for 10 years and then starts to decline. In women, this decline accelerates as we lose the protective effects of estrogen and so 1 in 2 women develop osteoporosis in menopause.

How To Cope With Menopausal Changes?

As detailed above, perimenopausal symptoms range from hot flashes, mood swings, memory loss, palpitations, vaginal dryness to even dry eyes. There are long term effects on our health particularly our heart, bones and brain health. The way we breakdown fat is different; thus, we may be more prone to weight gain, especially if we become less active as we get older. Lean body mass goes down and our metabolism starts to slow down.

We have the power to help ourselves with proper lifestyle changes. While hormone replacement therapy (HRT) can be lifechanging for some women, it is important that every woman examines her lifestyle, whether using HRT or not.

Diet can have a big impact on short term symptoms of menopause, as well as the long-term complications. Avoiding processed foods and increasing our intake of natural estrogens known as phytoestrogens can help. These can be found in soy products, chickpeas, lentils, grains, flaxseeds, fruits and vegetables. Changing our diet will not only help with weight control but also has an impact on bone, heart and brain health. For more on diet, see my blog titled “How Diet Can Affect Your Health During Menopause”

Sleep and prioritising sleep is another essential way of helping our health, particularly around the time of the menopause. This can be difficult, especially if we are experiencing night sweats and hot flashes. Having a regular bedtime routine with a winddown before bed (such as a bath or yoga) can be helpful. Exercising earlier in the day and getting natural light first thing in the morning can also help.

Exercise and physical activity will not only help with keeping our weight under control, but also helps with sleep. Exercise can also help with mood if we are feeling low with fluctuating hormones. Exercise or physical activity doesn’t need to be exhausting to be effective; 150 minutes of activity a week is the recommended amount. The intensity should be strenuous enough that one is able to still talk but not sing.

Stress management can also make a difference to our symptoms. We have a “fight or flight” mechanism in our bodies. When we are under stress, we activate our sympathetic nervous system and produce hormones such as cortisol and adrenaline (epinephrine). These hormones raise our heart rate and blood pressure, as well as increasing sugar levels in the blood. While these effects are very useful if under threat of a predator, they are not so great if we are under chronic stress. Accordingly, they don’t help women with symptoms of palpitations and hot flashes. The opposite pathway (when we are not stressed) is our parasympathetic nervous system. The phrases “rest and digest” or “feed and breed” can be used here. The parasympathetic nervous system drives our sex hormones, so it is particularly important if they are already low.

Deep breathing exercises, meditation, mindfulness yoga, thai chi or even just setting aside time to close the eyes and listen to relaxing music can help lower stress. A brisk walk, particularly in nature, can also make a huge difference. Social support and setting time aside to rest and to find meaningful social relationships can also help with stress management.

Summary

Perimenopause and menopause are stages in life when there can be lots going on in one’s life, e.g., children leaving home, relationship difficulties/divorce, caring for elderly parents or bereavement. It is crucial as women that we learn to look after ourselves. As we learn and understand what is going on in our body, we can take measures to overcome symptoms or help to cope with them.

As detailed above, a wide range of symptoms can be experienced during menopause; our bodies are changing. However, we are not powerless against these changes. Aside from HRT, there are a lot of lifestyle changes we can make. Looking after our diet, ensuring we keep active, prioritising sleep and stress management are key to a longer happier and healthier life.

Dr. Sherina Fernandes, MBBS, BSc, DCH, nMRCGP, IBLM, BSLM, is a lifestyle physician working as a clinical lead for a telehealth company in the UK. Her main interests are preventative medicine using a lifestyle approach, women's health and preventing burnout.