Dr Louise Newson
https://www.newsweek.com/-Headaches are a common symptom of the perimenopause.
My job is fulfilling but it’s also harrowing. I run a menopause clinic in Stratford-upon-Avon, England, where I see 4,000 women a month who are struggling to get help. Many have given up their jobs because their anxiety, memory problems and fatigue have become overwhelming. Others are having relationship difficulties or have even ended their relationship. Some are struggling with their mental health, and I have seen a lot of women who have felt suicidal.
My mission is to improve the health and lives of all women globally by giving them access to information about the menopause and how it can affect them.
The average age of the menopause is 51 but a lot of women are perimenopausal for about a decade before. Perimenopause is where your hormones are fluctuating wildly but you still have periods—although they will have changed in nature and frequency. Menopause occurs a year after your last period, where your levels of the hormone estrogen drop significantly. Approximately 1 in 100 women under the age of 40 have an early menopause—which means women in their 20s and 30s can be perimenopausal or menopausal.
There is no medical test to confirm someone is going through the menopause. Instead, we have to look at all of the symptoms together and work it out. The issue is when healthcare professionals just look at individual symptoms in isolation. If someone has heart palpitations, they may think they have heart problems; if someone has low mood, they may diagnose a mental health issue. They need to look at the bigger picture and see if there could be a link to a woman’s hormones.
In my work, I have seen a lot of tell-tale symptoms that someone is going through the menopause. Most people know about hot flushes and sweats but these are the other common symptoms to look out for.
Common signs of the menopause
- Fatigue and brain fog
Memory problems, fatigue and brain fog are the most common symptoms of menopause. I saw a barrister not so long ago—late 40s, really top of the game in her career—who said to me, “The shutters have come down, I can’t think. I’m going to give up my job.” She was struggling with brain fog and memory problems and she worried this was the start of dementia, as her mother had had the condition. She had no idea that these symptoms could be related to the menopause.
They are related because the hormones estrogen and testosterone stimulate the areas of our brain that help with memory and cognition. Without these hormones, the brain doesn’t work in the same way.
- Muscle and joint pain
Aches and pains in your muscles and joints are also common when going through the menopause—especially in the mornings. One of my clients told me that whenever she got up in the morning, it was like walking on glass. When she walked down the stairs, every step hurt her body. In the night-time, she felt like her bones were being wrung out—she got this awful, deep bone pain. I’ve since given her Hormone Replacement Therapy (HRT) and her situation has improved.
Estrogen works as an anti-inflammatory agent in our muscles and it also helps to lubricate the joints. So during the menopause, when estrogen levels dip, it can cause muscle and joint pain. This is most common in the mornings, as this is when estrogen levels tend to be lowest.
- Dry eyes
You might notice it’s harder to keep your contact lenses in while going through the menopause. My optician recently referred a lady to me who was struggling with her contact lenses as her eyes had become so dry. She came to see me and I gave her HRT, which made a huge difference.
There has been research that suggests a link between menopause and dry eyes, as estrogen plays an important part in the producing the components of the eye’s tear film.
Headaches and migraines are especially common in the perimenopause. I see a lot of women at my clinic who have been given heavy-duty drugs to help with their migraines, but they only really improve when they’re on the right dosage of HRT.
I saw a lady a few years ago, for instance, who had been to a specialist migraine clinic and been prescribed drugs that had big side-effects, including on her concentration. She had given up her job and her partner was close to leaving her because they were arguing all the time. When she told me she hadn’t had a period in eight years, I prescribed her HRT. Her migraines completely transformed, so she stopped all of her other medication.
Women tend to have more headaches and migraines during the perimenopause, when hormone levels are quite chaotic, compared to when they are menopausal and their hormone levels are low.
Tinnitus, or a constant ringing in the ears, is a really common symptom. I’ve seen patients who have been suicidal because of their tinnitus, as the noise stopped them from sleeping. Where the tinnitus has been caused by low estrogen and the menopause, I’ve prescribed HRT and the symptoms have improved.
Estrogen helps our nerves to conduct messages across neural pathways. Therefore, low levels of estrogen might cause the nerves to not work properly, which can lead to all sorts of symptoms, such as tinnitus, pins and needles and restless legs.
- Bleeding gums and burning mouth
Estrogen also helps with collagen production, so a lack of estrogen can alter the lining of blood vessel walls. This can cause people to experience bleeding gums and Burning Mouth Syndrome, where people feel like their mouth is burning.
I saw a patient recently who had had chemotherapy for cancer and had lost a lot of weight, but she couldn’t put it back on because her burning mouth meant she couldn’t eat very well. Everyone thought it was a chemotherapy-related thing, but actually the chemotherapy had affected the way her ovaries worked, meaning she had become menopausal in her twenties. I prescribed her HRT and a few months later her burning mouth improved, she could eat, she put on weight and she got better.
All views expressed in this article are the author’s own.
As told to Katie Russell.