Menopause specialist Dr. Louise Newson and broadcaster Rachel New talk about what everyone should know about perimenopause and menopause.

Hot flashes, sleep problems, and mood swings — these are the symptoms that many people may be familiar with when it comes to menopause.

Yet there is so much more to this biological transition that anyone who has periods goes through. When a person has stopped having periods for 12 months, they have officially gone through menopause.

The time leading up to this point is called perimenopause, and many experience a range of symptoms during this time. How long people will spend in perimenopause varies greatly from person to person.

To find out what everyone should know about menopause and why, as a society, we find conversations around women’s health so difficult, I spoke to broadcaster Rachel New, who recently wrote a Through My Eyes piece about her experience of menopause for Medical News Today.

Joining us in conversation was Dr. Louise Newson, a general practitioner (GP) in the United Kingdom and menopause specialist. Louise is the founder of the free balance app, which allows users to track symptoms and changes in their periods. The app also provides information about menopause.

To hear more about menopause, including the latest on hormone replacement therapy (HRT), listen to the accompanying podcast:

We started our conversation with Louise taking us through what happens during menopause.

“Most of us go through the menopause as a natural process. Our hormones deplete because our eggs run out in our ovaries. And when they run out, [the] hormones associated with them go down,” she explained.

“Some women have their menopause forced on them,” Louise continued.

For some, menopause happens as a result of a medical procedure, such as the surgical removal of the ovaries, or certain drugs or treatments.

“The average age in the U.K. is 51, but around 1 in 100 women under the age of 40 have an early menopause. My youngest patient is 14, [and] my oldest is 92, so it can affect all women [of] all ages,” Louise said.

And what about perimenopause? Louise told us that perimenopause can last several years, a decade, or even more.

“[The] symptoms can start sometimes just for a few days before each period, and then it can be a week or 2 weeks, and then all the time. It’s quite a transient process that often worsens with time,” she said.

She listed the range of symptoms that a person can experience:

“The list can go on and on and on, actually, and symptoms can vary between women and actually sometimes vary between the days and months.”

– Dr. Louise Newson

For some people, menopause means the end of their symptoms. But this is not the case for all.

Once a person has gone through menopause, their hormone levels will be low for the rest of their life. In some, this is accompanied by ongoing symptoms.

“The average length of time for symptoms is about 7 years, but I certainly have seen and spoken to many women who have symptoms for decades,” Louise explained. “But symptoms change.”

“A lot of women find that their hot flashes and sweats improve. And then when you talk to them, they’ll say, ‘Now I’ve gone through my menopause, I don’t have any symptoms.’ But then they will say, ‘Oh yes, but my sleep’s rubbish’ or ‘I have some joint pains, and I can’t exercise the same way’ or ‘I’m just a bit more irritable,’ so these symptoms often do linger,” she continued.

Rachel told us that she can trace back the beginning of her menopause to when she was 51. But prior to that, she had experienced problems with her sleep throughout her 40s.

“I was having vaginal problems, but I kept thinking I had thrush. I was getting urinary tract infections. But it was only when I was 51 that those problems started to really bother me. I kept going to the doctor [and] being put on antibiotics for urinary tract infections,” Rachel said.

“Sex was becoming painful at the same time. My periods were getting closer together and heavier. I’d always had quite heavy periods, but now, I wake up [and] I’d flood the bed […] But I didn’t know this was the perimenopause. I’d never heard of perimenopause.”

– Rachel New

Other symptoms that Rachel experienced included itchy skin all over her body. Her GP did not mention menopause or perimenopause to her at the time.

“It was only when I went and had a Mirena coil fitted for my really heavy periods [that] the gynecologists talked to me about perimenopause,” Rachel told us.

Her experiences led her to set up her own podcast about menopause, called “On My Last Eggs.” Rachel told us that she feels her experience mirrors that of many others. Faced with perimenopause, she sought out Louise’s YouTube videos.

“I [thought], Oh my gosh, this is what’s wrong with me. I felt like I had finally found someone that I could trust the advice of,” Rachel explained.

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I asked Rachel why it is so challenging for women to find information about menopause. “Women of menopausal age are very different from women of menopausal age in the past,” she said.

“Often, a woman may be in her perimenopause, [and] she may only have a 5-year-old child. She doesn’t equate herself with a menopausal woman — she may be at the peak of her career. She doesn’t look like our menopausal mothers or grandmothers looked like, and so I think often we just don’t understand,” Rachel continued.

Few women are equipped with the knowledge about the breadth of symptoms that can accompany perimenopause. Add busy lives to the mix, and it can be easy to miss the fact that these symptoms must have a cause.

Louise added that there is a gap in menopause education among doctors.

“I feel very embarrassed that I have probably missed thousands of women who’ve come to see me as a GP, telling me they have headaches, or they feel low, or they’re tearful, or they’ve had palpitations, and I’ve never thought about their hormones, because I didn’t really know,” she shared with us.

Louise missed the signs of her own perimenopause. “I was busy developing and writing the content for Menopause Doctor, and I was also lecturing other healthcare professionals, saying, You must not miss the other symptoms of the menopause,” she told us.

“Yet I had them all but thought it was because I was working hard trying to split my time with three children, being a GP, being a medical writer, and now developing a website and trying to get a job as a menopause specialist in the [National Health Service (NHS)].”

– Dr. Louise Newson

“So I had a lot of reason to be tired, irritable, and low mood, poor sleep, back-to-back migraines, etc. Not once did I think about my own hormones,” Louise explained.

“We need to be so much more open about women’s health,” Rachel advocated. She called for conversations about reproductive health, including periods, fertility, and endometriosis.

Louise pointed to the lack of menopause research and suggested a change in narrative.

“If we’re not going to listen to women talking about symptoms, then we need to think about the health risks, and we need to think about the risks to the economy,” she said.

Louise explained that around 20% of women either consider leaving their job or do so due to menopause. In addition, poor memory, anxiety, and fatigue are very common symptoms and can impact workplace productivity.

“It’s affecting the health economy, because 1 in 3 women will have an osteoporotic hip fracture, which costs the NHS £3 billion a year,” she added.

Rachel encouraged everyone to arm themselves with information about menopause. She was also keen to bring vaginal health into the spotlight.

“I would say to women, You deserve to have a healthy, happy, comfortable vagina […] and don’t take any kind of fob off for an answer. Everyone deserves to have a lovely, happy, useful vagina that they can carry on having sex with and enjoying, and so don’t be battered away from that.”

– Rachel New

To Louise, menopause should be on everyone’s radar. “A lot of the work that needs to be done about awareness is [that] not just middle-aged women need to be aware,” she said.

“We all need to be aware: men, women, children, adults, everyone. Because we all know women, [and] recognizing [menopause] within our friends or family or work colleagues can be really important,” she added.

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