World Menopause Awareness Day: the essential knowledge you need
It’s World Menopause Awareness Day on 18 October. Here’s Consultant Gynaecologist and menopause specialist Mr Benjamin Thomas with the essential knowledge you need to make decisions about managing this challenging time of your life.
Seven common myths about the peri-menopause – and the truth
This transitional phase before menopause can be confusing, especially with the amount of misinformation out there. The peri-menopause is associated with fluctuating hormone levels—particularly oestrogen and progesterone—and can lead to a range of physical and emotional symptoms. Let’s clear up some common myths to help you navigate this life-stage with confidence and clarity:
❌ Myth 1: Peri-menopause only starts in your 50s
✅ Truth: Perimenopause often begins in your 40s, and sometimes even in your late 30s. Hormonal fluctuations can begin years before your periods stop. The incidence of premature menopause (under the age of 40) is greater than previously thought, at around 3% of women.
❌ Myth 2: Hot flashes are the only symptom
✅ Truth: While hot flashes and night sweats are common, perimenopause can also bring irritability, low mood, anxiety, poor sleep, irregular periods, brain fog, vaginal dryness, painful sex, joint pain, and more. Many women are surprised by how varied the symptoms can be.
❌ Myth 3: You just have to put up with it
✅ Truth: The good news is that effective treatments are available. You don’t have to suffer in silence. Lifestyle changes often help, but hormone replacement therapy (HRT) is the most effective treatment for perimenopausal and menopausal symptoms. It works by replacing the hormones that your body is producing in lower levels. For women who cannot or do not wish to use HRT, there are new non-hormonal therapies. So help is available — and effective.
❌ Myth 4: HRT is unsafe
✅ Truth: Many of the concerns about HRT risks have been clarified in recent years, and modern HRT has a much better safety profile than in the past. For most women, HRT is safe and effective, especially when started before age 60 or within 10 years of menopause. It can reduce symptoms and improve quality of life, protect bone health, and decrease the risk of heart attack. Treatment should always be individualised, and support is available to help you make informed decisions.
❌ Myth 5: Declining sex drive is normal in the peri-menopause
✅ Truth: Well it is common, but the question is whether this is acceptable to you, or whether your low libido is troublesome to you. Testosterone therapy is now available for women, and may revitalise a relationship, restoring intimacy.
❌ Myth 6: You can’t get pregnant during peri-menopause
✅ Truth: While fertility declines, pregnancy may still be possible until you’ve gone 12 to 24 consecutive months without a period, depending on your age. If avoiding pregnancy, continue contraception until your doctor advises it is safe to stop.
❌ Myth 7: Blood tests are useful to diagnose peri-menopause
✅ Truth: Diagnosis is usually based on your symptoms, especially if you’re over 45. Hormone levels can fluctuate daily, making blood tests unreliable in many cases. This means that you may benefit from treatment even if your blood tests are normal.
When to seek help
You should see your GP or a menopause specialist if:
- Your symptoms are affecting your quality of life
- You’re unsure if what you're experiencing is perimenopause
- You’re under 45 and suspect early menopause
- You’re interested in discussing HRT or alternatives
- You have a family history of osteoporosis or heart disease
Women in Guernsey can see their GP, or alternatively book a private appointment with a menopause specialist at the Medical Specialist Group without a GP referral for expert guidance and personalised treatment options.
Take-home messages
1. Peri-menopause is a natural, but often challenging, phase of life.
2. Think of the peri-menopause with new symptoms, particularly aged 40-55. If you have low mood in your 40s that is new – you may benefit more from HRT than antidepressants.
3. Try exercise, relaxation, mindfulness, CBT, and talking to friends and family.
4. Be very cautious with supplements, and avoid unregulated preparations obtained over the internet – their safety is often unknown.
5. You don’t have to suffer: effective treatments exist. HRT is the most effective treatment, and may be life-changing.
6. HRT has the most safety data.
7. HRT is now mostly made from plant sources.
8. HRT: Identical molecules to natural hormones are available.
9. The decision to start (and when to stop) is individualised based on benefit / risk.
10. Early intervention can help prevent longer-term health issueslike osteoporosis and heart disease.
11. New effective non-hormonal options exist for women who cannot or do not wish to use HRT.
12. Low libido (sex drive) in the peri-menopause may respond well to testosterone therapy when HRT alone has not improved matters. This requires specialist supervision and monitoring.
13. Track your symptoms and speak up — you deserve to feel like yourself again.
Stay informed
Here’s a couple of high-quality sources of further information on the peri-menopause and menopause: