Active Menopause

Perimenopause is the transition leading up to the time before your periods stop, when you may have symptoms. The average time is 4 years, but this can vary. Normally, your GP can confirm a diagnosis of perimenopause based on your symptoms, but sometimes a blood test may be used, particularly if you are under 45 years.

Sometimes, women may experience early menopause. This is when your periods stop before the age of 45. If this happens before age 40 then this is known as 'primary ovarian insufficiency' (POI). Often the cause is unknown, but it can be related to genetic or autoimmune conditions, some cancer treatments (chemotherapy or radiotherapy) or surgical removal of the ovaries. It is more common in women who have a strong family history of POI.

Menopause refers to the day after which you haven't had a period for 12 consecutive months. This is due to a reduction in hormone levels (oestrogen and progesterone) as your ovaries stop producing eggs. The average age is 51 in the UK, but it can start much earlier, or much later than this.

Reduced levels of oestrogen in the body can cause most menopausal symptoms.

Every woman's experience of perimenopause and menopause is different, but some common symptoms include:

• Change in the normal pattern of your periods, for example they become irregular, during perimenopause
• Mood swings - such as low mood or irritability
• Odd taste in the mouth or the feeling of zaps under their skin.
• Mood swings - such as low mood or irritability
• Weight gain and changes in body shape
• Difficulty sleeping - which may be a result of night sweats and make you feel tired and irritable during the day
• Anxiety
• Brain fog - problems with memory or concentration
• Hot flushes - when you have sudden feelings of hot or cold in your face, neck and chest which can make you dizzy
• Exhaustion
• Joint pain, including stiffness and aches
• Perimenopause present as irregular menstruation while the menopause features a total absence of menstruation
• Low sex drive
• Vaginal dryness
• Headaches and migraines that are worse than usual
• Palpitations, when your heartbeats suddenly become more noticeable
• Increased risk of heart attack and high blood pressure during menopause due to the decline in oestrogen

Oestrogen offers some protection against coronary heart disease therefore reducing the risk of a heart attack. It helps to control your cholesterol levels and so reduces the risk of fatty plaques building up inside the artery walls.

During and after the menopause, a woman's body gradually produces less oestrogen than it used to. This increases your risk of developing heart disease or stroke due to increased cholesterol levels and blood pressure.

Regular physical activity of any type can offset some of these changes

(Source: Colpani V et al, 2018, Lifestyle factors, cardiovascular disease and all-cause mortality in middle-aged and elderly women: a systematic review and meta-analysis)

The decline in oestrogen production can affect the amount of calcium in your bones. This can decrease your bone density, leading to a condition known as osteoporosis.

It can also make you more susceptible to hip, spine, and other bone fractures. Many women experience accelerated bone loss the first few years after their last menstrual period.

Regular physical activity, particularly weight bearing, resistance exercise and low impact physical activity e.g. jogging can maintain bone density, preventing osteoporosis and the risk of fractures.

(Source: Shojaa M et al, 2020, Effect of Exercise Training on Bone Mineral Density in Post-menopausal Women: A Systematic Review and Meta-Analysis of Intervention Studies)

• Try to have 2-3 portions of food rich in calcium per day e.g., yoghurt, kale, tofu.
• Spend time outdoors to get sunlight on your skin as this helps to produce vitamin D. It is recommended to expose your skin to direct sunlight for around 10 minutes, once or twice per day, but avoid burning. Use at least SPF 30 and spend time in the shade in warmer months (11am-3pm).
• Consider taking a daily supplement containing at least 10 micrograms of vitamin D, especially during autumn and winter. Consider taking it all year round if you are: over 65 years, have dark skin from an African, African-Caribbean, or South Asian background, or if you have low sunlight exposure.

• Try to maintain a healthy weight. Being mindful of portion sizes helps to control the amount you eat.
• Reduce your intake of refined sugar and carbohydrates e.g., soft drinks, pre-made sauces, condiments
• Eat high fibre foods e.g., pulses (lentils, chickpeas), wholegrain breads and chia seeds.
• Reduce salt consumption by limiting salted snacks and ready meals.
• Eat at least 5 portions of fruit and vegetables, they can be fresh, frozen, canned or juiced.
• Reduce foods high in saturated fat e.g., red meat, fried fruits.
• Increase your uptake of monosaturated fats (healthy fats) e.g., avocado, some nuts (almond, peanut, brazil).

• Ensure you have good quality protein (either plant or animal based) as part of your meals.
• Plant based protein – edamame, quinoa, beans and legumes.
• Animal based protein – fish, eggs, lean meats e.g., chicken.