What are the signs, stages and symptoms of menopause?

How do I know if I am perimenopausal?

If you have landed on this page and you are a biological woman over 40 you may well be experiencing menopause symptoms. Although this topic is often discussed, there are many symptoms of menopause that are not well known and as such, might be missed. As a Women’s Health Specialist Physiotherapist, I think it’s crucial to recognise the signs and symptoms of menopause and understand what they mean, so you can manage them thrive in this next chapter of your life.

What are the first signs of menopause?

Menopause actually marks just one day in your life – exactly 12 months after your last period.  This is the most obvious sign that shows your ovaries have stopped producing oestrogen. Before this date, you might notice changes to your menstrual cycle … it may lengthen or shorten, or your periods could get lighter or heavier. If you have a Mirena coil and don’t have periods, your GP can determine if you are menopausal based on other signs and symptoms and a blood test to measure your hormone levels may be recommended if you are between 40-45 years old.

This hormone fluctuation starts around 8-10 years before menopause and signifies that you are in ‘perimenopause’. This stage can start in your 30’s, but most women enter this phase in their mid 40’s.

Although we generally talk about ‘the menopause’, it is the months and years leading up to this date known as ‘perimenopause’ and those that follow, called ‘post- menopause’, which are actually the critical phases for your long-term health.

What age does menopause start?

The average age of menopause in the UK is 51, however some women may enter this stage earlier. You have a higher change of starting early menopause if the other women in your mother’s family also had an early menopause so it’s a good idea to check this if you can. There are other causes for early menopause such as chemotherapy, pelvic radiation (medical menopause), or surgery to remove the ovaries or uterus (surgical menopause).

What are the symptoms of menopause?

There are more than 30 clinically recognised symptoms of menopause. From joint pain to headaches and tinnitus…a wide range of symptoms can signal that you are menopausal and many of these might be overlooked, especially if they come on gradually over several years.

We have oestrogen receptors all over our body, so when levels drop, it affects multiple systems in your body. Symptoms can be grouped into the systems that are affected – psychological, physical, vasomotor or urogenital – which helps you make sense of how best to manage them.

• Psychological: Often the first symptoms you might notice are changes in your emotional wellbeing. Mood swings, depression, panic attacks, anxiety, anger and low confidence are all symptoms of how menopause affects your psychological system.
• Vasomotor: These are symptoms related to do with changes to your blood vessels. When your hormone levels change, your body can become more sensitive to changes in temperature and your internal thermostat can become much narrower, so you can’t regulate your temperature as effectively anymore.Hot flushes, night sweats, and heart palpitations are all vasomotor symptoms, caused by your blood vessels dilating and contracting. Vasomotor symptoms are the ones women are more familiar with when talking about menopause.
• Somatic (physical): These are symptoms that we feel in our whole body, including headaches, sleep issues, weight gain and joint pain, and more. These are common symptoms of menopause, but joint pain or weight gain might be mistakenly attributed to ageing or lifestyle issues.
• Urogenital (sex and pelvic floor): Your pelvic floor muscles weaken as you age. The are particularly affected in menopause due to the many oestrogen receptors found in the pelvic floor and genital tract.  Symptoms include painful sex, low libido, urinary incontinence and vaginal discomfort. Women might not be as likely to discuss these symptoms until they become more severe or even realise that they could be related to menopause.

Identifying your symptoms and understanding their significance is the first step towards better management. A Menopause Symptom Questionnaire can be a helpful way of identifying which symptoms you are experiencing. It can also be used to assess the severity of your symptoms and to monitor them to see how they change with time or with a recommended treatment. I really recommend Dr Louise Newson’s Menopause questionnaire but if you prefer using an app, the balance app is based on the Greene Climacteric Scale (GCS) – a clinical measure used to measure where a patient is on their menopause journey – it’s a really useful way to track your symptoms.

Once you’ve recognised and understood your symptoms, the next step is to consult with a healthcare provider who specializes in menopause.
Some Women’s Health physiotherapists are also specially trained to help women during this transition. At our Physiotherapy clinic in Cambridge we offer an individualised menopause consultation and check-up to help women make sense of the changes they are experiencing, manage their symptoms better, learn to exercise safely and effectively and to help them make informed choices about their treatment options.

I can’t emphasise enough how important it is to exercise through menopause and beyond. A safe, effective specialised menopause exercise programme will help combat many of the mental, emotional and physical challenges of this stage in life, making it an essential part of your overall health strategy.
If you’d like to arrange a Menopause Check with one of our Women’s Health team, please don’t hesitate to give us a call.

Blog written by: Kate Cameron Physiotherapist specialising in Women’s Health.