What is the menopause? Symptoms, causes and how it links to incontinence

There are many perks to getting older. You may find you finally have the time to do all the things you put aside when you had small children, or perhaps deprioritised during the hectic beginning-of-a-career stage. That said, ageing comes with its challenges and bodily changes, one of which is the menopause
 
But menopause doesn’t have to stand in your way and stop you from doing what you love. To help you navigate the choppy waters of this new life stage, we’ve put together a guide below, with information on causes, symptoms and the link between the menopause and incontinence too. 

What is the menopause?

The menopause is when a woman stops getting her monthly period, marking the end of her reproductive years. During the menopause, the ovaries stop producing oestrogen and releasing eggs. This means that a woman can no longer get pregnant. She may experience a number of other symptoms too. 
 
It’s a normal part of getting older, and the average age for menopause is typically around late 40s – early 50s; however, some women who have had surgery to remove their ovaries, or have had certain cancer therapies, may experience a sudden medically-induced menopause. 
What is perimenopause?

Translating to “around menopause”, the perimenopause usually begins eight to ten years beforehand, and marks the time that your body starts to transition to menopause. The typical age for perimenopause is in a woman’s 40s, although some women may notice changes in their 30s. 
 
Perimenopause begins when the ovaries gradually start to produce less oestrogen, and ends when they stop releasing eggs. During the perimenopause, women still have periods and can still get pregnant. Menstrual cycles may shorten or lengthen, and there may be cycles in which the ovaries don’t release an egg. Some women also experience menopause-like symptoms during this time. 
 
What is postmenopause?
 
Postmenopause refers to the rest of a woman’s life after she has gone 12 consecutive months without having a period. For many women, menopause symptoms may start to ease, although some postmenopausal women continue to experience symptoms a decade or so afterwards. 
 
Due to decreased oestrogen levels, postmenopausal women have an increased risk of contracting a number of health conditions, including osteoporosis and heart disease. Medication and healthy lifestyle choices may reduce these risks, but it’s important to talk to your doctor to learn what’s best for you.

What causes the menopause?

Menopause can be caused by:

  • A natural decline in the reproductive hormones. Oestrogen and progesterone levels drop as a woman ages, leading to a decline in fertility.
  • Surgery that removes the ovaries. The ovaries produce oestrogen and progesterone, which means removing them may induce sudden menopause.
  • Chemotherapy and radiation therapy. Certain cancer therapies can induce menopause; however, it’s not always permanent following chemotherapy, and will only happen as a result of radiation therapy if directed at the ovaries.
  • Primary ovarian insufficiency. Primary ovarian insufficiency happens when the ovaries stop functioning normally before age 40. The ovaries stop producing regular amounts of the hormone oestrogen or releasing eggs, often leading to infertility. This condition is sometimes confused with premature menopause, however they aren’t the same. 

What are the symptoms of menopause?

Bladder weakness, or increased urination 
• Hot flushes 
• Night sweats 
• Insomnia, or difficulty sleeping
• Mood changes, including low mood, anxiety and depression
• Reduced sex drive
• Problems with memory and concentration
• Headaches
• Stiff joints, aches and pains
• Palpitations, or “racing heart”
• Sore or tender breasts
• Weight gain
• Reduced muscle mass
• Thinning hair and dry skin
Night Sweats
Hot Flushes
Bladder Weakness

What are the symptoms of menopause?

Nevertheless, symptoms of the menopause aren’t always obvious. As part of our Menopause Monologues series with Boots, we spoke to a group of women all experiencing different stages. Veena, 49, thought her sudden onset of mood swings were simply due to juggling life and work. 
“My periods became irregular and I was having awful mood swings; crying one minute, then angry the next. To me, menopause was just hot flushes you went through in your 60s. So when my GP said it was just stress, I agreed.” 
“But over the next few months, my hair started thinning and my eczema flared up, causing dry, flaky skin. My bones weakened – I’d have to hold on to the sides of the sofa when I stood up after watching TV. Then the hot flushes started; sudden heat rising through my body until my head felt like it was going to explode!”

