All you need to know about menopause from symptoms to sex life and brain fog

15 October 2023 , 15:07

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There are 13 million menopausal women in the UK [stock photo] (Image: Getty Images)

Of the 13 million women in the UK who are currently menopausal, 80 per cent report debilitating symptoms from brain fog and anxiety to hot flushes, sleeplessness and stiff joints. Little wonder nine out of 10 menopausal women say the menopause has adversely affected their work life and personal relationships.

But thanks in no small part to celebrities such as Davina McCall talking honestly about their menopause experience, the once taboo subject is now being openly discussed – and more women feel able to ask their doctors for help than ever before.

For World Menopause Day this Wednesday, we asked three of the UK’s leading midlife experts what every woman needs to know.

Tania Adib works at The Lister Menopause Clinic in London (DAILY MIRROR)

Davina McCall has been praised for her candid discussions about the menopause (Instagram)

Is it perimenopause or menopause?

“Medically speaking, menopause doesn’t occur until you’ve had 12 consecutive months without a period,” says Ms Tania Adib, consultant gynaecologist at The Lister Menopause Clinic in London. “The average age for this to happen in the UK is 51.

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But what many are only just starting to fully recognise is that it’s the perimenopause – which can start up to 10 years earlier – that is often the most debilitating time for women. That’s because it’s during this phase that hormone levels begin to decrease.”

Progesterone is the first hormone to drop, triggering the earliest symptoms including insomnia, irregular bleeding, anxiety, irritability and fatigue. Then, during late perimenopause, the ovaries start producing less oestrogen, which causes hot flushes, vaginal dryness, bladder problems and diminished libido.

“And while things often settle once the menopause itself happens, for 20 per cent of women these symptoms continue even after periods have stopped,” says Tania.

Is brain fog inevitable?

Last month Happy Valley star Sarah Lancashire, 59, opened up about this unsettling menopause symptom. “I’ve got brain fog,” she said. “I was in Sainsbury’s the other day, and I found myself just stood there in the aisle and couldn’t remember what I was there for. It just comes over you all of a sudden.”

And the BAFTA winner is not alone. Research has found that 60 per cent of women have problems with memory and concentration during menopause and perimenopause. This is due to both the drop in oestrogen affecting the oestrogen receptors that help different areas of the brain communicate, and the decrease in progesterone, which triggers memory problems and insomnia.

Sarah Lancashire stars in BBC drama Happy Valley (BBC/Red Productions)

“But not all women will have brain fog – just like we don’t all get PMS,” says Professor Hana Burianova, a cognitive neuroscientist. "What’s important if you are suffering is to know there are ways to ease it. Hormone Replacement Therapy (HRT) can help by replacing the lost hormones, as can exercising more. Starting a regular sleep regime of going to bed and rising at the same time is beneficial too, as sleep is when the brain gets ‘cleaned up’ so it can function better the nextday.”

Stimulating the brain during routine activities – rather than being on autopilot – can also help ease brain fog, Professor Burianova adds. “Try taking a different route to work or the shops, for example, being more mindful of your surroundings and consciously slowing down.”

Will it ruin my sex life?

It can certainly have an impact, says Tania. “Problems can start years before your periods stop with vaginal irritation and painful sex as the drop in oestrogen causes dryness. Plus your sex drive can suffer as a result of decreasing hormone levels and other menopausal factors such as tiredness and low mood.”

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Professor Hana Burianova (DAILY MIRROR)

Problems to your sex life can start years before periods stop (Getty Images)

In all cases, traditional HRT can help – in the form of oestrogen and ­progesterone. But less well known is the fact that adding in some testosterone – absorbed through the skin via a transdermal gel – can be effective too. “This so-called ‘male’ hormone is actually a normal female hormone too – made by the ovaries – and is ­important for energy and libido, so when levels fall during late perimenopause, it can have an impact,” explains Tania.

Should everyone take HRT?

“It’s an absolute fact that it’s the most effective treatment for perimenopausal and menopausal symptoms,” says Tania. “It also reduces your long-term risk of heart disease, osteoporosis, diabetes, high blood pressure and colon cancer.”

HRT replaces the body’sdeclining hormones with a combination of oestrogen and progesterone taken as a daily tablet, but it can also be taken as patches, gels, sprays, pessaries and implants. Women who no longer have a womb only need oestrogen, as progesterone is used to protect the lining of the womb from cancer.

“Most women can take it – with theexception of those who have had breast cancer – and research shows the sooner you begin treatment after symptoms first appear, the more effective it is.”

How safe is HRT?

“HRT has been linked with a very slightly higher risk of breast cancer – but only while you are taking it,” says Tania. “For every 1,000 women over 50 taking HRT for five years, two more will develop breast cancer. But this is still lower thanthe associated breast cancer risk of drinking two glasses of wine a night or being overweight, for example.”

The older type of oral combined HRT was linked to an increased risk of stroke, but the newer bioidentical gels and patches doctors can prescribe today don’t pose this same risk. The main message is that for most women under the age of 60, HRT is a reliable and safe treatment, with other potential health benefits,” says Tania.

Can changing my diet help symptoms?

“Definitely,” says Aimee Benbow, nutritionist and author of The Menopause Journal. “Evidence shows that women consuming a healthy balanced diet, such as the Mediterranean diet, noted a reduction in perimenopausal and menopausal symptoms, including hot flushes and night sweats.

“Eating phytoestrogen (a type of plant oestrogen) that is found in foods such as soy, flaxseeds and lentils, can also be an effective way to reduce common symptoms. Phytoestrogens are able to attach to oestrogen receptors in the body, which can help reduce the impact of declining oestrogen levels naturally,” she explains.

Aimee Benbow, author of The Menopause Journal (DAILY MIRROR)

Some supplements have also been shown to ease menopause symptoms including those containing phytoestrogenic herbs such as hops, sage and redclover.“Additionally, herbs such as saffron and lemon balm can help with the lower mood often associated with ­menopause, and nutrients such as ­magnesium and B6 aid hormone regulation and may be beneficial to take as ­supplements,” says Aimee.

Could menopause affect gut health?

Research suggests that menopause is associated with a decline in the different types of beneficial bacteria that live in your gut, due to the ­hormonal changes which take place. This can impact overall gut health.

“This change in bacteria diversity is also linked to an increased risk in cardiometabolic diseases including heart disease and type 2 diabetes in some women,” says Aimee. The good news is diet can help. “Adding fermented foods such as live yogurt, kefir and kimchi to your daily diet will naturally deliver a host of diverse bacteria into your digestive tract,” says Aimee.

“And consuming fibre-rich foods that contain the prebiotic starch inulin – such as bananas, garlic, onions and leeks – further increases good gut bacteria by providing food for them.” Probiotic ­supplements can also help. Try Viridian Synerbio Daily, £9.95 (viridian-nutrition.com).

Can I still get pregnant during menopause?

“Yes,” warns Tania. “You still need to use contraception for two years after your last period if you’re under 50, and one year if you’re over 50. So it’s a good idea to note the date of your last period.

“If you’re taking HRT it’s important to realise it doesn’t work like the ­contraceptive pill and won’t protect against pregnancy. It can even make some younger women – those in their late 30s or early 40s – more fertile, so don’t get caught out.”

Caroline Jones