Menopause symptoms 

The average age for a woman to reach the menopause in the UK is 51 years, but about one in 100 women experience the menopause before the age of 40; this is known as premature menopause or premature ovarian insufficiency. Menopause can also be caused by surgery to remove the ovaries (oophorectomy), some breast cancer treatments, chemotherapy or radiotherapy.¹ 

Most women will experience some menopausal symptoms, but their duration and severity will vary from woman to woman. Symptoms typically last for about four years after the last period but may continue for up to 12 years in about 10% of people. Women may experience symptoms as they approach the menopause (known as the perimenopause) as well as during the menopause.^1,2 Most menopausal symptoms are due to declining oestrogen levels.

The first sign of the menopause is usually a change in the normal pattern of a woman’s periods; they may start to have either unusually light or heavy periods. The frequency of their periods may also be affected; they may have a period every couple of weeks or may not have period for several months at a time. Eventually, women stop having periods altogether.¹

After the menopause, the risk of women developing some medical conditions increases. The risk of cardiovascular disease increases as oestrogen levels decline. During the first few years after the menopause, women may lose bone density at a rapid rate, increasing their risk of osteoporosis. This causes the bones to become brittle and weak, leading to an increased risk of fractures, especially in the spine, hips and wrists. Women may also experience urinary incontinence due to the tissues of the vagina and urethra losing elasticity.³ Reducing hormone levels may also affect the balance of vaginal bacteria, increasing the prevalence of infections such as bacterial vaginosis (BV).⁴

Managing symptoms⁵ 

The main treatment for menopausal symptoms is hormone replacement therapy (HRT), which replaces the oestrogen levels that are declining in the body. Women who have an intact womb (who have not had a hysterectomy) who choose HRT will need to use a combination product that also contains progestogen to protect the lining of their womb. HRT is available in different formulations including tablets, patches, implants and gels to rub on the skin. HRT is effective at relieving menopausal symptoms, including hot flushes, joint aches and pains, mood swings and vaginal dryness. It can also help to prevent osteoporosis.

Some women may be concerned that HRT might increase their risk of developing breast cancer or blood clots. You can advise them to discuss treatment options and the side effects/risks with their GP.

While HRT can help to relieve hot flushes and night sweats, other advice you can give to customers to help manage these symptoms includes:

• Keeping the bedroom cool at night
• Taking a cool shower or using a fan
• Wearing light clothing
• Avoiding potential triggers such as spicy food, caffeine, smoking and alcohol
• Doing regular exercise
• Maintaining a healthy weight.

To help manage vaginal dryness and discomfort, women could try using a vaginal moisturiser or lubricant. These can be safely used alongside HRT. Their GP may prescribe a vaginal oestrogen treatment such as a cream, pessary or vaginal ring.

After the menopause, women are at an increased risk of developing osteoporosis. Advice you could give to customers to help reduce their risk of developing this includes:

• Exercising regularly
• Eating a healthy diet that includes plenty of fruit and vegetables
• Stopping smoking
• Reducing alcohol consumption
• Getting some sunlight to help trigger the production of vitamin D, which supports bone health
• Ensuring adequate dietary calcium intake to help protect and maintain bone density.⁶

All women should consider a daily supplement of 10 micrograms of vitamin D during the autumn and winter months because the sun is not strong enough for the body to make sufficient amounts of vitamin D.⁷

Emotional impact⁸

Many women experience emotional symptoms before and during the menopause including irritability, anxiety, mood changes and lack of motivation. Some women may say that they feel as though they have constant premenstrual syndrome (PMS). 

Feeling sad and irritable are the most common emotional symptoms of the menopause. They can often be managed by making lifestyle changes, such as finding ways to relax and manage everyday stress. Advice you can give to customers who are struggling with the emotional symptoms of the menopause includes:

• Keeping active
• Eating a healthy balanced diet
• Trying relaxing activities such as yoga, tai chi or meditation
• Avoiding alcohol
• Keeping connected with family and friends
• Talking about how they are feeling.

If a customer is finding it difficult to cope with low mood or depression, you should refer them to the pharmacist. They may direct the customer to their GP for further advice or treatment.