How does menopause cause weak bladder?

The drop in oestrogen that happens during the menopause can cause the lining of the urethra (the tube that passes urine from the bladder) to thin. The vaginal tissue also becomes less elastic, and the pelvic muscles which support the bladder may weaken. Because of this, many women going through the menopause experience bladder problems, including urinary incontinence. TENA products such as Lights can be a great option when it comes to dealing with little leaks during the menopause.

Common menopause incontinence and bladder problems

The most common bladder issues women experience during menopause are:

How to treat menopause and incontinence

HRT for menopause

Hormone replacement therapy (HRT) replaces the hormones that decline during the menopause. It’s commonly used to relieve most menopause symptoms and can be an effective treatment for hot flushes, night sweats, vaginal dryness, reduced sex drive and mood swings. It can also help prevent osteoporosis, which is an increased risk for postmenopausal women.

“There’s a lot of fear around HRT, so my advice is stay clear of 'Dr Google', speak to your GP, do your research and make your own informed decision. For me, it’s been a lifeline. As helpful as HRT is, menopause has still been difficult to juggle with my responsibilities. I’ve cut back my hours, which is tough as a businesswoman, but it’s about tuning in to your body and listening to what it needs,” says Veena, who was given HRT patches and found her symptoms eased almost instantly. 

Oestrogen treatment

Oestrogen treatment in the form of creams and vaginal suppositories is one way to manage symptoms, as these treatments provide increased delivery of blood to the tissue. Locally administrated oestrogen adds moisture, making the mucous membranes of the vagina and urinary tract thicker, more acidic and less delicate. It improves the mucus defence against infections, also reducing the risk of irritation and urinary tract infection. In contrast, oestrogen administrated as pills might worsen urinary incontinence

Pelvic floor muscle training

Since your pelvic floor muscles are important to improve bladder and bowel control and prevent leaks, it’s essential to keep up the strength in this muscle group. A few minutes of pelvic floor training (Kegel exercises) a day can reduce the risk of menopause induced incontinence, or even make them go away entirely. 

“I do ‘beginners’ workouts’ on YouTube three times a week and now I don’t need to go to the toilet every half hour. I feel physically fitter and mentally stronger, too. Just going for a walk can make a massive difference to my mood,” says Veena. 

Natural remedies for menopause

There are several natural treatments and herbs many women use to relieve menopause symptoms. These include Black Cohosh for the treatment of hot flushes, soy, flaxseed, and vitamins E and D. There is mixed scientific evidence for the effectiveness of these treatments, however some women find them helpful.

Many menopause symptoms can be treated by lifestyle changes such as healthy eating, taking supplements and exercising regularly. Speak to your doctor to determine which treatment is right for you.

Menopause Monologues: Our series of menopause stories

Throughout the Menopause Monologues series, we’ll speak to women in the perimenopause, mid menopause and post menopause phases. We’ll discover how women’s menopause stories differ, and we’ll broach a wide range of subjects (including sexual wellbeing and body confidence) to lift the lid on how bladder leakage and the menopause intertwine within our everyday lives. Take a look at our stories hub here.
 
To find out more about the impact of incontinence on the lives of everyday women, as well as tips on how to manage the condition and which products to use, visit our full list of articles
You can buy our washable absorbent incontinence underwear online from our store too, and have them delivered directly to your home.
https://www.mayoclinic.org/diseases-conditions/perimenopause/symptoms-causes/syc-20354666#
https://www.mayoclinic.org/diseases-conditions/menopause/symptoms-causes/syc-20353397
https://my.clevelandclinic.org/health/diseases/15224-menopause-perimenopause-and-postmenopause
https://www.nhs.uk/conditions/menopause/
https://www.mayoclinic.org/diseases-conditions/premature-ovarian-failure/symptoms-causes/syc-20354683