Wondering whether your health symptoms mean you're in perimenopause or menopause? We hear from GP Rosemary Leonard and women who share their symptoms
The menopause is officially the moment after your last ever period and commonly happens between the ages of 49 and 53. But there’s nothing unusual about it happening five years either side, at 46 or 56 and for changes around the menopause to go on for years.
Predicting the age at which it happens is extremely difficult and symptoms (including headaches, hot flushes , sweats, anxiety, irregular periods) can often be attributed to other things. So how do you know when what you are experiencing is the menopause?
GP Dr Rosemary Leonard, one of the country's leading GPs and author of Menopause: The Answers says her own "here we go" moment happened around the age of 52, "when I suddenly found myself needing to shed my warm cardigan in the middle of a practice meeting on a cold winter’s night.” In her practice, she is often asked by women confused about their symptoms.
Here, six women in their 30s and 40s, put their questions to Dr Leonard.
1. What's with my erratic moods?
Kate, 49: “For the last few months my periods have been really erratic and completely unpredictable. One month I had two, then I had a six-week gap before I had a horrendously heavy one. And I’ve noticed I’m getting a bit more moody. I presume this means I’m perimenopausal, but how long is this going to carry on? Is there a test you can do which can show you when my periods are going to stop?”
Dr Rosemary Leonard: “The pattern of erratic periods at her age suggests that she was approaching the menopause. Unfortunately, there isn’t a test that can show when periods are going to stop. Checking the level of FSH – Follicle Stimulating Hormone, which ‘drives’ the ovaries – is hopelessly unreliable, it might suggest her ovaries were working normally one day, and then the next if checked again it could suggest she was menopausal. It’s impossible to know how long this completely erratic pattern of bleeding will continue, but in my experience, it’s unusual for ‘menstrual chaos’ to last more than a year. But if the bleeding really became a nuisance, I advised her that there are treatments that can help.”
2. How do I know when my periods will stop?
Melinda, 48: “My periods were regular until a couple of months ago, but now I’ve just missed one – there was a gap of eight weeks between my last one and the one that’s just started now. Does this mean I’m menopausal? If so, when are the flushes going to start? And what exactly is happening in my body? Is there a test you can do that will tell me for sure when my periods are going to stop?”
Dr Rosemary Leonard: “The change in her periods suggested that she was approaching the menopause. However, I had to tell her that there wasn’t a test she could do that would say when her periods were going to stop. Checking her FSH levels wouldn’t help – even if the level was very high today, it could be lower the next day and it wouldn’t tell her if she was going to have another period. Similarly, there is no way of knowing if she was going to have hot flushes or not – she will just have to wait and see what happens!”
3. I get anxious about silly things...
Angie, 46: “My periods have always been a bit erratic. My last one was four months ago, but this has happened before. I’m not having flushes or sweats, but I’m aware I’m quite moody, and I often get really anxious about silly little things, which isn’t like me at all. I am under stress at work, but I wondered if it’s the menopause? Is there any way of finding out?"
Dr Rosemary Leonard: “It would have been possible to do a check of her FSH levels, but it was unlikely to be very helpful, unless it was sky-high, indicating that her ovaries had stopped working completely. Not only that, but it wouldn’t be very helpful in managing her symptoms. It was the mood swings and anxiety that were bothering her, and although if she was menopausal HRT might help a bit, there are better, non-hormonal treatments for this type of problem, such as cognitive behavioural therapy, or antidepressants.”
4. My periods are more frequent
Flo, 43: "My cycle has changed. I always used to have periods every 29 days, counting between the first day of one and the first day of the next. But for the last five months they are coming more frequently, every 25 days, though they are still regular. I haven’t got any other symptoms, like hot flushes, but does this change in my cycle mean I’m perimenopausal? And if so, how long before my periods stop altogether?"
