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Symptoms

For some, menopause will be a breeze. Yet, almost three quarters will experience symptoms such as:

hot flushes
sweats
tiredness
poor memory
concentration problems
brain fog
vaginal dryness 
bladder issues 

You're unlikely to experience these all at once. Symptoms can come and go and fluctuate in severity. For most, they disappear altogether in time. 

Menopause can be a positive transition. Many see it as a liberating time. It can even bring feelings of confidence and empowerment as you look to the future. 

 
During the menopause transition, starting before periods stop, hormone levels fluctuate. This means your symptoms will too. You may have symptoms for weeks or months and then they subside, before returning again.
Most people will see the end of symptoms within three to five years. For some they can last much longer. Sometimes they can last until the seventies and beyond though this is rare. 
Panic attacks associated with anxiety can get worse during the menopause transition. The anxiety itself may be due to all sorts of factors. Hormonal fluctuations can influence your individual response to moments of anxiety. 
If you’ve always had a healthy sex drive, this will likely continue. Sometimes, you may notice a drop in libido. This is often because of a decrease in testosterone due to the menopause. If you experience a declining sex drive and low energy levels, speak to you GP. Testosterone gel or HRT can be effective treatments. 
Decreasing oestrogen levels can have an effect on the bladder and the vagina. You may need the loo more often or experience a cystitis-like sensation, but with no infection. The vagina, meanwhile, can become dry and sore, especially during sex. Known as ‘urogenital’ symptoms, they are easy to treat using vaginal oestrogen. This is available in cream, tablet, pessary or ring form and available from your GP. 

Diagnosis

The word, ‘menopause’, refers to the last-ever period you have. This happens when the womb lining stops preparing for pregnancy. It becomes thin to the point it no longer sheds. You are postmenopausal when it has been over a year since your last period.  

The perimenopause is the time before the menopause. This is when symptoms associated with menopause often start. These can last until your periods stop or, sometimes, months or even years beyond. Usually, this happens between the ages of 45 and 55. For one in 100, it will start before the age of 40.
Menopause symptoms can start before you see any change in your period pattern. We call this the perimenopause. It can start months or even years before the actual menopause.
You may not have periods if you:

take the mini-pill
have a coil 
have had a partial hysterectomy

This can be trickier to know when menopause creeps up on you. Usually, the symptoms will alert you to the fact that your hormones are changing. If you are under 45 years old, a blood test may be useful.
It’s not unusual to continue having menopause symptoms, even after your periods have stopped

Treatment and HRT

If there are medical reasons you can’t use HRT, there are other treatments available. These will depend on your symptoms, but discuss it with your GP. Your GP may offer you low dose antidepressants. This isn’t because they think you’re depressed but they can have a positive impact on flashes, sweats and mood.
As a first step, you can try over-the-counter remedies. There is some evidence that Red Clover and Black Cohosh may help flushes. There’s little evidence of magnets, oil of evening Primrose, or progesterone cream helping. If you’d like to try natural remedies, talk to your GP or pharmacist.   
You may well be able to use Hormone Replacement Therapy (HRT). It will depend how many relatives, how close they are to you and their age. 
There’s no point stopping HRT within a few months as your symptoms are likely to return. Many people take HRT for a couple of years, then reduce and stop. They then assess how they’re feeling. The longer you stay on HRT, the more benefit to your bone health and cardiovascular system. The risks of HRT are generally low. You don’t have to stop HRT because of your age.
Menopause does not usually cause high blood pressure, but it can happen at around the same time.  Wherever you are in your menopausal journey, speak to your GP. It will not stop you taking HRT once treated. 
Once settled on HRT, your GP should review you every year, or sooner if you prefer. Between visits, report any changes in bleeding or if your medical situation changes.
The term ‘bioidentical’ is often misunderstood. HRT is usually ‘bio’ or ‘body’ identical. This means they’re as close as possible to our natural hormones. HRT comes in set doses, at various strengths, personalised for you. Some private clinics use ‘Compounded’ bioidenticals, tailored to the individual. But they’re not regulated in the same way as conventional HRT, so may not be better for you. 
Hormones aren't the only factor to influence sex drive. Some people notice that starting HRT improves sex drive. It may be that they feel much better, leading to increased well-being and sensuality. 
If you take HRT to relieve symptoms, it’s reassuring that it will have added benefits too. This includes heart and bone health, brain function and could reduce the risk of Type 2 diabetes. It often improves skin and hair condition. It will also help to maintain a healthy vagina and bladder. If you’re under 40 and take HRT, it will have a particularly positive impact on your long-term health.
For the majority of HRT, it doesn’t matter when you take the medication, as long as you take it around the same time each day. If you’re using progesterone tablets (Utrogestan), they should be taken at night. You should also take them on an empty stomach. If you’re using oestrogen gel and have night sweats, you may find it better to use the gel in the evening.
Stick to a general healthy diet during menopause. This means a diet rich in calcium, low in saturated fat. Also limit sugar and avoid foods that might trigger symptoms. These include spicy foods, alcohol and hot drinks. You might consider adding soy to your diet, for renal health, but this may not help symptoms on its own. Take a vitamin D supplement from October to March (min 400iu). This is because it’s more difficult to get through winter and is vital for bone health.
Yes, you can use these together and for some, it makes a good treatment combination. Your GP will be able to advise you on the best medication combinations.