Do you need a menopause check at 40?

Why have a menopause check?

Despite society talking more openly about the menopause than ever before, there is still much misunderstanding about what it entails, the symptoms that may be experienced, and how they can be alleviated.

Having a menopause check at 40, as part of your discussions at your NHS health check - at an age when some women may have started to experience some early symptoms - would offer you the chance to discuss your particular circumstances with your GP. You can also gain a better understanding of what happens during menopause, as well as the potential treatment and support available.

In its manifesto, the Menopause APPG found that a large number of women come into primary care from the age of 40 with menopausal symptoms, unaware they are experiencing perimenopause or menopause. It's said that these symptoms often go undiagnosed by health professionals. So it recommends incorporating discussion and diagnosis into the free NHS Health Check that women over 40 are eligible for every 5 years¹.

According to research by University College London (UCL) there is a lack of knowledge of the issue in women of menopausal age². Whilst all women have a different experience of menopause, recognising the symptoms and knowing what to expect can make any problems easier to manage.

Embarrassment and fear

While menopause is a natural process, some women see the subject as embarrassing or shameful.

Dr Vikram Talaulikar, menopause specialist and honourary associate professor in women's health, UCL, says: "One of the biggest factors for women is embarrassment. Some women are embarrassed to bring the subject up with partners or family members. Others may be concerned or fearful about the possible symptoms of menopause, and this may lead to them avoiding the subject."

These issues may mean that some women feel unable to bring the subject up with their GP. Having a standard check-up and conversation about menopause could help more women to open up.

Although some women do experience unpleasant symptoms it is important to remember that many go through menopause with few issues. It's also important to understand that, if you do have issues with menopause, there are treatment options available that can make a huge difference to your quality of life. Having a GP consultation to bring up concerns and questions can help you to understand your options better and may ease some of the worry around menopause.

Fears around HRT

Hormone-replacement therapy (HRT) is one of the treatments available for those struggling with menopause symptoms. HRT has had some negative press in the past, due to the fact it has been shown to slightly increase the risk of breast cancer³ - taking oestrogen and progesterone as combined HRT for 5 years increases the risk by 5-10 extra women in 1,000 women.

However, oestrogen-only HRT carries no or minimal increase in risk of breast cancer. Modern forms of HRT are also much safer than the older forms which were used to calculate some of the above risks.

Nowadays, the benefits of HRT are thought to outweigh the risks - and these benefits include protection against other problems associated with ageing, including bone density loss, heart disease and muscle weakness.

There are also other treatments available for menopause symptoms and discomfort, including non-hormonal drugs and lifestyle adjustments. Having the opportunity to explore these with your GP is important.

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Perimenopause

Perimenopause refers to the transitional phase that occurs before menopause. It typically begins several years before menopause, although the exact duration can vary from woman to woman. During perimenopause, a woman's body undergoes hormonal changes as the ovaries start producing less oestrogen. Symptoms include hot flushes, night sweating, mood changes, vaginal dryness, and changes in libido.

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What will a doctor check for?

The main symptoms of menopause are hot flushes and changes to the menstrual cycle. But there are several other symptoms that you may experience, so it's best to be as open with your doctor as possible if you're experiencing any new mental or physical issues.

You can also experience symptoms when you enter perimenopause - the time when your body starts to prepare for menopause - because the ovaries start making less progesterone, testosterone and oestrogen hormones.

Your GP can check for the main symptoms of menopause:

• Hot flushes.

• Night sweats - which may lead to poor sleep and fatigue.

• Being unusually tired.

• Headaches.

• Difficulty concentrating.

• Brain fog - finding it difficult to remember things or think clearly.

As well as other, less common symptoms, including:

• Joint pain.

• Aches and pains.

• Vaginal dryness.

• Being more susceptible to bladder infections.

• Low mood, anxiety, or depression.

• Itching.

Talaulikar says: "For some, emotion and mood changes may be the only symptom, whereas for others, the physical symptoms might be the most troubling. Understanding the full range of potential symptoms will help you to identify them more easily and seek treatment and advice, rather than suffering in silence."

Speaking to your GP and exploring potential solutions could be a great step towards increasing your understanding, reducing your fear and embarrassment, and improving your overall experience of menopause.

Further reading

1. APPG Menopause: Manifesto for menopause.

2. University College London: Nine in ten women were never educated about the menopause.

3. Cancer Research UK: Does hormone replacement therapy increase the risk of cancer?