Mr. R Gazvani, MD, FRCOG

Consultant Gynaecologist

Subspecialist in Reproductive Medicine and Surgery

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Common signs of Menopause and symptoms of Menopause

The initial signs of the menopause are erratic menstrual periods, with monthly cycle becoming shorter and the bleeding heavier. Changes to the skin and the urinary system may occur. The sex drive (libido) may change and other psychological changes such as mood swings, depression and anxiety may be experienced.


A decrease in bone density is a natural part of ageing but occurs more rapidly during and after the menopause, progressively continuing throughout this part of life. A decrease in bone density (osteoporosis) puts women at a higher risk of fractures and related long-term consequences. Therefore, post-menopausal women should supplement their healthy diet with extra calcium and Vitamin D in addition to regular weight-bearing exercise. It is important to check the bone density of post-menopausal women every three years.

The use of hormone replacement therapy may be appropriate in certain cases; however specialist opinion has to be sought.

Hot flushes and night sweats (also known as vasomotor symptoms)

These symptoms are the result of the body’s inability to control its temperature due to the lack of oestrogen. Hot flushes and night sweats tend to come mostly in the year following the last period. They can be very uncomfortable, embarrassing and can affect sleep. Apart from self-help (wear cotton, take plenty of cool showers, avoid hot drinks and spicy food) there are several alternatives to minimise the vasomotor symptoms.


It can be caused by a weakening of the pelvic floor muscles. Incontinence is usually characterised by a leak of urine after coughing, sneezing and/or taking physical exercise. During the menopause, the chances of incontinence increase because the tissues supporting the bladder are further weakened due to oestrogen deficiency.

Hormone replacement therapy, bladder self-retraining and regular pelvic floor exercises have been shown to help incontinence, reduce urinary tract infections (water infections) and strengthen the muscles that support the bladder.

Loss of interest in sex (loss of libido)

A drop in sex drive often goes hand-in-hand with other symptoms during and after the menopause. This can be influenced by a variety of factors. The psychological symptoms of menopause — mood swings, depression, sleeplessness and vasomotor symptoms — weigh negatively on sex life. Oestrogen deficiency can also cause vaginal dryness and thinned vaginal walls, which can cause soreness and burning during intercourse, hence in turn affecting sex drive.

These problems are often helped by talking them through. A sympathetic partner (or husband) may be very useful. However, as hormone imbalance and deficiencies are at the root of this symptom, the use of topical hormone therapy (vaginal cream) may be very effective to restore a normal sex life.


Before the menopause, the vagina hosts bacteria and yeasts (unicellular fungi) which form a natural barrier to infection. Oestrogen contributes to provide the correct environment for these organisms. After the menopause, oestrogen levels inevitably fall resulting in a change in bacterial types and promoting an environment more conducive to bacterial growth. This commonly causes vaginal itching, burning sensation and discomfort. Some women might also experience the urge to urinate more frequently.

Psychological symptoms

During and after the menopause is common to experience mood swings, anxiety, depression and irritability. Although it is plausible that fluctuating hormone levels are responsible for these symptoms, however there is no definite evidence for this cause-effect relationship. External stimuli due to changes in career and marriage, children growing up and leaving the home, loss of parents and relatives, and fatigue from other menopause symptoms (for example, sleeplessness) may play a role in the onset of psychological symptoms.

Relaxation therapy, stress reducing measures and regular physical exercise often buffer these and other menopause symptoms. Hormone replacement therapy should not be considered as a first line therapy.

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What People Say!

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