Dr Rosemary Leonard: “It was very unlikely that Flo was in the perimenopause. She still had a regular cycle, indicating that her ovaries were working normally. Her shortened cycle was normal for a woman in her early forties, and was not in any way a sign that her periods were about to stop altogether. When that will happen is impossible to predict, but as with most women, it’s likely that her periods will stop somewhere around the age of 51.”
5. I'm getting bleeding between periods
Janey 48: I’m not sure what is happening with my periods. I still seem to get what I’d call a ‘normal’ period every month, but I’m getting some bleeding in between them as well. It’s generally a bit lighter than a period, sometimes just a bit of spotting. This tends to happen especially after sex. Does this mean I’m perimenopausal? I do feel a bit anxious sometimes, but haven’t had any flushes or sweats.
Dr Rosemary Leonard: “Though erratic bleeding can be a sign of the perimenopause, it is very unusual for hormone changes alone to cause spotting between periods, or after sex. This type of bleeding is much more likely to be due to another cause, unrelated to hormones, such as a small polyp (or outgrowth) from the lining of the womb or cervix, or an infection. When I examined her I could see nothing unusual, but an ultrasound scan showed she had a small polyp extending from the lining of her womb into her cervix, which was the cause of her bleeding. It was removed during a small operation, and after that, her unusual bleeding stopped.”
6. I'm only 34 but I'm having hot flushes and sweats
Rose, 34: “I came off the Pill a year ago, because my partner and I wanted to start a family. Since then I haven’t had a period. I’ve done loads of pregnancy tests and they have all been negative. But what’s worrying me now is I’m having hot flushes and sweats. A friend suggested it could be the menopause, but I’m far too young for that, surely?”
Dr Rosemary Leonard: “The combination of no periods, flushes and sweats does suggest the possibility of the menopause, which occasionally does happen in young women. I suggested we do a blood test for her FSH level, and also for ovarian antibodies. Her FSH was 34, suggesting that her ovaries were not working properly, which was due to her high level of ovarian antibodies. She was understandably devastated, especially as she wanted a baby. After I had given her some time for the news to sink in, I suggested she have HRT, to help stop her flushes and sweats, to protect her bones, and also to help maintain her skin and hair. I told her that the dose of oestrogen was low, and that it would not stop her ovulating if her ovaries did start working again. She gradually seemed to come to terms with her fate and started thinking about adoption. However, two years later, she came to see me because she had not had her usual monthly HRT withdrawal bleed and, rather miraculously, she was pregnant. She went on to have a healthy baby boy. After her pregnancy, she immediately became menopausal again, and only had the one child.”
WHEN IS IT MENOPAUSE? THE FACTS
The menopause marks the time when a woman’s ovaries stop working. They no longer produce any eggs, periods stop and a woman’s fertile years are at an end. They also stop producing hormones, and the dramatic decline in oestrogen, in particular, can lead to flushes, sweats and mood swings.
• The average age at which the menopause occurs is 51, but it’s normal for it to happen five years on either side of this. Occasionally the menopause occurs before the age of 46, in which case it’s known as a premature menopause. Occasionally it can occur at a much earlier age, often because the body’s immune system develops antibodies that attack ovarian tissue.
• The ovaries may work in a very erratic way in the run-up to the menopause, causing erratic and sometimes heavy periods, often with really bad accompanying premenstrual syndrome (PMS). This time is known as the perimenopause , but it rarely lasts more than a couple of years.
• It’s normal for the menstrual cycle to become a little shorter after a woman has turned 40, with periods occurring every 26 days instead of 28. This change does not signify you are approaching the menopause.
• Testing to see if you are in the perimenopause can be very difficult, as the ovaries work so erratically and hormone levels change from day-to-day.
• There is no accurate way of predicting when you are going to become menopausal, though some factors – such as smoking, a family history of earlier menopause, or having your womb removed – can mean you are slightly more likely to have an earlier menopause than the average woman.
Extracted from Menopause – The Answers by Dr Rosemary Leonard, published by Orion Spring, £14.99. To buy the book click here.