Your Essential Guide to Navigating Menopause Successfully

Welcome to the Menopause Support guide to understanding menopause. Menopause will directly affect approximately half the world’s population. If that includes you, we have written this booklet to help you understand more about it and to enable you to make informed choices about how you manage your menopause. Menopause can indirectly affect the other half of the population too: partners, family, friends and colleagues. We hope that the information here will also be helpful for those supporting somebody experiencing menopause.

How to use this information booklet

We suggest that you read the booklet and then complete the symptom checkers. If you decide to see your GP or practice nurse, take this booklet along with you to your appointment to help you to discuss menopause. It may be helpful for you to leave the booklet with your health care provider, so they can read it too. We hope that this approach will enable you to make informed choices about how you manage your menopause, supported by your doctor or practice nurse.

For more information, click the link to download the full Fact Sheet

Cognitive behaviour therapy is a brief, non-medical approach that can be helpful for a range of health problems, including anxiety and stress, depressed mood, hot flushes and night sweats, sleep problems and fatigue. CBT helps people to develop practical ways of managing problems and provides new coping skills and useful strategies. For this reason, it can be a helpful approach to try because the skills can be applied to different problems, and can improve wellbeing in general.

Anxiety and stress are common reactions to everyday life. The menopause is not necessarily a stressful time but it occurs during midlife when you may be dealing with other life challenges, such as parents’ ill-health or bereavement, adolescent children, children leaving home (or not leaving home), or work demands. Having hot flushes and night sweats can also be stressful, and being anxious and stressed can make hot flushes more difficult to deal with.

For more information, click the link to download the full Fact Sheet

The transition to menopause is a good time to review your current diet. Not only can this help manage menopausal symptoms in the short term, it can lay the foundations for good health through perimenopause, menopause, and the years to come.

Where do I start?

Getting started doesn’t have to be complicated, but there’s an enormous amount of misinformation when it comes to nutrition, and it’s easy to feel confused about what’s healthy and what’s not. Simple dietary changes are the basis of positive change for bone, heart and digestive health, as well as management of some menopause symptoms.

Can I eat carbohydrates?

Carbohydrates include complex, starchy foods like potatoes, rice, pasta, cereals and grains. They also include simple sugars like table sugar, honey and golden syrup. Your body uses carbohydrates to make blood sugar or glucose. Starchy foods breakdown to blood sugar slowly and provide a drip feed of energy while simple sugars give quick surges of energy to the body. It’s good to have starchy carbohydrates at every meal and only have simple carbohydrates occasionally.

It’s a common misconception that carbohydrates lead to weight gain. But as long as they’re eaten in moderation, as part of a healthy, balanced diet, they’re an essential part of any diet. They provide the body with energy, and this doesn’t change with menopause.

The key to balancing carbohydrates is separating simple sugars such as honey, table sugar and golden
syrup from complex, starchy carbohydrates such as bread, potatoes, rice, pasta and cereals.

For more information, click the link to download the full Fact Sheet

A healthy menopause lifestyle needs to include exercise to support mind, body and soul. Even if you’ve never exercised before, now’s the time to find what  works for you.

Do I need to exercise if I’m trying to lose weight?

While weight loss is possible without exercise, it’s much easier to manage weight with exercise as a regular part of your lifestyle. Exercise can aid weight loss by increasing the amount of energy used by the body, making an energy deficit, and weight loss, much easier.

Many women find their body shape changes with menopause, with an increase in body fat around the stomach. Strength-based exercise, discussed in more detail later on, can favourably help with this.

What types of exercise should I be doing?

There are three types of exercise that are beneficial during perimenopause and menopause – strength-based, steps and restorative. Each is equally important.

Strength exercise helps to build and maintain muscle mass, which increases metabolic rate. This is important, because decreased oestrogen levels during menopause cause muscle mass to decline, which in turn causes metabolism to decrease – one reason why weight gain is seemingly so much easier during perimenopause and menopause.

Your metabolic rate is personal to you. It’s the rate at which your body uses calories. If your metabolic rate slows down, you need fewer calories and if it increases, you need more calories. A big determinant of metabolic rate is the amount of lean muscle tissue your body holds compared to fat. More muscle tissue means faster metabolic rate. You lose some muscle tissue as you age which is why it’s so important to try to include some regular strength exercise. Strength exercise is the best way to build new muscle.

For more information, click the link to download the full Fact Sheet

Non Hormonal Treatments for Menopause Symptoms

The majority of women experience a natural menopause when their periods finish, usually between the ages of 45-55. During the years when women are having periods, the ovaries produce eggs and the female hormones estrogen and progesterone. As women approach the menopause, there are few remaining eggs in the ovaries and those that remain are less likely to develop. Fewer eggs are released and less of the hormones are produced, until the ovaries finally stop working and periods stop. Often the menopause is accompanied by uncomfortable symptoms. These symptoms are caused by fluctuating and lower levels of estrogen.

Anecdotally, many women have expressed the view that they would try complementary and alternative therapies before HRT because they think they are more natural and because they are worried about the health risks of HRT. The NICE Guideline Menopause: diagnosis and management (NG23) has used carefully weighed evidence-based evaluations of the effectiveness of alternative treatments compared with placebo (no treatment) and also with conventional forms of HRT.

