We ask experts to sort the menopause fact from fiction to help you navigate this transition
One in three UK women[1] is currently going through the menopause and yet it's often misunderstood, leading to women handling the signs and symptoms on their own, potentially causing anxiety around what's normal and confusion around when to reach out for help.
"Menopause signifies the end of your menstrual cycle, which is 12 months after your last period," explains Dr Zahra Ameen, consultant gynaecologist and obstetrician at the Cadogan Clinic. "Menopause happens when the ovaries produce significantly less oestrogen as we get older."
Signs and symptoms can range from hot flushes to low mood and muscle aches to joint pains, which can take their toll on day-to-day life. With 44% of menopausal women in employment saying their ability to work has been affected by their symptoms[2], we speak to the experts to help debunk some of the most common myths surrounding the menopause, so that when it happens to you or someone you love, you know what to expect.
Myth #1: menopause only happens after 50
"Menopause usually occurs between the ages of 45-55, but it can vary dramatically from person to person," says Dr Ameen.
The average age for a woman to reach the menopause in the UK is 51[3]. But this age is only a guide.
"Premature menopause – otherwise known as primary ovarian insufficiency – is defined as menopause occurring before the age of 40 years," Dr Ameen continues.
"It’s estimated that premature menopause affects 1% of women under the age of 40 and as low as 0.1% under 30, with 5% of women experiencing menopause before the age of 45[4]."
Dr Sarah Welsh, gynaecology doctor and co-founder of Hanx, adds: "There are certain factors that can influence earlier menopause, such as medical conditions, surgical procedures like removal of the uterus (a hysterectomy) and cancer treatment (chemotherapy). However, we aren’t always able to pinpoint the reason for an early or late menopause."
Myth #2: menopause starts when your period stops
"Perimenopause is the stage before the menopause and before the periods stop," says Dr Sohère Roked, a GP and hormone and integrative medicine doctor.
"It usually lasts for a couple of years, but may go on for longer and is often more difficult to manage as periods can be more frequent or irregular and fluctuating hormones may affect mood and energy."
Dr Ameen adds that perimenopause can commence several years before menopause itself, when in your 30s, but most often over the age of 40[5]. "Perimenopause presents variably with changes to the menstrual cycle – they may become longer or shorter, lighter, heavier or women may begin to skip periods," she says.
"Common symptoms of perimenopause are hot flashes, sleep disturbance including night sweats, changes to vaginal discharge, reduced libido and mood swings. Hormonal imbalances can also cause thinning hair on the head in perimenopausal women and, in some cases, more hair on the face[6]."
It’s important to note that some signs of menopause might be symptoms of an underlying medical condition, so contact your GP if you’re experiencing any of these changes in isolation.
Myth #3 : you can’t get pregnant
"It’s important to remember you can still get pregnant during perimenopause and menopause," advises Dr Welsh. "As long as you’re still having periods, you can conceive."
So, remember to use an effective, safe and suitable method of birth control until menopause is confirmed to avoid an unplanned pregnancy[7].
"Contraception should be used until two years after the last natural menstrual period in women under the age of 50, and one year after the last period after 50 years[8]," says Dr Welsh.
Myth #4: menopause symptoms last forever
Symptoms tend to start months or years before your periods stop, rather than lasting forever. "Perimenopause, the period ahead of the menopause occurring, is different for every person in terms of both symptoms and timespan," says Dr Welsh. "The average length tends to be four or five years," she adds. It can last up to between 10 and 13 years in some people though[9].
Symptoms usually continue for around four years after your last period, though for some they can continue for longer (but, to reiterate, not forever)[10].
Myth #5: hot flushes are all in your head
"Hot flushes are very real and are caused by a decline in oestrogen, in response to glands releasing higher levels of other hormones, which affect the brain’s thermostat, thus causing a sudden fluctuation in body temperature," explains Dr Ameen.
Dr Welsh adds: "They’re characterised by a sudden feeling of warmth in the upper body, which can be intensely focused around the face, neck and chest. It’s sometimes accompanied by redness and sweating. Some women experience them once a day, whereas others get them multiple times throughout the day and even at night, disrupting sleep."
Myth #6: you’ll never want to have sex again
While the experts concede that decreased levels of oestrogen and testosterone can lead to a diminished sex drive[11], it’s not usually for forever – and in some cases, the opposite is true.
"It’s common to see changes to your sex drive during the menopause, as oestrogen levels drop," explains Dr Welsh. ‘Many find that this, combined with physical discomfort caused by vaginal dryness and other symptoms, such as mood swings or night sweats, negatively impact their sex drive.
"However, others may find they have a higher sex drive, especially when their periods stop. Some people report that the feeling of relief that they don’t have to worry about pregnancy postmenopause has a positive impact on their desire."
If this is you, it’s worth bearing in mind that, during the menopause, vaginal tissue can become more dry and fragile, making you more susceptible to injury or tearing, especially during sex.
"A natural vaginal lubricant can help relieve irritation or soreness on a day-to-day basis," says Dr Welsh. "Make sure to check the ingredients list for glycerine, as this can actually dehydrate and damage your vaginal tissue more, plus potentially lead to yeast infections[12]."
