Menopause Treatment London - Women's Wellness

Medically Reviewed April 2023, by Mr. Bryan Mayou (GMC: 1414396) - founder of the Cadogan Clinic and one of the world's leading plastic surgeons

What is Menopause?

Menopause is when a woman’s periods stop as a result of falling hormone levels. This usually happens somewhere between the ages of 45 and 55, but can occur sooner, for example after a surgery to remove the ovaries (oophorectomy) or cancer treatment. Sometimes a woman may go through menopause early for no apparent reason. The period before menopause when hormone levels are falling is called perimenopause.

These falling hormone levels can cause menopause symptoms such as hot flushes, reduced sex drive and weight gain. These symptoms can vary in severity and can sometimes impact on your work and cause relationships to become strained.

Fortunately there are treatments available to replace the lost hormones, via pills, patches, implants or gels. If you would rather not use hormones, there are other medications that can be prescribed to alleviate menopause symptoms, such as hot flushes and mood swings.

It is important to remember that help is available and women are no longer expected to just ‘put up’ with menopause symptoms, particularly those which are having an adverse impact on your day-to-day life.

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What are the signs and symptoms of Menopause?

There are a number of menopause signs and symptoms, some which may be more familiar to you than others. A menopausal woman may experience one or more of the following:

Hot flushes: A hot flush is a sudden feeling of warmth on the upper body, which may result in dizziness, sweating and the skin turning red, as if blushing. Hot flushes commonly affect the face, chest and neck. They often come on without warning. Sometimes after an intense hot flush you may feel coldness.
Not all women experience hot flushes during menopause, although many do. There is nothing you can do to prevent a hot flush from occurring, but avoiding triggers that may make them more severe or more frequent can help. These triggers include spicy foods, caffeine, alcohol, stress and cigarette smoke.
Vaginal dryness: Vaginal dryness is caused by a change in oestrogen levels which can affect vaginal lubrication. Vaginal dryness can make it difficult or painful to have vaginal sexual intercourse. Vaginal dryness can also cause itching.
Urinary tract infections (UTIs): Falling oestrogen levels alter the pH levels in the vagina, increasing the likelihood of urinary tract infections developing.
Reduced sex drive (reduced libido): A drop in levels of oestrogen and testosterone during menopause can often lead to a reduced sex drive. Some women find that they get less aroused during foreplay than before, which can also lead to a lack of interest in sex.
Weight gain: Menopause affects how the body stores fat, which can lead to weight gain and a change in body shape. In menopausal women, excess weight settles around the stomach, rather than being evenly distributed around the body.
Mood changes: Menopause can affect your mental health and wellbeing as well as your body. Fluctuating hormone levels may cause mood swings, anxiety or a general low mood.
Difficulty sleeping (insomnia): This may be as a result of night sweats, another common menopause symptom. Broken or missed sleep can exacerbate other menopause symptoms, for example by making mood swings even worse.
Memory and concentration problems: Menopausal women often find that they become more forgetful or struggle to concentrate and focus on certain tasks. This is often referred to as ‘brain fog’ and is a common menopause symptom.
Skin changes: Collagen is the protein which gives our skin its elasticity. As we get older, our collagen levels drop, causing the skin to sag and wrinkle. During menopause, the skin gets a lot drier and more itchy.
Palpitations: Menopause can cause palpitations, which is where your heartbeats suddenly become much more noticeable. Palpitations are often prompted by a hot flush.
Headaches and migraines: It is common for women to experience headaches and migraines linked to their menstrual cycle. These usually occur when the oestrogen levels drop at certain points of the cycle. Hormonal headaches usually worsen as you approach the menopause because the hormone cycle is disrupted.
Aching joints and muscles: Falling oestrogen levels can affect joints and the connective tissue that 'glues' the bones together, resulting in aches and stiffness in the joints and muscles.

What are the stages of Menopause?

There are three stages of menopause: perimenopause, menopause and postmenopause.

