It’s not the end of the world – it’s perimenopause

Go on social media for information on menopause and it’s easy to think you’re headed for hell, your life upended by uncontrollable weight gain, insomnia and memory loss. Or you’ll read that menopause is a reminder of ageing and mortality – even though turning 50 in the 21st century can mean you’ve another four or even five decades to go.

“Social media is bombarding women with misinformation and messages about how bad menopause is,” says Professor Martha Hickey, professor of obstetrics and gynaecology at the University of Melbourne.

“It’s true that an estimated 14 per cent of women have severe hot flushes and night sweats, but we’re not hearing from women with either no symptoms or less severe symptoms. About a third of women have moderate hot flushes while others have mild or no symptoms – and many women also report a new-found freedom from managing menstruation and contraception.”

Evidence suggests that women who hold negative expectations of perimenopause are more likely to have a hard time.Credit: Getty Images

Hickey works at the menopause coalface, treating women with complex menopause problems at the Royal Women’s Hospital in Melbourne. She was also lead author of a paper published last year in medical journal The Lancet, which urged an end to stigmatising menopause as a time of decline, and blaming its symptoms on hormonal changes alone – with Menopausal Hormone Therapy (MHT) as the best solution.

“There’s good evidence that hot flushes and night sweats are caused by hormonal changes, but much less evidence they cause other symptoms,” she says. “Lifestyle factors, along with stress related to midlife issues like raising teenagers, concerns for ageing parents and the demands of work, can all contribute too.”

And making women dread menopause doesn’t help.

“There’s evidence that women who go into menopause with negative expectations are more likely to have a difficult time,” she adds. “Menopause is a normal life stage, and providing women with support and balanced information will often help them navigate it.”

Hot flushes

“Hot flushes start when a drop in oestrogen disrupts the part of the brain regulating temperature, so treatments that work on the brain like MHT, or psychological interventions like hypnosis and cognitive behaviour therapy, can effectively reduce their impact,” Hickey says. “But smoking and being overweight can make hot flushes worse, while stress and alcohol can trigger them for some women.”

Problems with sleep

“Night sweats are the night-time version of hot flushes and can disrupt sleep. Some women say that they can cope with hot flushes during the day but not at night,” Hickey says. “Sleep is complicated, and whether menopause contributes to poor sleep beyond night sweats isn’t clear. But again, cognitive behaviour therapy can help.”

Other factors that can disturb midlife sleep include stress (your teenager’s still out and it’s 2am), and alcohol, which can send you to sleep but then cause you to wake up during the night, says Jean Hailes for Women’s Health.

Weight gain

Menopause itself doesn’t add kilos, though symptoms such as lack of sleep can make it harder to stick to a healthy weight. But hormone changes can mean you store weight differently, with extra fat settling around the middle instead of hips and thighs. In post-menopausal women, belly fat can account for 15 to 20 per cent of total body fat, compared with 5 to 8 per cent before menopause.

Age-related muscle loss can also increase weight. Losing muscle slows your metabolism, meaning your body burns fewer kilojoules, making it harder to keep weight off, says Professor Robin Daly, chair of exercise and ageing at Deakin University’s Institute for Physical Activity and Nutrition.

Maintaining or building muscle strength through weight training will help with weight gains typical during menopause.Credit: iStock

But there’s an antidote. “Our research with post-menopausal women found that four months of twice-weekly strength training was enough to rebuild most of the muscle they’d lost in the previous seven to eight years,” he says.

Memory loss

Brain fog – being easily distracted and having difficulty concentrating, for example – is common. But whether it’s because of hormone changes is uncertain, Hickey says. “The few studies conducted show small changes in memory during perimenopause that recover after menopause. There’s no evidence to suggest cognitive decline or any association with later cognitive issues like dementia. It’s likely that pressures in midlife and sleep difficulties are contributing.”

Mood changes and mental health

Low mood affects some women at menopause, but it can be difficult to untangle the cause. Lack of sleep and stress related to juggling family and work can have an effect. Suggested coping strategies range from practising mindfulness and getting more exercise to seeking therapy.

As for a higher risk of problems such as anxiety and depression, a review of studies of menopause and mental health last year found no universal increased risk, Hickey says.

“Although it’s possible that women with a history of depression might have a recurrence during menopause, and that women with severe menopause symptoms might have a higher risk,” she says.

Changes to the vagina ...

It’s one thing to be upfront about hot flushes, but if there’s one post-menopausal topic we don’t broadcast, it’s that cause of sandpaper sex – less lubrication in the vagina and vulva that affects some women after menopause. Low levels of oestrogen mean these tissues get thinner and lubrication scantier, sometimes making sex painful.

“But it doesn’t happen overnight,” says Dr Judith Hammond, a GP working with Jean Hailes for Women’s Health in Melbourne. “It’s a gradual process over time, although during perimenopause, when oestrogen levels can go up and down, levels of lubrication can fluctuate, so there may be times when you’re more lubricated than others. But menopause may not be the only culprit. If you’re feeling stressed during sex for some reason, you won’t lubricate as well.”

There are also other ways to stay lubricated, she adds, including over-the-counter vaginal moisturisers, silicone-based personal lubricants, and prescription vaginal oestrogen. Very little oestrogen from vaginal oestrogen products is absorbed, and it’s considered safe for most women – check with your doctor.

… and the bladder.

The same hormone changes can affect the bladder, making you need to pee more often, or more urgently, Hammond says. Again, vaginal oestrogen may help (and reduce the risk of recurrent UTIs). Strengthening pelvic floor muscles helps too – a specialist physiotherapist can show you how.

The ups and downs of libido

Menopause isn’t the death knell to good sex. A 2015 study found about 73 per cent of 57- to 64-year-old women reported an active sex life. You’ll hear that shifting hormone levels at menopause can cause a drop in libido, but there’s not much evidence for this, Hickey says. Besides, as Judith Hammond says, issues such as stress, fatigue, painful sex and the quality of your relationship can have an effect.

“How women experience menopause is very individual, and for some women, it’s business as usual.”

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