Women should receive an individualised approach at all stages of their care, to help them make decisions based on the evidence given to them. Healthcare professionals are tasked with providing an explanation of the stages of the menopause and women should receive an explanation about what to expect. These include changes in the menstrual cycle and the symptoms which may be experienced such as hot flushes and night sweats, musculo-skeletal problems, mood changes (different from depression), urogenital symptoms and sexual difficulties. There will be changing symptoms at different stages and this too needs to be recognised.

For more information, click the link to download the full Fact Sheet

Hormonal changes in menopause not only affect physical health, they can also have an impact on emotional and mental wellness. Feelings of anxiety, low mood and difficulty concentrating are all very common symptoms of menopause.

Other emotional and cognitive symptoms can include:

• Anger
• Brain fog
• Crying spells
• Depression
• Irritability
• Loss of confidence and self-esteem
• Loss of joy
• Mood swings
• Panic attacks
• Poor motivation

Although less visible, these symptoms can be as debilitating as any physical symptom and shouldn’t be dismissed out of hand. Help is available. A woman doesn’t need to feel alone or struggle to cope.

Can poor sleep make things worse?

Poor or disturbed sleep is a very common symptom of menopause, with some studies indicating up to 63% of women are affected. It can make emotional and cognitive symptoms feel even worse if left untreated. Frustratingly, there are many reasons for sleep disturbance, both hormonal and non- hormonal, and it can take time to identify causes and treatments for this.

Identifying and treating sleep disturbance can help manage other menopause symptoms. Talk to your GP or Menopause Specialist. They are there to offer help and support. Don’t suffer in silence.

For more information, click the link to download the full Fact Sheet

Although there have been concerns raised about HRT and the potential risks to various aspects of women’s health, more recently published findings show that although not entirely risk free, it remains the most effective solution for the relief of menopausal symptoms and is also effective for the prevention of osteoporosis. It may in certain age groups provide protection against heart disease.

This leaflet sets out the known facts about HRT. It summarises the results of studies regarding its safety and addresses the controversy that still surrounds it, together with current thinking about its suitability. It is written specifically for women wishing to know about HRT. Our medical advisory panel strongly recommends that you should discuss with your doctor both the benefits and the risks of HRT on an individual basis. The types of HRT available are listed below.

Concerns over the safety of HRT – a history

HRT was first available in the 1940s but became more widely used in the 1960s, creating a revolution in the management of the menopause. HRT was prescribed commonly to menopausal women for the relief of their symptoms such as hot flushes, night sweats, sleep disturbances, psychological and genito-urinary problems – urinary frequency and vaginal dryness – and for the prevention of osteoporosis.

In the 1990s two of the largest studies of HRT users were undertaken, one clinical randomised trial in the USA [Women’s Health Initiative (WHI)] and one observational questionnaire study in the UK [the Million Women Study (MWS)]. The published results of these two studies during 2002 and 2003 raised concerns regarding the safety of HRT. These safety concerns revolved around two main issues: 1) that the extended use of HRT may increase the risk of breast cancer and 2) that the use of HRT may increase the risk of heart disease.

The results of the studies received wide publicity, creating panic amongst some users and new guidance for doctors on prescribing.

For more information, click the link to download the full Fact Sheet

Why Sleep Matters

Most adults need around 7–9 hours of sleep each night. Although the need for sleep does not reduce as we age, many women find that getting sufficient, good quality sleep becomes more difficult during midlife and menopause. Poor sleep can have knock on effects on other areas of health and can impact on other menopause symptoms. As well as feeling fatigued during the daytime, poor sleep can also affect mental health, memory, concentration, heart health and bone health.

Types of Sleep Disturbance

Sleep problems are very common in the menopause transition (affecting around 40–56% of women). These may include:

• difficulty falling asleep
• waking often during the night
• waking too early in the morning
• poor or unrefreshing sleep
• restless legs or other movement disorders
• breathing problems such as snoring or sleep apnoea

Chronic Insomnia

Chronic insomnia is one of the most common sleep disorders during menopause. It is defined as difficulty getting to sleep, staying asleep, or waking too early, at least three nights a week for three months or more, with symptoms such as tiredness, low mood, or poor concentration during the day.

For more information, click the link to download the full Fact Sheet

Weight gain during perimenopause and menopause is one of the most common and distressing symptoms women experience. In fact, over half of all women are affected.

Excess weight often accumulates around the middle, changing body shape and composition, and overall weight-related health risk factors. On average women may gain around 1.5kg per year during perimenopause, with an average total weight gain of 10Kg.

Why does menopause weight gain happen?

Perimenopause is often described as the ‘perfect storm’ for weight gain, with hormonal, metabolic and lifestyle changes all having an affect.

As oestrogen levels decline, the body becomes more prone to laying down visceral fat (internal fat) around the abdomen, unlike more evenly distributed gains experienced before perimenopause.

The body loses lean muscle tissue through the normal pattern of ageing, which causes metabolic rate (the rate at which the body uses calories) to reduce.

A more sedentary lifestyle can occur for some women while others may consume slightly more calories. The amount you eat and drink, as well as how much you move, remain the most significant factors in controlling weight.

Does HRT cause weight gain?

Despite many women experiencing weight gain while taking Hormone Replacement Therapy (HRT) to manage menopause symptoms, there is no evidence to support the theory that HRT is responsible for weight gain. Some women may experience side effects of bloating and fluid retention with some HRT application types, but this typically settles over time.

For more information, click the link to download the full Fact Sheet