What is menopause?

What is ‘perimenopause’?

The ‘perimenopause’ refers to the years directly before menopause when hormones start to decline and the classic symptoms, such as changes to your regular cycle and hot flushes, occur. This stage can last for a variable number of years, often around four or more.

What is the average menopause age?

The average age of the menopause in the UK is 51 but it’s important to stress menopause does not only affect women in mid-life. About one in 100 women will go through the menopause before the age of 40, and one in 1,000 before the age of 30. This is known as premature ovarian insufficiency.

What are the symptoms of menopause?

During the menopausal transition, levels of oestrogen and progesterone, two hormones made by the ovaries, vary greatly. While both these hormones are important, oestrogen is crucial for every cell in your body, which is why the perimenopause may trigger literally dozens of symptoms including:

• Changes to periods, often an early sign of perimenopause
• Hot flushes and night sweats (about 3 in 4 women will suffer from these)
• Fatigue
• Psychological symptoms such as mood changes, anxiety and poor concentration/brain fog
• Low libido
• Weight gain
• Headaches and worsening migraines
• Vaginal dryness
• Dry and/or itchy skin
• Thinning hair and excess facial hair
• Recurrent urinary tract infections (UTI)
• Sleep disturbances

What are the signs of early menopause?

Early menopause happens when a women’s periods stop before she reaches the age of 45; it may happen naturally or as a side effect of medical treatment.

The main symptom is that your periods become more infrequent or stop altogether. Some women may also experience the classic symptoms associated with menopause.

How long does menopause last?

Although the menopausal transition is commonly referred to as ‘menopause,’ your true menopause is a single point in time – 12 months from your final period. After this you enter post-menopause, and it’s at this stage women become more vulnerable to conditions like heart disease and osteoporosis.

Are there menopause treatments?

Deciding how to treat the symptoms of menopausal transition is very personal and can often be complicated. You will need to discuss your specific symptoms, family and medical history as well as your preferences with your doctor, and be prepared to review your treatment plan regularly.

Hormone replacement therapy (HRT) is often the first-line treatment for menopausal symptoms. As the name suggests, HRT replaces the hormones that your body is no longer producing at the same levels as it did. HRT may improve symptoms and help protect against the long-term health risks associated with this life stage, such as osteoporosis, cardiovascular disease and diabetes.

Oestrogen is the main hormone prescribed to alleviate menopausal symptoms. If you’ve had a hysterectomy, this may be all you need; if not, then oestrogen and progesterone are used together. HRT is available in different forms and dosages – you may be prescribed pills, patches, gel, a spray or an intrauterine device (IUD). It is quite normal to need to try different dosages and methods to find the right combination that works for you.

Other options include topical vaginal oestrogen, which may help ease vaginal dryness, while testosterone may be helpful for women who are still experiencing symptoms like fatigue, brain fog or low sex drive even though they have been taking HRT for a few months.

Can diet and lifestyle changes help relieve menopauses symptoms?

Menopause is a natural life stage that affects women differently but what it does for all of us is offer the opportunity to make positive changes to improve your diet and lifestyle. In the immediate term these may help manage your symptoms and in the longer term improve your overall health.

Following a balanced diet with regular exercise plays an important role in managing menopause symptoms and safeguarding your long-term health. Individualised treatment, regular exercise (particularly bone-strengthening exercises such as walking), good nutrition and relaxation are all key.

What are the best foods for menopause?

At this time in your life, your body begins to use energy differently, fat cells change and you may notice that you gain weight more easily. Eating the right types of food may help combat fatigue and boost energy levels. A good starting point is to follow the principles of the Mediterranean diet – this way of eating is high in vegetables, nuts, beans, cereals, fish (or other sources of omega-3 oils) and unsaturated fats such as olive oil.

In conjunction with this, it’s a good idea to focus on carbohydrate foods that have a low-GI (glycaemic index), these release their energy in a more moderate way and as a result help stabilise blood sugar levels. Examples include wholemeal bread, brown rice, pulses and legumes. You might also find smaller, more regular meals help regulate your mood.

Another popular dietary inclusion are foods rich in phytoestrogens, these are plant nutrients that mimic the effects of oestrogen in the body and are useful in the early years of menopause. That said, it’s never too late (or too early) to add them to your diet – although you may need to be patient as it can take 2-3 months before you see any benefits. You'll find them in plant foods like flaxseed, fermented soy products (like tamari, miso and tempeh) as well as beans and pulses, including lentils and wholegrains.

Our bodies convert these plant nutrients into oestrogen-like compounds with the help of friendly bacteria that live in our gut, so it’s important to maintain good gut health. This is thought to be one reason why some women benefit more than others.

Read more about what to eat to ease menopause.

Is there a link between gut health and menopause symptoms?