Myth #7: symptoms are purely physical
"Mood changes are common in menopause and often seem to be low mood or anxiety," says Dr Sohère. "Of course, this can have many different causes, but if you are going through the menopause, it should also be considered that some of your symptoms may be hormonal."
Speak to your GP if you’re concerned as they can refer you for psychological interventions or prescribe medicine if deemed appropriate.
Other options include cognitive behavioural therapy, a talking therapy that can also help with some physical symptoms, such as hot flushes and joint pain, alongside low mood and anxiety[13].
Myth #8: weight gain is inevitable
"Menopausal weight gain is not inevitable," Dr Welsh reassures. "During and after perimenopause, your oestrogen levels wane, causing a slowing of your metabolism and reduction of muscle mass."
"This can lead to unconscious weight gain. If this is of concern, maintain your portion sizes and get moving more in your daily life. Resistance activities, such as weights or swimming, can be highly effective alongside a balanced diet, and have a broader positive impact on your health and wellbeing[14]."
Myth #9: you’re forgetful because you’re getting old
While forgetfulness can sometimes be put down to age, it can also go hand in hand with the menopause, especially if you’re experiencing other menopausal symptoms. "Some women experience brain fog or forgetfulness," says Dr Ameen. "Sleep disturbance can contribute to this and the changing levels of oestrogen, which help with brain processes such as memory, language skills, attention and mood[15]. Employing good lifestyle habits, such as good-quality sleep, regular exercise and a healthy diet can be beneficial."
Myth #10: you just need to get on with it
There are steps you can take that may help minimise the impact menopause symptoms will have on your body and life, and there's help out there for those who need it.
"Making healthy lifestyle choices is always a good place to start," says Dr Ameen. "Exercise may boost serotonin levels, while maintaining a healthy diet, avoiding alcohol and drinking lots of water to stay hydrated may also be beneficial. Some people also find mindfulness and meditation beneficial."
It's also worth considering hormone replacement therapy (HRT). This treatment can help relieve the symptoms of menopause, such as hot flushes, night sweats, mood swings, vaginal dryness and reduced libido.
Speak to your GP who can assess whether HRT is suitable for you and your needs.
Alternatively, you may want to consider the Boots Online Doctor Menopause and HRT Treatment service*, which provides access to advice and treatment, if appropriate.
Found this helpful? Find out how menopause could be affecting your skin in our guide.
*Access to prescription-only medicine is subject to a consultation with a clinician to assess suitability. Subject to availability. Charges apply.
[1] https://www.lboro.ac.uk/internal/news/2021/may/the-menopause/
[2] https://www.fawcettsociety.org.uk/news/landmark-study-menopausal-women-let-down-by-employers-and-healthcare-providers
[3] http://www.bridgewater.nhs.uk/wp-content/uploads/2014/02/The-Menopause-what-to-expect-when-you-are-expecting-the-menopause.pdf
[4] https://www.nhsinform.scot/healthy-living/womens-health/later-years-around-50-years-and-over/menopause-and-post-menopause-health/early-and-premature-menopause#:~:text=Premature%20menopause%20is%20estimated%20to,ovaries%20aren't%20working%20properly.
[5] http://www.bridgewater.nhs.uk/wp-content/uploads/2014/02/The-Menopause-what-to-expect-when-you-are-expecting-the-menopause.pdf
[6] http://www.bridgewater.nhs.uk/wp-content/uploads/2014/02/The-Menopause-what-to-expect-when-you-are-expecting-the-menopause.pdf
[7] https://www.menopause.org/for-women/sexual-health-menopause-online/reminders-and-resources/contraception-you-need-it-longer-than-you-may-think
[8] https://www.womens-health-concern.org/help-and-advice/factsheets/contraception-older-woman/#:~:text=Contraception%20should%20be%20continued%20until,be%20continued%20until%20age%2055.
[9] http://www.bridgewater.nhs.uk/wp-content/uploads/2014/02/The-Menopause-what-to-expect-when-you-are-expecting-the-menopause.pdf
[10] https://www.ageuk.org.uk/information-advice/health-wellbeing/mind-body/6-things-to-know-about-the-menopause/
[11] https://www.nhs.uk/conditions/menopause/symptoms/
[12] https://patient.info/news-and-features/is-your-lifestyle-giving-you-thrush#:~:text=Some%20lubes%20contain%20irritating%20ingredients,infections%2C%20especially%20after%20sex.%22
[13] https://www.nhs.uk/conditions/menopause/treatment/
[14] https://www.nhsinform.scot/healthy-living/womens-health/later-years-around-50-years-and-over/menopause-and-post-menopause-health/after-the-menopause/#:~:text=Some%20women%20will%20experience%20weight,body's%20ability%20to%20burn%20calories.
[15] https://www.womens-health-concern.org/help-and-advice/factsheets/menopause-and-insomnia/#:~:text=The%20menopausal%20decline%20of%20estrogen,sleep%20and%20early%20morning%20wakening.
