Whilst we all know about hot flushes and night sweats, did you know that anxiety and low self-esteem can get much worse around menopause? HRT can work better than antidepressants for women around menopause.
According to the National Institute of Health and Care Excellence (NICE), women may experience low mood (mild depressive symptoms that impair quality of life but are usually intermittent and often associated with hormonal fluctuations in the perimenopause) or depression. Women with a past medical history of depression are at risk of recurrence during menopause transition. There is also an established link between post-natal depression and depression around menopause.
“Be vigilant as menopause approaches and seek help early if you know you experienced a particularly tough time with your mental health after having a baby.”
HRT: Risks v benefits
- If you are fit and well and suffering menopausal symptoms, the benefits of HRT outweigh the risks until the age of 60.
- There is no longer an absolute age limit on when to stop HRT. A yearly review is recommended to ensure that for you, the benefits continue to outweigh the risks.
- If your periods have stopped under the age of 40, some form of hormone replacement until at least the natural age of menopause is recommended. Unless you have been told that there is a specific reason that you are unable to do so, the health benefits outweigh the risks.
- Have you been told you can’t have HRT? There are plenty of prescribable alternatives to HRT available.
- HRT is not the only option, but one of several that may help. Cognitive Behavioural Therapy (CBT) has also been shown to help with low mood and anxiety during menopause.
Menopause and the brain
- Falling oestrogen levels during perimenopause can reduce serotonin, a key chemical in the brain linked to mood. This may explain why some women experience symptoms like anxiety or low mood. Although common, these feelings are treatable and you’re not alone.
- ‘Word finding’ difficulties are a really common symptom of menopause. It gets better.
- Have you noticed your ability to pack the boot of the car has changed? Have you found your brain just can’t work out that Rubik’s cube anymore? We need good spatial ability for these tasks. This commonly gets worse around menopause. The good news is that it improves again.
Menopause and osteoporosis
- Once our periods stop, our bones will begin to become thinner.
- Osteoporosis is bone thinning, which means you are more likely to break bones easily. Think of a healthy bone as a honeycomb-based chocolate bar which becomes more like one full of little bubbles (you know what we mean) over time – not as strong and more likely to snap or crush.
- Osteoporosis happens to about one in five women. The younger you are when your periods stop, the more likely you are to get it. Getting enough calcium in your diet, taking regular weight bearing exercise and using HRT all help keep your bones strong.
Menopause symptoms
- The average age for periods to stop is 51 years, but most women start to be aware of symptoms in their late forties.
- Symptoms can start a good 10 years before your last period. If you think your hormones are changing then they are probably changing. Remember, you know your own body best.
- The perimenopause or lead up to your last period can be the worst time for many women.
- Premenstrual syndrome often gets worse or may hit for the first time in your forties. This is due to the body working harder to produce an egg. The result is a roller coaster of hormones. This is what drives those wild mood swings.
- Some women flush well into later life.
- This is a time of adjustment, for mostly women it will get better in two to seven years. It doesn’t go on forever.
Menopause and sex
- You can still get pregnant once your periods have stopped. The simplest approach may be to assume you’ll need contraception up to your 56th birthday.
- Contraception is recommended for at least one year after your last period if you are over 50 and at least two years if you are under 50.
- It is normal to get less wet with sex. This is called vaginal dryness. It is very common.
- Vaginal oestrogen is a brilliant solution and is very safe for most people. It ‘plumps up’ the vaginal skin allowing it to produce your natural lubrication again. Goodbye ‘sandpaper’ sex.
- Sex with lube is the key to comfort. Oil-based lubricants work much better than water based. There are good products easily available online or in the chemist. If you are using condoms then you must stick to water-based lubricants only.
- Coconut oil that you use for cooking is a good oil-based lube; just pop a chunk inside the vagina and it will melt providing a simple home-based solution.
If you’re struggling with your mental health during menopause, talk to a healthcare professional. There are effective treatments available, from HRT to talking therapies.
This resource has been reviewed and revised by Anthony Singh.
