Dr Rosie Shire is an experienced GP with a special interest in menopause. She is passionate about making sure women receive the most up to date information about menopause, to enable them to make the right decision for them about treatment. Dr Shire also works in an Adult ADHD clinic; she is experienced in supporting women whose hormonal cycle and/or menopause impacts their ADHD, and vice versa.
Menopause is a hot topic, but we have to be careful where we get our information from. There are some excellent websites, social media accounts, and books about menopause, which base their information on studies and guidelines. However, there are a few that do not.
What is the menopause?
The menopause is the time when your periods have stopped due to a decline in oestrogen levels, and your ovaries have stopped releasing an egg. It is sometimes called “The Change” or The Climacteric”. It is a natural part of life that most women go through between 45-55 years old, although symptoms can start earlier than this. The average age for a woman to go through the menopause in the UK is 51 years old
What is the difference between perimenopause, post-menopause, early menopause and premature menopause?
Perimenopause, is the time leading up to the menopause. This is when your periods can become irregular, you may start getting hot flushes and other menopausal symptoms caused by the fluctuation in your hormone levels.
Post-menopause is the time at the end of the perimenopause; it is the phase of life after your menopause (12 months after your last period).
Early menopause occurs when your ovaries stop functioning, and your periods stop for 12 months between 40 and 45 years old (without other reason, such as contraception or other hormone imbalance).
Premature menopause happens when a women goes through menopause before she is 40 years old. This maybe due to genetics, surgery to remove her ovaries, or some cancer treatments like chemotherapy.
Premature ovarian insufficiency (POI, also known as premature ovarian failure) is a clinical syndrome where the ovaries stop working before the age of 40 years (this can be permanent or temporary).
How will I know if I am going through the menopause?
There are many symptoms of the menopause, some which are more well known, such as hot flushes, night sweats, and irregular periods, and some less well known ones, such as joint pains, anxiety, and itchy skin. If you are using certain types of contraception, such as the implant or the mirena coil, you may not be having periods so you can’t use this as a clue to when you might be entering the menopause. You can make a note of your symptoms over a few months, using a symptom tracker (you can download one here) or an app, and see if they seem to fit in with the menopause. You could also ask female relatives what age they went through the menopause, as this can be similar in families.
Can I have a test to tell me if I am perimenopausal?
Generally, we base the diagnosis of being perimenopausal on symptoms rather than blood tests. This is because the hormone levels can change multiple times through the day- so even if the hormone level came back as ”normal” this may not be accurate and , your doctor would still consider your symptoms, your family history, and any other conditions or treatments you might have had, like chemotherapy. In women under 40 years old, we may do blood tests, but would still take into account her symptoms. Some women buy kits on line which claim to predict menopause based on hormones in the urine; these are not regulated and the accuracy can vary- they are not recommended.
Why does it matter if I am going through the menopause?
Some women sail through this time in life with no symptoms other than their periods stopping. Others have such severe symptoms they are unable to work or enjoy life. Most women are somewhere in between. If your menopausal symptoms are affecting your ability to function in everyday life- at work, at home, with your partner or family, then treatments for menopause might help you. HRT, and non-HRT treatments can help reduce menopausal symptoms to get you back up and running again. Some treatments have other positive effects, such as reducing the risks of osteoporosis (thinning of the bones) and heart disease. There are also simple changes you can make to your lifestyle which may help- such as stopping smoking, regular exercises, and eating a healthy diet.
Can I still get pregnant when I am perimenopausal?
Yes! It is very important that women know there is still a chance of pregnancy until you are postmenopausal. For most women contraception is recommended up until the age of 55. HRT is not a contraception*, so if you do not want to get pregnant, you need to have additional contraception as well. (*the exception to this is the mirena coil, which can be used as part of HRT and also reduces heavy periods and prevents pregnancy).
How does menopause affect ADHD?
ADHD is caused by low levels of dopamine, a hormone, in the brain. Oestrogen helps the dopamine to work, so when levels of oestrogen start fluctuating, a women can experience her ADHD getting worse. This often happens in the week before a period is due, and also in the perimenopause. HRT, hormonal contraception, and ADHD medication can be used to counteract this.
For help managing your menopause symptoms or to make an appointment with Dr Shire, please do get in touch.