Understanding Menopause

Many women have minimal/mild hormone related symptoms during and after the menopausal transition. Many welcome, at long last, the cessation of the “monthlies” and the associated inconveniences.

Some will experience the occasional hot flush, but nothing they can’t manage. Others will experience an irritating forgetfulness – they leave the bedroom to make a cup of tea downstairs, but once in the kitchen they forget what they came down for.

Some may feel not quite as energetic as they felt a year ago, but they accept this as part and parcel of the ageing process. The slight vaginal dryness they experience during intercourse is readily dealt with using a dollop of lubricant gel.

Other women, liberated from a fear of pregnancy, experience a surge in their libido (sex drive), while some accept the decline in libido as just “one of those things”, matched by a similar decline in the libido of a partner / husband – and a mutual acceptance that “sex is no longer that important to us” ….. the “ultimate graceful ageing process ….?”

But a sizeable proportion of women, probably about 25-30%, experience significant symptoms that negatively impact on their quality of life. The erstwhile formidable company board chair suddenly finds that she is self-conscious of the hot flushes that she now frequently experiences during crucial meetings – “surely everybody can see my sweating and red face” – and the clouding of her memory and decline in concentration powers.

The relationship with her husband is not great, and she could not care less if they were never intimate again – which saddens her, because she still loves him, just not interested in the sex thing. She wakes up tired rather than refreshed as her sleep was interrupted by the cycles of heat and cold, and waking up several times to empty her bladder. The woman whose hair was once her pride and joy now finds that she fills the sink with dropping hair every time she shampoos her now dry and coarse hair. She now needs gallons of moisturising cream for her skin, and her nails break all the time. Her energy levels have declined so much she feels she could sleep for England, and she feels so bad at how easily she snaps at her teenage children for the slightest of misdemeanours – and some times for no good reason at all.

She watches a movie on an afternoon and finds herself in floods of tears, something she never used to – become sentimental in her old age? There is also this feeling of global anxiety for no obvious reason, and a loss of self-confidence – she no longer feels able to stride boldly into a room full of people, and does not feel able to express her opinions as publicly as she used to be able to.

Mary Buchan has depicted the main menopausal symptoms in terms of the SEVEN Dwarves who have "mutated from the fabulous 7 little guys who help Snow White escape from the curse of her wicked stepmother into gremlins on a mission to haunt the midlife woman".


Women can find that their skin becomes itchier and drier, particularly on the vulva, after the menopause. The vaginal and vulval tissues become thinner and more fragile without oestrogen and this can make them become irritated or more prone to infections and skin conditions.


Dropping levels of oestrogen can have an effect on the level of endorphins (or feel good chemicals) in your brain. Many women will feel snappy or irritable with those around them during the menopause. Lack of sleep, depression and adapting to changes in your life (such as your children leaving home or retirement) can be the cause of this just as much as the menopause though.


Most of us have heard of, or experienced, hot flushes. That overwhelming tidal wave of heat, flushing and sweating that comes out of the blue. This is because of changes in the part of the brain that regulates temperature.  The good news is that they do eventually settle although this does vary between women.


Hormone changes can cause some women to retain water or produce more gas than before the menopause. Becoming less active can also make bloating worse. Women often blame the menopause for weight gain at this time of their life but most cases of weight gain around your 40s and 50s are actually due to decreasing activity levels and changes in diet. The good news is that these can be influenced, whereas the onset of the menopause can’t.


Many women report that they struggle to get to sleep during or after the menopause.  Hot flushes are often the cause of this. Insomnia or lack of sleep may mean that you feel tired and sleepy throughout the day.


Although lots of women report that they started to become forgetful after their periods stopped, there isn’t actually any evidence to link memory problems with the menopause. However, there is a link between getting older and not being able to remember things as well. If you are preoccupied with lots of other symptoms then this will also make you more likely to become forgetful.


The familiar stereo-type is of the knife wielding menopausal woman. Contrary to popular opinion, women do not turn into axe wielding maniacs once they stop needing to buy Tampax, and there is much than can be done to help cope with the irritability and mood swings that some women experience.

There are other symptoms associated with the menopause which people do not generally recognise are part of the effects of the decline in oestrogen levels.

These include flatulence, aching in muscles and joints, aches in back of neck or head, decrease in physical strength and stamina, weight gain (unfortunately the proverbial “middle-age spread” is a reality!), increased facial hair, involuntary urination on laughing or coughing, being dissatisfied with one’s personal life, feelings of wanting to be alone, and being impatient with other people, and feeling depressed, down or blue.

What happens to these symptoms over time, if left untreated?

In some women the symptoms do burn out, while in others they may persist for decades. Unfortunately, it is not possible to predict what will happen to symptoms in any given woman. What is evident is that no woman has to put up with debilitating symptoms just because the menopause is a natural phenomenon. Most, if not all of the symptoms can be controlled or eradicated. Conventional HRT is the most effective weapon, but where it may be contra-indicated, such as in women with a history of breast cancer, there are other weapons in the armamentarium.

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