Perimenopause: At the perimenopausal stage, you have started to experience menopause symptoms, such as hot flushes, sleep problems and mood swings, but you are still having menstrual periods, although these may be becoming more irregular. These changes may come on gradually and sometimes women experience them and do not necessarily associate them with perimenopause. The average length of perimenopause is four years, but this figure varies from woman to woman.
Menopause: Once you have gone for 12 consecutive months without a menstrual period, then you have officially reached the menopause.
Postmenopause: Once a women has finished the menopause and the menopause symptoms may be improving, this is known as the postmenopause stage. Once you are postmenopausal, you are no longer ovulating and cannot get pregnant and women at this stage are at an elevated risk of certain health conditions, such as osteoporosis (brittle bones) and heart disease. Once you have entered the postmenopausal phase, you will stay there for the rest of your life.

What treatment options are available for Menopause?

There are a number of different treatment options available for women going through the menopause.

Hormone replacement therapy (HRT)

HRT uses oestrogen to replace the body’s falling hormone levels and relieve most menopause and perimenopause symptoms, including hot flushes, vaginal dryness and mood swings. By taking HRT, you should notice an improvement in your hot flushes and night sweats within weeks. However other symptoms such as vaginal dryness and mood swings can take longer to improve.

There are different types and doses of HRT and the treatment comes in tablet form, a gel or spray that can be applied directly to the skin, skin patches or an implant.

Women who have been through the menopause and still have their uterus (womb) will also need to take the hormone progesterone to protect the uterine lining from the effects of the oestrogen. A treatment that involves taking oestrogen and progesterone is known as combined HRT.

Progesterone comes as tablets, an intrauterine system (IUS or coil) and patches.

Taking HRT can reduce the risk of hormone-related health problems developing, including osteoporosis (brittle bones) and heart disease.

Testosterone gel

If you are suffering from a reduced sex drive related to menopause and HRT is not helping, you may also be offered testosterone gel or cream. It can be used alongside HRT and can help improve sex drive, energy levels and overall mood.

Vaginal oestrogen

Vaginal dryness is a common complaint during the menopause. Your doctor may prescribe oestrogen treatments that can be applied directly to vagina, such as cream, tablet or ring. The hormone in these treatments only works on the affected part of the body. The hormone will not get into your bloodstream. You can use vaginal oestrogen alongside HRT.

Some women choose to take HRT or another hormone treatment once they have reached menopause. Not all women do, and it is entirely your choice. If you decide not to have hormone treatment, there are alternative medications that can treat menopause symptoms, such the drugs Clonidine and Gabapentin to treat hot flushes and night sweats and antidepressants to help with anxiety and mood disorders. Some women also find that talking therapy, such as cognitive behavioural therapy, can also help.

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Mr. Yasser Diab

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Frequently Asked Questions

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Is there a test for Menopause, how is it diagnosed?

To date there is no effective menopause test. The condition is often self-diagnosed. You should note down all your symptoms and speak to your doctor, who should be able to make a diagnosis based on that information. They will then be able to discuss next steps with you.

What are the symptoms of pre-Menopause?

The symptoms of pre-menopause, or perimenopause, are similar to menopause symptoms and include irregular periods, changes in sexual function, sleep problems, hot flushes, mood changes and vaginal and bladder problems. Not all perimenopausal women will experience all of these symptoms.

How long does Menopause last?

Menopause symptoms may go on for several months or even several years and this varies from person to person. The menopausal transition takes around seven years, but it may take as long as 14 years. Symptoms may change or fluctuate over this time frame.

What exactly does HRT do?

Hormone replacement therapy (HRT) does exactly what it says - it replaces the hormones that are at a low level. HRT may include oestrogen-only medication, oestrogen and progesterone combined or testosterone. Your doctor will recommend which combination of treatments is right for you.

What happens when you start HRT?

When you start HRT, you will start on a low dose that may be increased over time. You may feel some side effects at the beginning of your treatment, such as breast tenderness and headaches, before the HRT starts to alleviate your menopause symptoms. If after three months your treatment is not helping, then your doctor may recommend trying a different one.

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Menopause