Yes, there is. The evidence supporting the link between our gut and health is advancing at pace, particularly in the area of hormonal health. The ‘estrobolome’ is a collection of bacteria that live in our gut and play an important role in balancing oestrogen levels. They do this by secreting an enzyme that metabolises oestrogen into its active form. When our gut bacteria are out of balance, they may be unable to do this and as a result we may experience lower levels of circulating oestrogen. Sadly, an imbalance of gut bacteria is very common and can come about because of our genetics, age, weight, diet, alcohol intake and even prescribed medication, like antibiotics.

The health and diversity of our gut bacteria also play a part in how well we use the phytoestrogens in our diet. Studies suggest this is because we need specific gut bacteria to convert these plant nutrients into the active form we need.

What foods should I eat to support my gut health?

The main foods for gut health are classified as ‘prebiotic’ and ‘probiotic.’ Prebiotic foods feed the beneficial bacteria in the gut and help them thrive and increase in number. These foods include fibre-rich, brightly-coloured fruit, vegetables and grains. Aim to include a variety of foods such as garlic, onions, asparagus, chicory, ginger, cabbage, beetroot and blueberries.

Probiotic foods contribute live bacteria and yeasts that may help restore the natural balance of bacteria in the gut – these include kefir, live yogurt, kombucha, sauerkraut and kimchi. Eating both pre- and probiotic foods regularly as part of a varied, balanced diet is key to sustaining gut health. As a result it may also support hormone levels, energy and weight, and may improve your mood, too.

What are the best vitamins and minerals for menopause?

All vitamins and minerals play an important role in maintaining health and well-being during the peri- and post-menopause years. However there are some key nutrients that may help address the increased health risks associated with this stage of life.
These include calcium and vitamin D, as well as vitamins C and K which are all important for bone health. Evidence also suggests magnesium may provide symptom relief, including those of cramping, migraine and disturbed sleep.

What are the best supplements for menopause?

The menopausal transition affects each woman uniquely so there is no ‘one size fits all’ approach to supplement regimes. A balanced diet is essential. However, where adequate dietary intake is not achieved, supplementation may be considered – especially for women with malabsorption issues or deficiencies. For example, supplementing with vitamins C, D and K along with calcium may be recommended for bone health.

Many women benefit from the addition of a probiotic supplement. An oral formulation that includes bacterial strains such as Lactobacillus ssp, casei, helveticus, rhamnosus and reuteri may be especially useful because it may support calcium absorption, reduce vaginal pH and improve cardiovascular risk factors.

Botanical products are another popular choice, especially the likes of black cohosh, soy, red clover and St John’s wort. Studies suggest that black cohosh may be effective for reducing hot flushes and mood disorders. Evidence for soy and red clover is variable, however, with some studies suggesting minimal effects on menopausal symptoms but greater likelihood of reducing the risk of heart disease and improving bone density. St John’s wort has demonstrated efficacy for mood disorders related to the menopause as well as mild to moderate depression in the general population. However, there remains uncertainty about the appropriate dose, preparation and potential safety of some of these products and so, while more research is ongoing, adopting a healthier diet in line with dietary guidelines is the best current support before, during and after menopause.

If you are on prescribed medication, including but not limited to the contraceptive pill, SSRI anti-depressants or a blood thinner like warfarin, refer to your GP before taking a botanical supplement.

How can I best manage menopause symptoms?

It’s important to be aware of the symptoms of menopause and perimenopause, and if they are affecting your everyday life then speak to a healthcare professional about available treatments.

Keeping track of symptoms can be really beneficial: simply write them in a diary, track them on a smartwatch or access the free app, Balance. Balance allows you to log symptoms and create a personalised health report to take to your medical appointments.

Other useful menopause resources:
Health and her
My meno plan
Menolabs
Menopause exchange

What meals could help ease my transition to menopause?

We asked clinical nutritionist Emma Ellice-Flint, who works alongside clinicians at the Newson Health Menopause and Wellbeing Centre, to pick some of her favourite recipes.

Roast sea bass & vegetable traybake
Acquacotta
Mediterranean fish gratins
Mediterranean-style bean salad
Vegetarian casserole
Layered aubergine lentil bake

Discover more like this

Why is the Mediterranean diet so healthy?
How to improve your sleep
The best calcium-rich foods
What supplements should I take?
Health benefits of exercise
Top probiotic foods

Dr Louise Newson is a GP and menopause specialist who campaigns for better menopause care for all. She is a No 1 Sunday Times bestselling author, founder of the free Balance app and The Menopause Charity.

Kerry Torrens BSc. (Hons) PgCert MBANT is a registered nutritionist with a post graduate diploma in Personalised Nutrition & Nutritional Therapy. She is a member of the British Association for Nutrition and Lifestyle Medicine (BANT) and a member of the Guild of Food Writers. Over the last 15 years she has been a contributing author to a number of nutritional and cookery publications including BBC Good Food. Find her on Instagram at @kerry_torrens_nutrition_

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